Feasibility study of dual-task-managing training to improve gait performance of older adults

Factors influencing gait performance in older adults in a dual-task paradigm

The aim of this study was to determine the effect of cognitive interference through a dual-task (DT) paradigm on gait parameters by sex or other predictive variables, such as physical fitness, health status, and cognition. A total of 125 older adults joined in this study (age, 72.42 ± 5.56 years old; 28 men and 97 women). The DT paradigm was evaluated through Comfortable Linear Gait (CLG) and Complex Gait Test (CGT). The gait parameters between single task (ST) vs. DT condition in men showed a significant reduction in speed (p < 0.001), cadence (p < 0.001), and step length (p = 0.049) and increased time to execute the CGT (p < 0.001), while women showed a decreased speed (p = 0.014), cadence (p < 0.001), and double support coefficient variation (CV) (p = 0.024) and increased single support time (p < 0.001) and CV step length (p < 0.05). In addition, women increased CGT time (p < 0.001). Furthermore, correlations between DT cost (DTC) cadence vs. Physical Activity for Elderly questionnaire (PASE) (r =  - 0.399; p = 0.008), DTC single support vs. 30 s Sit to Stand Test (r = - 0.356; 0.016), DTC single support vs. Rey Auditory Verbal Learning Test-Learning curve (r =  - 0.335; p = 0.023), DTC double support vs. 30 s Sit to Stand Test (r =  - 0.590; p < 0.001), DTC CV step length vs. 30 s Sit to Stand (r =  - 0.545; p = 0.003), and DTC CGT vs. 30 s Sit to Stand Test (r =  - 0.377; p = 0.048) were found. The results of our study indicate that the gait parameters within the DT condition decreased speed and cadence, while increasing CV step length and CGT time, causing slower gait with shortened steps in men and women.

Uncorking the limitation-improving dual tasking using transcranial electrical stimulation and task training in the elderly: a systematic review

Introduction

With aging, dual task (DT) ability declines and is more cognitively demanding than single tasks. Rapidly declining DT performance is regarded as a predictor of neurodegenerative disease. Task training and non-invasive transcranial electrical stimulation (tES) are methods applied to optimize the DT ability of the elderly.

Methods

A systematic search was carried out in the PUBMED, TDCS (transcranial direct current stimulation) databases, as well as Web of Science, and a qualitative analysis was conducted in 56 included studies. Aiming to summarize the results of studies that implemented tES, task training, or the combination for improving DT ability and related performance changes in healthy elderly and geriatric patients. For different approaches, the training procedures, parameters, as well as outcomes were discussed.

Results

Task training, particularly cognitive-motor DT training, has more notable effects on improving DT performance in the elderly when compared to the neuromodulation method.

Discussion

Anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (L-DLPFC), or its combination with task training could be promising tools. However, additional evidence is required from aged healthy people and patients, as well as further exploration of electrode montage.

The relationship between the local dynamic stability of gait to cognitive and physical performance in older adults: A scoping review

BACKGROUND

Local dynamic stability (LDS) has become accepted as a gait stability indicator. The deterioration of gait stability is magnified in older adults.

RESEARCH QUESTION

What is the current state in the field regarding rthe relationship between LDS and cognitive and/or physical function in older adults?

METHODS

A scoping review design was used to search for peer-reviewed literature or conference proceedings published through May 2023 for an association between LDS and cognitive (e.g., Montreal Cognitive Assessment) or physical performance (e.g., Timed Up & Go Test) in older adults. Only studies investigating gait stability via LDS during controlled walking, when dealing with a subject group consisting of healthy older adults, and quantifying LDS relationship to cognitive and/or physical measure were included. We analysed data from the studies in a descriptive manner.

RESULTS

In total, 814 potentially relevant articles were selected, of which 15 met the inclusion criteria. We identified 37 LDS quantifiers employed in LDS-cognition and/or LDS-physical performance relationship assessment. Nine measures of cognitive and 20 measures of physical performance were analysed. Most studies estimated LDS quantities using triaxial acceleration data. However, there was a variance in sensor placement and signal direction. Out of the 56 studied relationships of LDS to physical performance measures, sixteen were found to be relevant. Out of 22 studied relationships between LDS and cognitive measures, only two were worthwhile.

SIGNIFICANCE

Considering the heterogeneity of the utilized LDS (caused by different sensors locations, signals, and signal directions as well as variety of computational approaches to estimate LDS) and cognitive/physical measures, the results of this scoping review does not indicate a current need for a systematic review with meta-analysis. To assess the overall utility of LDS to reveal a relationship between LDS to cognitive and physical performance measures, an analysis of other subject groups would be appropriate.

