Can two multimodal psychomotor exercise programs improve attention, affordance perception, and balance in community dwellings at risk of falling? A randomized controlled trial

BACKGROUND

Falls are associated with cognitive and physical function deterioration. Attention decline, inaccurate affordance perception, and balance impairment are considered to be risk factors for falls. Furthermore, few studies have reported psychomotor intervention as a fall prevention program. This study aimed to investigate the effects of two multimodal programs on attention, perceptual and stepping-forward boundaries, and balance in community-dwelling older adults at risk of falling.

METHODS

Fifty-one community-dwelling older adults were recruited to participate in a 24-week randomized controlled trial. Participants (75.4 ± 5.6 years) were randomly assigned to one of three groups: the 1) multimodal psychomotor program [EG1], 2) combined program (multimodal psychomotor program + whole-body vibration program) [EG2], and 3) control group. Participants were assessed at baseline, at post-intervention, and after a 12-week no-intervention follow-up period.

RESULTS

The within-group comparisons showed significant improvements in attention and balance in EG1 and EG2 after the intervention (p <  0.05). The magnitudes of the treatment effects were similar in both EGs, ranging from medium to large. Decreases in the fall rate were also observed in EG1 (- 44.2%) and EG2 (- 63.0%) (p <  0.05). During the follow-up period, these improvements in attention were maintained, while those in balance were reversed in both EGs. No significant differences between groups were found.

CONCLUSIONS

These study results suggest that both multimodal exercise programs were effective for fall prevention and were well tolerated by the participants. Specifically, EG1 and EG2 showed identical improvements in attention, and EG2 presented a slightly larger enhancement in balance and a larger decrease in the fall rate. Our findings demonstrate the benefits of maintaining the psychomotor intervention program by itself or in combination with the whole-body vibration program to prevent cognitive and physical function deterioration.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03446352 . Date of registration: February 26, 2018.

Dual-Task Conditions on Static Postural Control in Older Adults: A Systematic Review and Meta-Analysis

Dual-task (DT) consists of the performance of two tasks simultaneously. An index of DT difficulty has been linked to decreased postural control. Because a wide range of DT is employed, this study aimed to evaluate its effects in static balance in older adults. PubMed, Web of Science, and Scopus were screened, and the secondary tasks were grouped as manual, reaction time, discrimination and decision making, mental tracking, verbal fluency, working memory, or "other" tasks. A total of 66 studies have been included. The meta-analysis was conducted on 28 effects and showed a significant mean effect size of d = 0.24 (p = .02, SE = 0.10; confidence interval [0.04, 0.44]), indicating a worsening in stability during DT. In conclusion, postural control was worsened by the Stroop test and the arithmetic tasks improved it. The results do not underpin any conclusive statement on the impact of DT, and a standard operating procedure was created.

Dual-task training on cognition and resistance training improved both balance and working memory in older people

Objectives: With increasing age, declines in executive functions and basic motor skills such as posture control, muscle strength, and balance performance have been observed. However, no intervention has focused on enhancing both executive functions and balance performance concomitantly. Accordingly, the aim of the present study is to investigate whether and to what extent two different dual-task interventions improved both working memory and balancing. Specifically, we examined whether either a motor-cognitive dual task training (mCdtt) or a motor-motor dual-task training (mMdtt) impacted more favorably on working memory and on balance performance among a sample of older adults.Methods: A total of 60 older males (mean age: 68.31 years; SD = 3.83) were randomly assigned either to the mCdtt, the mMdtt or to control condition. Balance performance and working memory performance were tested at baseline, four weeks later at study completion, and again 12 weeks later at follow-up.Results: Balance and working memory improved from baseline to post-intervention and to follow-up (significant Time effect), but more so in the mCdtt compared to the mMdtt condition (significant Time × Group interaction). Further, compared to the mMdtt condition, higher scores were observed in the mCdtt condition (significant Group effect).Conclusion: Dual-task interventions improved both balance performance and working memory, but more so if cognitive performance was specifically trained along with resistance training.

Postural responses of galvanic vestibular stimulation: comparison between groups of older adults and young people

Abstract Objective: To evaluate the effect of vestibular manipulation on the postural sway and muscle activation of younger and older adults. Methods: The study analyzed the effects of three intensity levels of galvanic vestibular stimulation (GVS) (0.3; 0.6 and 1m) on the pattern of muscle activity and center of pressure (CP) displacements of 12 older adults (EG) and 12 young adults (CG) while maintaining their balance on a stable surface, with no vision. Results: The EG showed a positive correlation between CP displacement and muscle activity and GVS intensity. On the other hand, the magnitude of postural response in the EG was not modulated in accordance with GVS intensities. Additionally, during the highest GVS intensity level (1 mA) greater muscle activity was used to increase stiffness, decrease the amplitude of oscillation and ensure stability. This unusual response characterizes a pattern of co-activation and is perhaps a safety mechanism to ensure stability. Conclusion: The EG individuals were not able to select the appropriate motor strategy to efficiently compensate the effects of GVS. This unusual strategy reflects deficits in the vestibular system of older adults, a fact which negatively interferes with their ability to reevaluate sensory information.