Effects of Square-Stepping Exercises on Balance and Cognitive Function among Older Persons in The Phitsanulok Municipality
Keywords:
Balance, Cognitive Function, Older Persons, Square-Stepping ExerciseAbstract
These two groups, pretest-posttest quasi-experimental study aimed to examine the effects of the Square-Stepping Exercise on balance performance and cognitive function among older persons in the Phitsanulok Municipality. The 52 participants were selected by purposive sampling then assigned into experimental and control group. The 26 persons in the experimental group participated in the Square-Stepping Exercise program, which was approved by health experts with item objective congruence (IOC) 0.67-1.00. The exercise program used specific patterns of square-walking from easy to complex and practiced for 12 weeks, 40 minutes/sessions, 3 times a week. The other 26 older persons in the control group exercised as their convenient. Research instruments included assessments of balance performance using the Time Up and Go test (TUG), which Intraclass Correlation Coefficient (ICC) was 0.97–0.99 and cognitive function using the Montreal Cognitive Assessment (MoCA), which test–retest reliability was 0.92 and inter-rater reliability was 0.87. Data were analyzed using the Wilcoxon Signed Ranks Test and the Mann-Whitney U test.
The results revealed that the Square-Stepping Exercise statically significantly improved both balance performance and cognitive function among older persons (p < .05). After the intervention, the experimental group showed significantly higher balance and cognitive function scores compared to both their pre-test scores and those of the control group. These findings indicate that the Square-Stepping Exercise, which involves multidirectional movements, effectively stimulates the neuromuscular system and enhances coordination, thereby improving balance and cognitive performance in older persons.
References
Burns, N., & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th ed.). Saunders Elsevier.
Centers for Disease Control and Prevention. (2023). Older adult fall prevention. https://www.cdc.gov/falls/data-research/facts-stats/
Chen, F. T., Etnier, J. L., Chan, K. H., Chiu, P. K., Hung, T. M., & Chang, Y. K. (2020). Effects of exercise training interventions on executive function in older adults: A systematic review and meta-analysis. Sports Medicine, 50(8), 1451–1467. https://doi.org/10.1007/s40279-020-01292-x
Department of Disease Control, Ministry of Public Health. (2023). Falls among older adults. https://ddc.moph.go.th/dip/news.php?news=23843 (in Thai)
Department of Older Persons. (2026). Statistical information of older persons. https://www.dop.go.th/th/statistics_page?cat=1&id=2594
Fernandes, M. S. S., Ordônio, T. F., Santos, G. C. J., Santos, L. E. R., Calazans, C. T. S., Gomes, D. A., & Santos, T. M. (2020). Effects of physical exercise on neuroplasticity and brain function: A systematic review in human and animal studies. Neural Plasticity, 2020, 8856621. https://doi.org/10.1155/2020/8856621
Goodarzi, S., Teymouri Athar, M. M., Beiky, M., Fathi, H., Nakhaee, Z., Omran, S. P., & Shafiee, A. (2024). Effect of physical activity for reducing anxiety symptoms in older adults: a meta-analysis of randomized controlled trials. BMC Sports Science, Medicine and Rehabilitation, 16(1), 153. https://doi.org/10.1186/s13102-024-00947-w
Hemrungrojn, S., Tangwongchai, S., Charoenboon, T., Panasawat, M., Supasitthumrong, T., Chaipresertsud, P., Maleevach, P., Likitjaroen, Y., Phanthumchinda, K., & Maes, M. (2021). Use of the Montreal Cognitive Assessment Thai version to discriminate amnestic mild cognitive impairment from Alzheimer’s disease and healthy controls: Machine learning results. Dementia and Geriatric Cognitive Disorders, 50(2), 183–194. https://doi.org/10.1159/000517822
Institute of Geriatric Medicine. (2019). Clinical practice guidelines for geriatric syndromes. Journal of Thailand Nursing and Midwifery Council, 31(1), 5–18. https://he02.tci-thaijo.org/index.php/TJONC/article/view/51843
Chinakat, K., & Dankamon, U. (2018). Balance training for ankle sprain prevention and rehabilitation. Sports Authority of Thailand.
