UNIVERSIDADE FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE DEPARTAMENTO DE FISIOTERAPIA Isadora Schäfer Richter EFFECTS OF SQUARE STEPPING EXERCISE ON MOTOR AND COGNITIVE FUNCTIONS IN COMMUNITY-DWELLING OLDER ADULTS Porto Alegre 2025 Isadora Schäfer Richter Effects Of Square Stepping Exercise On Motor And Cognitive Functions In Community-dwelling Older Adults Trabalho de Conclusão de Curso de Fisioterapia, da Universidade de Ciências da Saúde de Porto Alegre, como requisito parcial para a obtenção do título de Bacharel em Fisioterapia Orientadora: Profa. Adriana Torres de Lemos Coorientador: Prof. Felipe de Souza Stigger Porto Alegre 2025 FOLHA DE APROVAÇÃO ISADORA SCHÄFER RICHTER EFFECTS OF SQUARE STEPPING EXERCISE IN MOTOR AND COGNITIVE FUNCTIONS IN COMMUNITY-DWELLING OLDER ADULTS Trabalho de Conclusão de Curso de Fisioterapia, da Universidade de Ciências da Saúde de Porto Alegre, como requisito parcial para a obtenção do título de Bacharel em Fisioterapia Orientadora: Profa. Adriana Torres de Lemos Coorientador: Prof. Felipe de Souza Stigger Aprovado em 24/11/2025 BANCA EXAMINADORA: _________________________ Prof. Mauro Antônio Félix UFCSPA ________________________ Prof. Luiz Fernando Alvarenga UFRGS Dedico esse trabalho a meus pais, Roseméri e Eduardo, por serem amor, apoio e porto seguro, nesta e em todas as etapas da minha vida. AGRADECIMENTOS Primeiramente, agradeço aos meus pais, Roseméri e Eduardo, por me proporcionarem uma vida de afeto, incentivo e oportunidades. Palavras não são suficientes para agradecer por tudo que vocês fizeram e fazem por mim. Sou reflexo do seu amor e cuidado. Agradeço também ao restante da minha família, aos que estão aqui e aos que já se foram, por acompanharem meu crescimento e contribuírem para a minha formação como pessoa. Sou grata às minhas melhores amigas: Aimê, Gabriele, Isabelle e Larissa, por serem fonte interminável de risadas, parceria constante e suporte incondicional. Aos meus colegas que se tornaram amigos, Chiara, Isabela, Mariane, Ana Paula, Lucas, Augusto, Jorel, João e Otávio, minha gratidão. Essa experiência não teria sido tão leve sem a companhia de vocês. Aos meus professores, sou grata pelos ensinamentos que contribuíram para a minha trajetória acadêmica e profissional. Em especial aos professores, Adriana de Lemos e Felipe Stigger, pela orientação e incentivo não só no desenvolvimento deste trabalho, mas durante toda a graduação. Agradeço aos colegas que agora participam do Programa de Exercício, Saúde e Cidadania para Idosos (PESCID), projeto que despertou em mim paixão pelo envelhecimento e que possibilitou este estudo. Anna, Ana, Bruna, Heitor, Isabella, Laura Caye e Laura Poeta, obrigada pela ajuda e colaboração na realização deste projeto. E aos meus colegas de turma que também auxiliaram no andamento do estudo, obrigada. Por último, sou grata aos idosos que se disponibilizaram a fazer parte do meu trabalho e tornaram tudo isso possível. Expresso a minha profunda gratidão a todos que contribuíram com a realização deste trabalho, seja de forma direta ou através do seu apoio. Todos vocês foram imprescindíveis para que eu concluísse essa etapa da graduação. Muito obrigada! RESUMO Introdução: Programas de exercício que integram desafios motores e mentais, como no treinamento em dupla-tarefa, têm demonstrado benefícios para o envelhecimento saudável. Assim, este estudo tem como objetivo avaliar os efeitos de uma intervenção de dupla-tarefa, o Square Stepping Exercise (SSE), na performance cognitiva e física de idosos da comunidade. Métodos: Este estudo é um ensaio clínico controlado randomizado. Os participantes foram alocados aleatoriamente no grupo intervenção e controle (IG e CG). Ambos os grupos fizeram exercícios de força de membros inferiores e equilíbrio. O IG também participou do protocolo de SSE enquanto o CG fez exercícios de força de membros superiores. Os sujeitos passaram por uma anamnese e responderam questionários que avaliaram sua confiança em manter equilíbrio (Activities-specific Balance Confidence Scale) e nível de depressão (Geriatric Depression Scale-4). Em relação a capacidade mental dos participantes, este estudo investigou a sua função cognitiva geral (Montreal Cognitive Assessment) e funções executivas (Phonemic Verbal Fluency Test, testes Trail Making, Stroop Test e testes Digit Span). Quanto às capacidades motoras dos participantes, este estudo determinou qualidade de marcha e equilíbrio dinâmico (Timed Up and Go), força de membros inferiores (testes de One-Minute and Five-Times Sit-to-Stand), controle postural (Functional Reach Test and Mini Balance Evaluation Test), agilidade, tempo de reação (BlazePod Four-Square Step Test and BlazePod Stepping Reaction Test) e performance em dupla-tarefa (Timed Up and Go associado a tarefa de transferir moedas e de subtração). Os participantes foram avaliados pré e pós intervenção. Resultados: Os resultados mostraram melhora significativa em força de membros inferiores, agilidade e tempo de reação em ambos os