Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Petrella, Robert J


Square-stepping exercise (SSE) is a cognitive training program with a physical component. An instructor demonstrates a stepping pattern across a gridded mat and participants are required to memorize and repeat the patterns on their own. In community-dwelling older adults, SSE has demonstrated some benefits on global cognitive functioning (GCF), balance, functional fitness, and social interaction.

Aims: to investigate the feasibility and efficacy of SSE in varied populations and settings to improve mobility and cognition. Populations included older adults with: knee osteoarthritis (OA), type 2 diabetes mellitus (T2DM) and self-reported cognitive complaints (sCC), and those living in long-term care (LTC) and continuum care (CC) homes.

Methods: We conducted 3 pilot randomized controlled trials ranging from 12- to 24-weeks of SSE. Feasibility was determined through recruitment and attendance. Participants were assessed on a host of cognitive, functional, and gait outcomes before and after SSE.

Results: We found that SSE was not feasible in older adults with knee OA and results were inconclusive whether it effected mobility in this population. SSE demonstrated improvements in the planning domain in older adults with T2DM and sCC. However, attendance remained a challenge in this group due to high disease burden (i.e. appointments and illness), and therefore it was not feasible. In LTC and CC homes, SSE was not feasible because recruitment and attendance were low. However, we showed that adults living with dementia improved on mood and behaviour symptom scores.

Conclusions: Square-stepping exercise is not a feasible program as implemented in this thesis and SSE showed limited benefit to cognitive and mobility outcomes. These pilot studies demonstrated the challenges of feasibility in adults with diverse cognitive and mobility impairments. Future studies should focus on addressing recruitment and adherence strategies for chronic disease populations.