Including cognitive assessments with functional testing predicts capabilities relevant to everyday walking in older adults

BACKGROUND

Dual-task (DT) testing reflects real-world walking demands in older adults but is not always feasible to perform in clinic. Whether clinical measures that predict single-task (ST) performance also predict DT performance or dual-task effects (DTEs) has not been fully explored.

RESEARCH QUESTION

What are the relationships between cognitive performance, functional mobility, and self-reported physical activity and balance confidence and ST and DT Gait Speed and Cognitive Reaction Time, as well as DTEs on Gait Speed (DTE_GS) and Cognitive Reaction Time (DTE_RT), in older adults?

METHODS

Sixty-two older adults (71.5 ± 7.1 years, 17 males) completed cognitive performance, functional mobility, and self-report physical activity and balance confidence assessments. Three 1-min trials were performed: 1) ST Cognition (clock task), 2) ST Gait and 3) DT Cognition + Gait, with Cognitive Reaction Time (recorded during clock task performance via DirectRT) and Gait Speed (measured during walking trial via APDM system) recorded, and DTE_GS and DTE_RT calculated, as the cognitive and gait outcomes. Six multivariate regressions were conducted to test whether cognitive performance, functional mobility, and self-report assessments predicted Gait Speed and Cognitive Reaction Time in ST and DT conditions and DTEs.

RESULTS

The Comprehensive Trail Making Test (CTMT) predicted Reaction Time in ST cognitive (β = - 0.525, p = .003) and DT (β = - 0.510, p = .006) trials. The Physical Activity Scale for the Elderly (PASE) predicted DTE_RT (β = - 0.397, p = .008). The 10-Meter Walk Test (10MWT) predicted Gait Speed in ST gait (β = 0.692, p < .001) and DT (β = 0.715, p < .001) trials. The Four Square Step Test (FSST) predicted ST Gait Speed (β = - 0.233, p = .034). The Montreal Cognitive Assessment (MoCA) (β = 0.293, p = .027), 10MWT (β = 0.322, p = .046), and the FSST (β = 0.378, p = .019) predicted DTE_GS.

SIGNIFICANCE

The 10MWT, CTMT, and MoCA can be easily implemented in the clinic and may be good choices to assess cognitive and functional abilities necessary for ambulation in older adults.

Effects of combined cognitive and physical intervention on enhancing cognition in older adults with and without mild cognitive impairment: A systematic review and meta-analysis

Background

Combined cognitive and physical intervention is commonly used as a non-pharmacological therapy to improve cognitive function in older adults, but it is uncertain whether combined intervention can produce stronger cognitive gains than either single cognitive or sham intervention. To address this uncertainty, we performed a systematic review and meta-analysis to evaluate the effects of combined intervention on cognition in older adults with and without mild cognitive impairment (MCI).

Methods

We systematically searched eight databases for relevant articles published from inception to November 1, 2021. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) were used to compare the effects of the combined intervention with a single cognitive or sham intervention on cognition in older adults with and without MCI aged ≥ 50 years. We also searched Google Scholar, references of the included articles, and relevant reviews. Two independent reviewers performed the article screening, data extraction, and bias assessment. GRADEpro was used to rate the strength of evidence, and RevMan software was used to perform the meta-analysis.

Results

Seventeen studies were included in the analysis, comprising eight studies of cognitively healthy older adults and nine studies of older adults with MCI. The meta-analysis showed that the combined intervention significantly improved most cognitive functions and depression (SMD = 0.99, 95% CI 0.54–1.43, p < 0.0001) in older adults compared to the control groups, but the intervention effects varied by cognition domains. However, there was no statistically significant difference in the maintenance between the combined and sham interventions (SMD = 1.34, 95% CI −0.58–3.27, p = 0.17). The subgroup analysis also showed that there was no statistical difference in the combined intervention to improve global cognition, memory, attention, and executive function between cognitive healthy older adults and older adults with MCI.

Conclusions

Combined intervention improves cognitive functions in older adults with and without MCI, especially in global cognition, memory, and executive function. However, there was no statistical difference in the efficacy of the combined intervention to improve cognition between cognitive healthy older adults and older adults with MCI. Moreover, the maintenance of the combined intervention remains unclear due to the limited follow-up data and high heterogeneity. In the future, more stringent study designs with more follow-ups are needed further to explore the effects of combined intervention in older adults.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD42021292490.

