Thinking and stepping training – Knowledge

1. What this text is about

In thinking and stepping training you solve a movement task and a thinking task at the same time. You step to a target when a signal appears. You deliberately leave another signal alone. You hold a sequence in mind and then step it. The technical term for this is cognitive-motor training.

This text answers four questions:

• What exactly do you practise?
• Who does this training suit?
• What do the studies show, and what do they not show?
• How often and for how long do you practise?

One point belongs at the start. The best evidence covers stepping on a signal [6]. On walking with a simultaneous thinking task there are 44 studies with 2'782 older people [10]. The certainty of those findings ranges from very low to moderate [10]. That such training improves your memory in daily life is not established [18], [19], [20].

The five exercises of this section have their own pages. Section 8 takes you there.

2. What thinking and stepping training is

Walking requires attention. You notice this as soon as you calculate or look for a house number while walking. A review of studies on this question summed up what then happens: both performances give way [1]. You walk more slowly, and you solve the thinking task less well. In older people this drop is larger than in younger people [1].

Walking and switching between tasks draw partly on the same brain regions [2]. Someone who switches quickly between two demands also has reserve for the unexpected step.

In thinking and stepping training you practise both together. Your head decides where the foot goes. The time until the step is called stepping reaction time. It can be measured, and in older people it relates to falls [3].

2.1 The five kinds of task

All exercises in this section consist of five basic forms. They can be practised singly and in combination.

• Choosing. Several targets are ready, one is indicated. You step there. This trains the decision under time pressure.
• Holding back. Some signals count, others do not. You stop the step you have begun. This trains braking a movement already under way.
• Resolving conflict. Two pieces of information contradict each other, for example the word "red" printed in green. You answer one and pass over the other. This task goes back to a paper from 1935 [5].
• Remembering. You keep a sequence in mind and then step it. This trains holding something briefly while moving.
• Dividing. You walk and solve a second task at the same time. This trains sharing your attention.

3. Who this training suits

The studies were done in four groups. The strength of the evidence differs for each.

3.1 Older people at higher risk of falling

Most studies come from this group. What has been studied is stepping on a signal [6], step training at home in front of a screen [7], [8] and walking with a thinking task [10]. How high your own risk is stands in our guide Assessing the risk of falling.

3.2 People with a neurological condition

In Parkinson's disease the training was tested in a study with 121 people [16]. One group practised walking and thinking task separately, the other simultaneously. Both groups walked better under a dual task afterwards, and the improvement lay between 7.75 and 13.44 per cent compared with their starting values [16]. Fall risk changed in neither group [16]. There was no untrained group in this study. Part of the improvement might therefore have occurred without the training as well.

For multiple sclerosis and for the time after a stroke we did not search a separate review for this text. We use the exercises there and rely on the general work [9], [12]. More on those conditions is in Parkinson's disease, Multiple sclerosis and Cerebellar stroke: physiotherapy.

3.3 People with mild memory problems

One study looked at 92 community-dwelling people aged 60 to 83 with a mild impairment of thinking [13]. They practised for 12 weeks, one to three times a week for 60 to 90 minutes. The number of falls did not differ between the groups at 12 or at 36 weeks [13]. In standing up and walking three metres the trained groups were faster after 36 weeks. They needed 9.0 and 8.6 seconds, the untrained group 11.1 seconds [13].

3.4 Returning to sport

After a leg injury or after a concussion, situations return in which you react fast and without warning. We use these exercises in that phase. We know of no studies showing a lower injury rate as a result. The steps for returning after a concussion are in our guide Concussion.

4. What the studies show

4.1 What gets better

What improves most clearly is what you practised. A review analysed seven randomised studies with 660 participants [6]. After step training the participants reacted faster with a step. They stood longer on one leg and were quicker to stand up and walk [6]. Strength did not change [6]. The effect therefore works through response speed.

With walking plus a thinking task, dynamic balance and everyday mobility improved [10]. In a study of 89 people over 70 the difference was small: an advantage of the simultaneous thinking task showed only during fast walking [11].

4.2 What happens to falls

For step training the result is favourable. Across the seven studies the training groups fell about half as often as the comparison groups (rate 0.48; confidence interval 0.36 to 0.65) [6]. The share of people who fell at all was about half the share in the comparison groups (0.51; confidence interval 0.38 to 0.68) [6]. [absolute numbers to be checked: the review reports no frequencies per 100 people]

Two further studies found no difference in falls. In the 92 people with mild memory problems the number of falls stayed the same [13]. In a study of 503 people aged 70 and over who trained balance at home for two hours a week, falls did not differ after one year [15]. The training group fell 0.60 times a year, the comparison group 0.76 times [15]. Only after two years was the fall rate 16 per cent lower [15].

