Distinctive Effects of Combined Physical Cognitive Training and Physical Training on Fall and Fall-Related Outcomes in Institutionalized Older Adults with Mild Cognitive Impairment

The Cognitive Physical Training (PCT) intervention will be conducted in groups of 8-9 participants, led by an instructor and assisted by a facilitator, typically a local nurse. The PCT program will run for 12 weeks, with sessions held twice weekly, totaling 24 sessions, each lasting 50 minutes. Before each session, participants will submit a notebook to the facilitator, who will use it to record attendance, vital signs at the start of the session, and any complaints or falls reported by participants. The instructor will demonstrate the exercises while the facilitator ensures that all participants follow the movements and instructions correctly. The principal investigator will be present at each session to observe and provide feedback to the instructor to correct any deviations from the procedure. The physical exercise focuses on improving muscle strength and balance in the lower extremities. It includes a sequence of exercises such as range of motion movements (e.g., head, shoulder, arm, back, waist, and leg stretches), strength training (e.g., leg lifts, squats, heel raises, step-ups), and balance exercises (e.g., standing on one foot, sit-to-stand, and heel-to-toe walking). Each exercise segment is timed, with warm-up, strength, balance, and breathing exercises lasting 30 minutes. All exercises will be standardized across participants, ensuring a similar level of physical ability among them. However, the facilitator will assist those with limitations, and specific movements can be modified to be performed in a seated position if necessary. Cognitive Stimulation Therapy (CST) will follow the physical exercise session, consisting of three phases: introduction, the main activity, and a final activity. The same instructor and facilitator will guide the CST sessions, utilizing various tools according to each session's topic. Essential items such as a large desk calendar for time orientation and a small whiteboard will be used in all sessions. For instance, in the first session, a rubber ball will be provided for a ball-throwing activity, and in the second session, recorded sounds (e.g., birds chirping or motorbike noises) will be played for a listening activity. Other tools include songbooks, old-fashioned toys, grocery replicas, photographs, maps, playing cards, and quiz books to stimulate cognitive engagement.