Kittiphimanon, K. (2017). Assessment and management of fall risk factors among community-dwelling older adults: The role of community nurses in primary care settings. Journal of Public Health Nursing, 30(3), 183–195.
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., & Kales, H. C. (2020). Prevention, intervention, and care: Report of the Lancet Commission. The Lancet, 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
Muangpaisal, W. (2017). Gerontology and geriatrics for primary care practice. Thai Society of Gerontology and Geriatric Medicine. (in Thai)
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. CMAJ, 173(7), 695–699. https://doi.org/10.1503/cmaj.050051
National Statistical Office of Thailand. (2023). The 2021 survey of older persons in Thailand. https://www.nso.go.th/nsoweb/storage/survey_detail/2025/20241209145003_27188.pdf
Nokham, R., Panuthai, S., & Kamphonsiri, T. (2016). Effects of square-stepping exercise on balance in older adults. Nursing Journal CMU, 43(3), 58–68. https://he02.tci-thaijo.org/index.php/cmunursing/article/view/75136 (in Thai)
Phitsanulok Provincial Public Health Office. (2024). Elderly health screening report. https://hdc.moph.go.th/plk/public/standard-report-detail/aa86b13e8cb60cae6c3216b7e3e5f151
Prommoon, M. (2019). Effects of square-stepping exercise on balance and cognitive function in older adults with normal cognition or mild cognitive impairment (Master’s thesis). Chulalongkorn University. https://digital.car.chula.ac.th/chulaetd/9492/ (in Thai)
Saengsawang, P., Jintanawat, O., & Sukamwang, K. (2016). Effects of step table exercise on physical fitness among older adults. Journal of Thailand Nursing and Midwifery Council, 31(1), 5–18. https://he02.tci-thaijo.org/index.php/TJONC/article/view/51843
Shigematsu, R., Okura, T., Nakagaichi, M., Tanaka, K., Sakai, T., Kitazumi, S., & Rantanen, T. (2008). Square-stepping exercise and fall risk factors in older adults: A single-blind, randomized controlled trial. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 63(1), 76–82. https://doi.org/10.1093/gerona/63.1.76
Steffen, T. M., Hacker, T. A., & Mollinger, L. (2002). Age- and gender-related test performance in community-dwelling elderly people: Six-minute walk test, Berg balance scale, timed up & go test, and gait speeds. Physical Therapy, 82(2), 128–137. https://doi.org/10.1093/ptj/82.2.128
Teixeira, C. V. L., Gobbi, S., Pereira, J. R., Vital, T. M., Hernandéz, S. S. S., Shigematsu, R., & Gobbi, L. T. B. (2013). Effects of square-stepping exercise on cognitive functions of older people. Psychogeriatrics, 13(3), 148–156. https://doi.org/10.1111/psyg.12017
U.S. Department of Health and Human Services. (2018). Physical activity guidelines for Americans (2nd ed.). https://health.gov/sites/default/files/2019-09/Physical_Activity_ Guidelines_2nd_edition.pdf
World Health Organization. (2023). Falls. https://www.who.int/news-room/fact-sheets/detail/falls
World Health Organization. (2023). Dementia. https://www.who.int/news-room/fact-sheets/detail/dementia
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Boromarajjonani College of Nursing, Nakhon Lampang
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles, information, images, etc., published in the Journal of Health Sciences Scholarship is the copyright of the Journal of Health Sciences Scholarship. If any person or entity wants to bring all or part of it to publish or to do any action must be authorized by a letter from the Journal of Health Sciences Scholarship. The content and information in the article published in the Journal of Health Sciences Scholarship is considered and the responsibility of the author of the article directly, which editorial journals, no need to agree or share any responsibility.
Messages and Comments The author of the article. This is not the opinion of the journal, and the journal does not need to agree with the text and any comments of the author. The magazine reserves the right to consider publication as appropriate include the correct or refine the language to meet the criteria.