We draw two conclusions. First, a benefit shows when you train for long enough. Second, how large it is differs between groups. That exercise lowers falls in older age is well established independently of this [14]. The figures are in our guide Fall prevention.

4.3 What remains open

One question is whether what you practise carries over into other areas. The largest study on this is called ACTIVE and followed 2'832 older people [17], [18]. One group trained memory, one reasoning, one speed of processing.

After ten years two of the three training effects were still measurable, namely for reasoning and for speed of processing [18]. The effect of memory training on memory performance had disappeared [18].

In everyday activities there was a difference. After ten years 60 out of 100 trained people were at or above their starting level. In the comparison group it was 50 out of 100 [18]. That figure rests on the participants' own report.

Two reviews have examined the question across many programmes [19], [20]. Both reach the same result: whoever practises a task gets better at that task. Neither found a general improvement in thinking [19], [20].

For you this means: expect better steps and more security when walking while distracted. Do not expect names to come to you more easily.

4.4 What the movement contributes

A network meta-analysis compared cognitive training, physical training and the combination of both [21]. For thinking, the combination was superior to either alone, and most so when both ran at the same time [21].

The difference was small. On a standardised scale it was 0.22 for cognition (confidence interval 0.14 to 0.30) and 0.25 for physical function (0.13 to 0.37) [21]. A value of 0.22 means about a fifth of the spread that exists between participants anyway.

One further observation from the same work is worth noting: screen games with movement came last of all the forms examined [21].

Exercise on its own also improves cognitive performance [22]. If you have to choose between exercise and a thinking programme on a screen, the evidence favours the exercise [21], [22]. Which ingredient makes the difference is still open [23].

4.5 How certain this knowledge is

The certainty of the 44 studies on walking with a thinking task was rated from very low to moderate [10]. For the question of which dose lowers falls, the data were not sufficient [10].

One example shows how carefully the results must be read. A study had 90 people with an average age of 81 practise stepping at home in front of a screen for 16 weeks [8]. The primary outcome set in advance was a stepping test with conflicting colour information. In exactly that test there was no improvement [8]. What did improve were speed of processing, visuo-spatial ability and concern about falling [8]. Those results had not been set as the primary question beforehand.

The measuring itself has limits too. Whether a dual-task test predicts future falls is inconsistent across studies [4].

5. How often, how long, how hard?

First the dose from the studies.

• For dynamic balance, 30 minutes three times a week over four weeks with moderately demanding tasks was enough [10].
• For everyday mobility it took 50 minutes three times a week over 13 weeks [10].
• Both figures apply to participants who attended 95 per cent of the sessions [10].
• Step training at home ran three times a week for 20 minutes over 16 weeks [8].
• Training with a simultaneous memory task ran twice a week for an hour over six months [11].
• With balance training at home the difference in falls appeared only after two years [15].

From this we derive our suggestion. It is not a study figure.

• Two to three times a week.
• 20 to 30 minutes per session, in blocks of two to three minutes with rests in between.
• At least 12 weeks before you take stock.
• Choose a difficulty at which you are right on about 4 out of 5 attempts. Hitting everything means it is too easy. Missing half means it is too hard.

The fourth rule comes from practice and not from a study. It keeps the task demanding on attention while still solvable.

6. What you practise with

In the practice we use reaction lights. These are flat discs that light up and respond to a touch or a step. We use two systems, BlazePod and A-Champs ROXs.

The devices measure the time until a response. How reliably they do that was studied in young athletic adults [25]. We know of no study showing that training with such lights lowers falls in older people. The falls studies in section 4 used step mats in front of a television [7], [8] or exercises without a device [6]. The lights make measuring and progressing easier for us. On present knowledge the benefit of the training does not depend on the device.

At home you need none. These items are enough:

• Four to six coloured sheets of paper or adhesive dots for the targets on the floor.
• A stack of coloured cards that a second person turns over.
• A second person who calls out colours, numbers or directions.
• A chair with a backrest or a wall within reach.

If nobody can call out, it works alone as well. Each exercise sheet gives instructions for that.

7. Safety: what to watch for

These exercises raise your speed under time pressure. They make you less stable in the moment in which you react fast. Keep to four rules.

