Protocol for an unblinded randomised controlled feasibility trial of Piano Instruction for Adult Novices as Online Cognitive intervention (PIANO-Cog): a novel remote piano training programme for cognitive and motor functions in older age.

BACKGROUND: Ageing is associated with a loss of fluid intelligence and motor functions which hamper independence and quality of life. Training in a musical instrument can improve fluid intelligence and executive function (EF) in older non-musicians but the neural correlates underpinning the benefits remain elusive. The primary aims of this study are to: i) test the acceptability of Piano Instruction for Adult Novices as Online Cognitive Intervention (PIANO-Cog), a novel bespoke 8-week self-guided piano training programme for adults over the age of 50 years; and ii) to test the feasibility (in terms of recruitment, retention and adherence) of a large scale RCT comparing PIANO-Cog to a passive control. Secondary aims of this study are: i) to investigate the effects of online piano training on fluid abilities, EF and motor function; ii) to investigate training-induced microstructural brain changes using ultra-strong gradient (300mT/m) magnetic resonance imaging (MRI) and iii) to investigate how the latter may be linked to cognitive improvements post-training. METHOD: A two-armed unblinded RCT will be conducted on 50 healthy non-musician adults over the age of 50. Participants will be randomised to a piano training (PT) or passive control group for 8 weeks, stratified for age and sex. PT participants will receive a training manual and 20-min video tutorials each week, and will practice 30 min, 5 days per week. Control participants will receive no intervention for the 8-week period. Cognitive testing and MRI of the brain will take place before and after the intervention. DISCUSSION: The primary aim of the trial is to determine the acceptability of PIANO-Cog as an online cognitive intervention for adults over 50 who are non-musicians, and the feasibility of conducting a large-scale RCT in terms of recruitment, retention and adherence. Self-guided music training programmes could provide a cost-effective method of maintaining or improving cognitive and motor functions that individuals can implement in their own homes. Secondary aims are regarding the investigation of positive transfer of piano training to EF and fluid abilities in ageing, and to provide evidence for the relationship between training-induced cognitive enhancements and underlying white and grey matter microstructural changes. TRIAL REGISTRATION: ISRCTN11023869 (retrospectively registered). PROTOCOL VERSION: 20/10/2025 version 1.5.