A feasibility study of dual-task strategy training to improve gait performance in patients with Parkinson's disease

Gait disorders in patients with Parkinson’s disease (PD) impact their mobility and self-dependence. Gait training and dual-task (DT)-training improve gait quality. This study aims to assess the feasibility of a specific, gradually intensified DT-training for PD patients with a special focus on gait performance under single task (ST) and DT conditions. Correlations to Freezing of Gait (FoG) were examined. 17 PD patients (70.1 ± 7.4 years, H&Y Stadium 2–3, FoG-Q 9.0 ± 5.5) participated in a four-week DT-training (1x/week, 60 min) with progressively increasing task difficulty and number of tasks. Gait performance (spatiotemporal parameters) was assessed during ST and DT conditions. The training improved DT gait performance, especially gait velocity + 0.11 m/s; (F_(2,16) = 7.163; p = .0171; η²part = .309) and step length (+ 5.73 cm). Also, physical well-being and absolved walking distance improved significantly. Correlation analyses of the FoG score at baseline with relative change of gait metrics post-training revealed significant correlations with training-induced changes of step length and improvement of gait velocity. Overall, the developed DT-training was feasible and effective. Further studies should examine the long-term benefits and the optimal setting to achieve the highest impact. The study was registered in the DRKS (ID DRKS00018084, 23.1.20).

Can cognitive-motor training improve physical functioning and psychosocial wellbeing in nursing home residents? A randomized controlled feasibility study as part of the PROCARE project

BACKGROUND

A multi-component training program holds promises for the elderly, but still has to be tested on its feasibility and effect in nursing homes.

AIMS

The aim of this study was (1) to design a multi-component training program which improves physical functioning and psychosocial wellbeing and (2) to evaluate the feasibility of this intervention in nursing home residents.

METHODS

This study is a two-arm, stratified-randomized controlled feasibility trail. Twenty-four nursing home residents (aged 83.7 ± 6.4, 21 women) were divided into an intervention and a waiting-list control group. The intervention group completed a multi-component training (including dual-task, dynamic balance, endurance and strength exercises) for 16 weeks (twice per week for 45-60 min). Primary outcomes were lower extremity functionality (SPPB), gait performance (GAITRite), health-related quality of life (SF-12) as well as life satisfaction (SWLS).

RESULTS

Life satisfaction (SWLS) and physical functioning (SPPB) increased in the intervention group after training whereas the control group showed a decrease. Gait parameters could only be analyzed for n = 5 participants of the intervention group and n = 2 of the control group and showed no time differences for the intervention group. The mean number of participants was 12.5 ± 1.9 per session (attendance ranged between 66% and 90%).

CONCLUSION

A multi-component training seems (1) to lead to clinically relevant improvements in physical functioning as well as in psychosocial wellbeing and (2) to be feasible and well accepted in nursing home residents. Nevertheless, the complexity and progression of the program as well as the testing protocol have to be adapted. Further research should test the effectiveness of this adapted program in a larger sample size.

Dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults: A protocol for a randomized controlled trial : Variable- and fixed-priority dual-task for older adults

BACKGROUND

Functional independence and safe mobility, especially in older people, mostly rely on the ability to perform dual tasks, particularly during activities with variable- and fixed-priority attention. The aim of this study is to compare the dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults.

METHODS

This is an assessor- and participant-blinded, two-arm, randomized controlled trial with 60 community-dwelling male and female older adults between the ages of 60 and 80 years old. Participants will be randomly allocated into either the intervention group or the control group using a computer-generated permuted block randomization schedule. The intervention group will undertake a progressive dual-task training in which the participants will be progressively submitted to dual-task walking and postural balance exercises with variable- to fixed-priority instructions. The control group will be submitted to dual-task training with variable-priority attention exercises. Both groups will receive 48 sessions lasting for 60 min each over 24 weeks. The primary outcome will be the gait speed under single- and dual-task conditions. Secondary outcomes will include spatiotemporal gait parameters, functional balance, executive function, falls, quality of life, and depression symptoms. All the analyses will be based on the intention-to-treat principle.

