Outdoor versus Indoor Cognitive–Motor Therapy in Alzheimer’s Disease: Evidence from a Longitudinal Randomized Study

Alzheimer’s disease leads to progressive cognitive and motor decline, reducing independence and social adaptability in older adults. Combining cognitive and motor stimulation in natural environments may enhance neuroplasticity and functional abilities. This study aimed to compare the effectiveness of outdoor versus indoor cognitive–motor therapy in elderly women with Alzheimer’s disease, focusing on cognitive performance and functional independence. A double-blind randomized controlled trial was conducted with 50 female participants aged 66–70 years from two long-term care facilities. The intervention lasted seven months (five sessions per week, 45 minutes each). The experimental group received outdoor cognitive–motor therapy in garden areas, while the control group underwent identical sessions indoors. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) and functional independence with the Functional Independence Measure (FIM). Data were analyzed using Wilcoxon and Mann–Whitney U tests, and effect sizes (r) were calculated. Both groups showed significant cognitive improvement (MMSE: experimental Z = 4.78, p < .001; control Z = 4.29, p < .001). However, only the outdoor group demonstrated significant gains across all FIM domains daily tasks, mobility, and social adaptability (p < .001; large effects, r = .66–.68). Outdoor cognitive–motor therapy produced broader improvements in cognitive, motor, and social functioning compared with indoor therapy. Exposure to natural environments enhances sensory stimulation, motivation, and rehabilitation outcomes, suggesting that integrating outdoor settings into dementia care may increase the effectiveness of non-pharmacological interventions.