Assessing the impact of mindful meditation, combined with exercise, on mobility and cognitive function among older adults with chronic stroke : a proof-of-concept study

Introduction: Deficits in balance, mobility and executive functions are common among chronic stroke survivors and contribute to increased falls risk. Targeted exercise training reduces falls risk among older adults with chronic stroke and is a promising strategy to promote cognitive function. Specifically, the Otago exercise program (OEP) reduces falls risk and improves executive functions in older adults with a history of falls. Mindful based meditation (MBM) may be a complementary approach to the OEP for promoting balance and mobility and cognitive outcomes among older adults with chronic stroke. Purpose: The purpose of this proof-of-concept study was three-folds: 1) To examine whether MBM combined with OEP (OEP+MBM) is more efficacious than OEP alone (OEP-only) on improving balance, mobility and cognitive outcomes among older adults with chronic stroke. 2) To explore whether OEP-only or OEP+MBM has benefits for mindful attention, as measured by the Five Factor Mindfulness Questionnaire. 3) To assess components of feasibility to optimize larger repeat trials. Methods: Subjects: Twenty-three community dwelling adults aged > 55 years, who experienced a single ischemic or hemorrhagic stroke at least 12 months prior to study Study Design: 12-week proof-of-concept, assessor single-blinded randomized controlled trial Results: There is preliminary evidence for meditation practice as a safe intervention for older adults with chronic stroke. Although no statistically significant effects were found, two cognitive variables with marginally significant improvements for the OEP+MBM group provide support for MBM to improve attention and processing speed. Examination of the between-group differences on the outcome variables standardized to standard deviation values provide tentative support for the OEP+MBM intervention and rationale for further research. Self-reported levels of mindfulness did not increase for either group. The feasibility of conducting future repeat studies was verified with 27 subjects recruited to attend information sessions within six weeks, 24/27 (.89) consenting to study participation and strong adherence (>.80) to interventions for all participants. Conclusions: This proof-of-concept study provides an early indication that future studies are warranted to examine whether the addition of MBM to therapeutic exercise has the potential to positively impacts balance, mobility, and cognitive outcomes in older adults with chronic stroke.