DISCUSSION

This is the first assessor- and participant-blinded, two-arm, randomized controlled trial with 6 months of intervention and an additional 6-month post-training follow up aiming to evaluate the effectiveness of training with progression from variable- to fixed-priority instructions on gait biomechanics, postural balance, falls episodes, executive functioning, and quality of life in community-dwelling older adults. If our hypotheses are confirmed, this training protocol can be implemented widely to improve gait speed and other functional activities and quality of life in community-dwelling older adults. This study protocol can be used to improve these functional aspects of community-dwelling older adults. This study may also contribute to future guidelines for the improvement of these clinical and biomechanical aspects in older people.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier - NCT03886805, Registered 22 March 2019.

A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project

BACKGROUND

Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life.

METHODS

A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45-60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents' capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only).

DISCUSSION

This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents.

TRIAL REGISTRATION

The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

Concurrent validity and intratester reliability of the video-based system for measuring gait poststroke

BACKGROUND AND PURPOSE

Spatio-temporal parameters are commonly used in gait assessment. Advanced tools provide valid and reliable data, considered very effective for physiotherapy intervention. However, these tools may be limited in clinical usage caused by complicated applicability, inaccessibility, and high cost. Therefore, a video-based system is an alternative choice that is easy and affordable for the clinical setting. The purpose of the study was to evaluate the concurrent validity of the video-based system against the validated instrumented gait system (Force Distribution Measurement [FDM]) on the spatio-temporal gait parameters in individuals with stroke. In addition, the intratester reliability of a novice tester was determined.

METHODS

Twenty individuals with stroke participated in the study. Gait was captured by the video-based and FDM systems simultaneously to measure the degree of concurrent validity. Parameters composed of the affected and unaffected step lengths (cm) and step time (s), stride length (cm), gait velocity (m/s), and cadence (steps/min). Pearson correlation coefficient, paired t test, and intraclass correlation coefficient (ICC) were used to determine the concurrent validity, the difference of the data, and intratester reliability.

RESULTS

All spatio-temporal gait parameters showed excellent degrees of correlation (r_p = .94 to.99, p <.001) between the video-based and FDM systems. No significant difference in all parameters was found between the two systems. Excellent intratester reliability (ICC_3,1 = 0.91 to 0.99, p < .001) of all gait parameters were found in a novice tester.

CONCLUSION

The video-based system was valid and reliable for a novice tester to measure the spatio-temporal gait parameters in individuals with stroke.

Gait Stability and Its Influencing Factors in Older Adults

A stable gait pattern is a prerequisite to successfully master various activities of daily living. Furthermore, reduced gait stability is associated with a higher risk of falling. To provide specific intervention strategies to improve gait stability, gaining detailed knowledge of the underlying mechanism and influencing factors is of utmost importance. The effects of relevant influencing factors on gait stability are poorly examined, yet. Therefore, the aim of the current study was to quantify the effects of various influencing factors on gait stability. In a cross-sectional study, we assessed dynamic gait stability and relevant influencing factors in 102 older adults (age >65 years). In addition to dynamic gait stability (largest Lyapunov exponent [LLE] and gait variability measures) during normal over-ground (single-task: ST) and dual-task (DT) walking, we registered the following influencing factors: health status (SF12), pain status (painDETECT, SES), fear of falling (falls efficacy scale), depression (CES-D), cognition performance (Stroop test), physical activity (Freiburger Fragebogen zur körperlichen Aktivität), proprioception (joint position sense), peripheral sensation (mechanical and vibration detection threshold), balance performance (static balance on force plate) and muscular fitness (instrumented sit-to-stand test). We used a principal components regression to link the identified principal components with the gait stability and gait variability responses. The four principal components “strength and gender” (e.g., p = 0.001 for LLE during ST), “physical activity” (e.g., p = 0.006 for LLE during ST), “pain” (e.g., p = 0.030 for LLE during DT) and “peripheral sensation” (e.g., p = 0.002 for LLE during ST) were each significantly associated with at least two of the analyzed gait stability/variability measures. The dimension “balance” was a significant predictor in only one gait measure. While “proprioception” tends to correlate with a gait variability measure, we did not find a dependency of mental health on any gait measure. In conclusion, the participants' ability to recover from small perturbations (as measured with the largest Lyapunov exponent) seems to be related to gender and strength, the amount of physical activity the participants spent every week, peripheral sensation and pain status. Since the explained variance is still rather low, there could be more relevant factors that were not addressed, yet.

Effect of interactive cognitive motor training on gait and balance among older adults: A randomized controlled trial

BACKGROUND

Aging is a normal degenerative process that results in a decline in the gait and balance performance of older adults. Interactive cognitive motor training is an intervention that integrates cognitive and motor tasks to promote individuals' physical and cognitive fall risk factors. However, the additive effects of the interactive cognitive motor training on objective quantitative data and comprehensive descriptions of gait and balance warrants further investigation.