1. Put a chair with a backrest within reach or practise at a wall. Move rugs, cables and stools away.
2. Practise on a non-slip floor. Wear firm shoes or non-slip socks.
3. Start every new exercise with light support at the backrest or wall. Let go only once ten repetitions go safely.
4. Practise the first few times together with a second person.

Stop the exercise if any of these occurs:

• You become dizzy or your vision goes dark.
• You get chest pain or shortness of breath.
• You lose your balance and catch yourself only with difficulty.
• A joint hurts during the movement.
• You are so tired that your steps become imprecise.

After stopping, sit down and have a drink. Next time start one level lower. If dizziness or pain occur repeatedly, contact your doctor.

8. The five exercises

Each exercise has its own page. There you will find aim, equipment for practice and home, set-up, procedure, three levels of difficulty, safety notes and duration.

Start with choice stepping. That exercise is the basis of the other four.

9. The same tasks on screen

Three of our learning games use the same kinds of task. You are seated and practise only the thinking part. The movement part is missing, and on the studies in section 4.4 it is probably the essential one [21], [22].

• Dual Track measures how much you lose when you keep a rhythm and think at the same time.
• Memory Track tests how many words and digits you retain.
• Reaction Lab measures your reaction time and contains a task with conflicting colour information.

Use the games to get to know the tasks. The training itself you do standing up.

10. When to get in touch with us

Get in touch if one of these applies to you:

• You have fallen in the past year.
• You feel less steady when walking than a year ago.
• You stop walking when someone speaks to you.
• You avoid routes or activities out of concern about falling.
• You have a neurological condition and want the exercises adapted.

We first work out where the unsteadiness comes from. How that goes is described in Assessing the risk of falling. After that we choose the suitable exercises and level together.

Go to the emergency department at once if you suddenly see double, if one side of your body becomes weak, if your speech becomes unclear or if severe dizziness with vomiting occurs.

11. For physiotherapists

How this training is steered in the practice has its own page: progression, measures and documentation. It names the parameters, the calculation of dual-task cost [24] and the data export from the device apps.

12. What you should know

• Thinking and stepping training combines a movement task with a thinking task. Five basic forms occur: choosing, holding back, resolving conflict, remembering, dividing.
• Stepping on a signal has the best evidence. In seven studies with 660 people the training groups fell about half as often [6].
• Two other studies found no difference in falls [13], [15]. The evidence is mixed.
• What you practise gets better: stepping reaction time, single-leg stance, standing up and walking [6]. Strength stays as it was [6].
• A general improvement in thinking is not established. In the ACTIVE programme the effect of memory training had disappeared after ten years [18].
• Combining movement with a thinking task works better than either alone. The difference is small and amounts to 0.22 on a standardised scale [21].
• Screen games with movement came last in the same analysis [21].
• Our dosage suggestion: two to three times a week, 20 to 30 minutes, at least 12 weeks. The studies name 30 minutes three times a week over four weeks for balance [10].
• At home, coloured sheets, adhesive dots or a second person calling out are enough. We know of no falls study on reaction lights in older people.
• Keep a chair or a wall within reach. Stop if you become dizzy or get chest pain or shortness of breath.

References

All Digital Object Identifiers (DOIs) were checked against the Crossref register. The links in the reference list lead through the DOI service to the publishers' pages. Some of these are outside Switzerland and the EU. When you click, your IP address is transmitted to that provider. On our own page this does not happen.

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Transparency

• Authorship: Roger Hilfiker
• AI support: the literature search and the draft were produced with Claude (Anthropic). Roger Hilfiker checked all statements, figures and sources and revised the text. [TODO(review): this check is still outstanding]
• Created: 30 August 2026
• Last updated: 30 August 2026
• Sources: the 25 works in the reference list. All DOIs were checked against the Crossref register, and two faulty DOIs were corrected in the process.
• How the sources were found: queries of Crossref and Europe PMC in August 2026 on step training, dual-task training, combined cognitive and physical training, stepping reaction time and the limits of transfer. Where this text says that no study exists on a question, that refers to this search.
• Conflicts of interest: our practice offers physiotherapy, fall prevention and training support and earns money from it. We have bought reaction lights of the BlazePod and A-Champs brands. We receive no money and no equipment from those companies. Section 6 of this text states explicitly that no falls study exists for these devices in older people.
• Funding: Physiotherapie Tschopp & Hilfiker, 3902 Glis. This article was produced from the practice's own funds.
• Next review: 30 August 2028.