grupos. Avanços em função executiva, equilíbrio dinâmico e dupla-tarefa motora-motora foram exibidos pelo IG após o protocolo de oito semanas. Além disso, o CG melhorou função cognitiva geral, velocidade de marcha e dupla-tarefa cognitiva-motora após a intervenção. Conclusão: Não houve diferenças significativas entre o protocolo de dupla-tarefa - que incluía SSE - e de simples-tarefa nos desfechos cognitivos e físicos em idosos da comunidade. Entretanto, SSE revelou alguns benefícios para essa população e pode ser uma estratégia acessível, adaptável e de baixo custo para exercício em idosos. Palavras-chave: idoso; exercício físico; desempenho físico funcional; flexibilidade cognitiva. ABSTRACT Introduction: Exercise programs that integrate both motor and mental challenges, as in dual-task training, have been shown to provide benefits for healthy aging. Therefore, this study aimed to assess the effects of a dual-task intervention, the Square Stepping Exercise (SSE), on cognitive and physical performance in community-dwelling older adults. Methods: This study is a randomized controlled clinical trial. Participants were randomly allocated to the intervention and control groups (IG and CG). Both of the groups performed lower extremity strength and balance exercises. The IG also participated in SSE while the CG did upper body strength exercise. The subjects went through anamnesis and responded to questionnaires that evaluated their confidence in maintaining balance (Activities-specific Balance Confidence Scale) and screened for depression (Geriatric Depression Scale-4). In regards to the participants’s mental capacities, this study assessed their overall cognitive performance (Montreal Cognitive Assessment) and their executive functions (Phonemic Verbal Fluency Test, Trail Making Tests, the Stroop Test and the Digit Span Tests). As for the subjects’ motor capacities, this study measured quality of gait and dynamic balance (Timed Up and Go), gait speed (Three-Meter Walk Test), lower extremity strength (One-Minute and Five-Times Sit-to-Stand Tests), postural control (Functional Reach Test and Mini Balance Evaluation Test), agility, reaction time (BlazePod Four-Square Step Test and BlazePod Stepping Reaction Test) and dual task performance (Timed Up and Go associated with coin transfer and subtraction tasks). Participants were evaluated pre and post-intervention. Results: The results showed significant improvements in lower extremity strength, agility and reaction time in both groups. Enhancements executive function, dynamic balance and motor-motor dual-task were exhibited by the IG post the eight-week protocol. Moreover, the CG improved overall cognitive function, gait speed and cognitive-motor dual-task following the intervention. Conclusion: There were no significant differences between the dual-task - which included SSE - and single-task protocols on cognitive and physical outcomes in community-dwelling older adults. However, SSE revealed some benefits for this population and can be an accessible, adaptable and low-cost strategy for exercise interventions in older adults. Key-words: aged; exercise; physical functional performance; cognitive flexibility. SUMÁRIO 1 INTRODUCTION................................................................................................................. 13 2 METHODS........................................................................................................................... 14 2.1 STUDY DESIGN AND PARTICIPANTS......................................................................14 2.2 INTERVENTION......................................................................................................... 15 2.3 VARIABLES AND MEASURES...................................................................................16 2.3.1 Anamnesis and questionnaires................................................................................16 2.3.2 Physical performance.............................................................................................. 16 2.3.3 Cognitive performance.............................................................................................17 2.4 DATA ANALYSIS.........................................................................................................17 3 RESULTS............................................................................................................................ 17 4 DISCUSSION.......................................................................................................................23 5 CONCLUSION.....................................................................................................................26 REFERENCES....................................................................................................................... 28 APPENDICES.........................................................................................................................35 REFERENCES 1. 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