OBJECTIVES

To investigate the effect of interactive cognitive motor training on older adults' gait and balance from immediate to long-term time points.

DESIGN

A double-blind randomized control trial.

SETTINGS

Four senior service centers and community service centers in Taiwan.

PARTICIPANTS

62 older adults who met the inclusion criteria.

METHODS

The study participants were older adults without cognitive impairment, and they were randomly allocated to the experimental group or active control group. In both groups, older adults participated in three sessions of 30-min training per week for a total of 8 weeks, with the total number of training sessions being 24. The primary outcome was gait performance, which was measured using objective and subjective indicators. iWALK was used as an objective indicator to measure pace and dynamic stability; the Functional Gait Assessment was employed as a subjective indicator. The secondary outcome was balance performance, which was measured using iSWAY. A generalized estimating equation was used to identify whether the results of the two groups differ after receiving different intervention measures; the results were obtained from immediate to long-term posttests.

RESULTS

Stride length in the pace category of the experimental group improved significantly in immediate posttest (p = 0.01), 3-month follow-up (p = 0.01), and 6-month follow-up (p = 0.04). The range of motion of the leg exhibited significant improvement in immediate posttest (p = 0.04) and 3-month follow-up (p = 0.04). The Functional Gait Assessment result indicated that statistically significant improvement was observed in immediate posttest (p = 0.02) and 12-month follow-up (p = 0.01). The results of balance performance showed that the experimental group attained statistically significant improvement in centroid frequency in the immediate posttest (p = 0.02).

CONCLUSIONS

The research results validated that the 24 sessions of the interactive cognitive motor training intervention significantly improved gait and balance performance. Future studies should extend the sample to communities to promote the gait and balance performance of community-dwelling older adults without cognitive impairment and reduce their risk of falling and developing gait-related diseases.

The beneficial effects of different types of exercise interventions on motor and cognitive functions in older age: a systematic review

The decline in cognitive and motor functions with age affects the performance of the aging healthy population in many daily life activities. Physical activity appears to mitigate this decline or even improve motor and cognitive abilities in older adults. The current systematic review will focus mainly on behavioral studies that look into the dual effects of different types of physical training (e.g., balance training, aerobic training, strength training, group sports, etc.) on cognitive and motor tasks in older adults with no known cognitive or motor disabilities or disease. Our search retrieved a total of 1095 likely relevant articles, of which 41 were considered for full-text reading and 19 were included in the review after the full-text reading. Overall, observations from the 19 included studies conclude that improvements on both motor and cognitive functions were found, mainly in interventions that adopt physical-cognitive training or combined exercise training. While this finding advocates the use of multimodal exercise training paradigms or interventions to improve cognitive-motor abilities in older adults, the sizeable inconsistency among training protocols and endpoint measures complicates the generalization of this finding.

Effects of Dual-Task Management and Resistance Training on Gait Performance in Older Individuals: A Randomized Controlled Trial

Background: Dual-task (DT) training is a well-accepted modality for fall prevention in older adults. DT training should include task-managing strategies such as task switching or task prioritization to improve gait performance under DT conditions.

Methods: We conducted a randomized controlled trial to evaluate a balance and task managing training (BDT group) in gait performance compared to a single task (ST) strength and resistance training and a control group, which received no training. A total of 78 older individuals (72.0 ± 4.9 years) participated in this study. The DT group performed task managing training incorporating balance and coordination tasks while the ST group performed resistance training only. Training consisted of 12 weekly sessions, 60 min each, for 12 weeks. We assessed the effects of ST and BDT training on walking performance under ST and DT conditions in independent living elderly adults. ST and DT walking (visual verbal Stroop task) were measured utilizing a treadmill at self-selected walking speed (mean for all groups: 4.4 ± 1 km h^-1). Specific gait variables, cognitive performance, and fear of falling were compared between all groups.

>Results: Training improved gait performance for step length (p < 0.001) and gait-line (ST: p < 0.01; DT p < 0.05) in both training groups. The BDT training group showed greater improvements in step length (p < 0.001) and gait-line (p < 0.01) during DT walking but did not have changes in cognitive performance. Both interventions reduced fear of falling (p < 0.05).

Conclusion: Implementation of task management strategies into balance and strength training in our population revealed a promising modality to prevent falls in older individuals.

