Nonlinear Gait Variability and the Role of Cognitive-Physical Exercise in Mitigating Mobility Decline in Institutionalized Older Adults with Cognitive Impairment

Background: Age-related cognitive decline is linked to reduced gait complexity and higher fall risk. Traditional linear gait measures may miss subtle motor-cognitive deficits in older adults with dementia. This study examined whether an 8-week motor-cognitive exercise program could improve gait adaptability in institutionalized older adults with cognitive impairment. Gait complexity, measured using Sample Entropy, was the primary outcome. Methods: Forty-two institutionalized older adults completed follow-up assessments, including 26 with cognitive impairment and 16 controls. Gait was assessed during normal walking (single-task) and while performing cognitive tasks (dual-task), such as naming animals or counting backward. Inertial sensors recorded stride intervals, and Sample Entropy was calculated to evaluate gait regularity and adaptability, (gait complexity). The intervention included 24 structured sessions combining physical and cognitive exercises targeting balance, coordination, and executive function. Non-parametric tests (Wilcoxon) were used, with Bonferroni correction for multiple comparisons. Results: Participants with cognitive impairment showed increased gait complexity, especially during dual-task walking. Significant improvements were found in both limbs under dual-task conditions (left: p = 0.015, effect size = 0.34; right: p = 0.030, effect size = 0.31). During single-task walking, a significant improvement was observed in the left limb (p = 0.006, effect size = 0.39). Conclusions: Motor-cognitive exercise may enhance non-linear gait complexity in institutionalized older adults with cognitive impairment. The use of dual-task training in rehabilitation and highlight the value of entropy-based gait assessment for detecting subtle functional changes. However, the lack of a randomized non-exercising cognitive impairment control group limits definitive conclusions about causality.