Trial registration: German register of clinical trials DRKS00012382.

Neural correlates of motor-cognitive dual-tasking in young and old adults

When two tasks are performed simultaneously, performance often declines in one or both tasks. These so-called dual-task costs are more pronounced in old than in young adults. One proposed neurological mechanism of the dual-task costs is that old compared with young adults tend to execute single-tasks with higher brain activation. In the brain regions that are needed for both tasks, the reduced residual capacity may interfere with performance of the dual-task. This competition for shared brain regions has been called structural interference. The purpose of the study was to determine whether structural interference indeed plays a role in the age-related decrease in dual-task performance. Functional magnetic resonance imaging (fMRI) was used to investigate 23 young adults (20–29 years) and 32 old adults (66–89 years) performing a calculation (serial subtraction by seven) and balance-simulation (plantar flexion force control) task separately or simultaneously. Behavioral performance decreased during the dual-task compared with the single-tasks in both age groups, with greater dual-task costs in old compared with young adults. Brain activation was significantly higher in old than young adults during all conditions. Region of interest analyses were performed on brain regions that were active in both tasks. Structural interference was apparent in the right insula, as quantified by an age-related reduction in upregulation of brain activity from single- to dual-task. However, the magnitude of upregulation did not correlate with dual-task costs. Therefore, we conclude that the greater dual-task costs in old adults were probably not due to increased structural interference.

Does dual task training improve walking performance of older adults with concern of falling?

Background

Older adults with concerns of falling show decrements of gait stability under single (ST) and dual task (DT) conditions.

To compare the effects of a DT training integrating task managing strategies for independent living older adults with and without concern about falling (CoF) to a non-training control group on walking performance under ST and DT conditions.

Methods

Single center parallel group single blind randomized controlled trial with group-based interventions (DT-managing balance training) compared to a control group (Ninety-five independent living older adults; 71.5 ± 5.2 years).

A progressive DT training (12 sessions; 60 min each; 12 weeks) including task-managing strategies was compared to a non-training control group. Setting: group based intervention for independent living elderly in a gym. ST and DT walking (visual verbal Stroop task) were measured on a treadmill. Gait parameters (step length, step width, and gait line) and cognitive performance while walking were compared with a 2x2x2 Repeated Measures Analyses of Variance.

Results

Participants in the intervention group showed an increased step length under ST and DT conditions following the intervention, for both people with and without CoF compared to their respective control groups. Foot rolling movement and cognitive performance while walking however only improved in participants without CoF.

Conclusions

The results showed that DT managing training can improve walking performance under ST and DT conditions in people with and without CoF. Additional treatment to directly address CoF, such as cognitive behavioural therapy, should be considered to further improve the cautious gait pattern (as evidenced by reduced foot rolling movements).

Trial registration

The study was retrospectively registered in the German Clinical Trials Register (DRKS; Identification number DRKS00012382, 11.05.2017).

Influence of age, gender and test conditions on the reproducibility of Dual-Task walking performance

BACKGROUND

The review of methodological problems (confounding factors) of gait analysis in intervention studies with seniors is underrepresented.

AIM

This study focusses on two common problems of gait analysis under single-task (ST) and dual-task (DT) conditions (visual verbal Stroop test): (1) reproducibility of walking variables and (2) the effects of gait velocity, gender and age on peak plantar pressure to identify confounding effects on relevant outcome parameters.

METHODS

The participants (N = 86, 71.9 ± 4.6 years) were divided into a (1) reproducibility (n = 28) and an (2) outcome parameter group (n = 58). Gait kinematics (step length; cadence) and kinetics (peak plantar pressure under heel, midfoot and forefoot) were analyzed walking barefoot on a treadmill (100 Hz) at self-selected speed for the reproducibility and at two different speeds (v = 3.5; 4.5 km/h) for outcome parameters. ICC analysis combined with the repeatability coefficient and SEM calculation, an ANOVA with repeated measurements and determination of effect sizes (η _p² ) as well as a partial correlation analyses with body mass were done.

RESULTS

The reproducibility of the walking variables under ST and DT conditions was excellent with ICC values of .67 to .99. The SEM and CR results as presented in Table 2 support these findings for some of the parameters.

DISCUSSION

Plantar pressure values were influenced by gait velocity but less by age and gender. For DT walking the differences between preferred and fixed gait speed have to be controlled to assign the DT effects.

CONCLUSION

Effects of intervention studies should be carefully interpreted regarding the absolute reproducibility.