A Physical-Cognitive Intervention to Enhance Gait Speed in Older Mexican Adults

Impact of Motor-Cognitive Interventions on Selected Gait and Balance Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Efficient performance of most daily activities requires intact and simultaneous execution of motor and cognitive tasks. To mitigate age-related functional decline, various combinations of motor and cognitive training have shown promising results. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy of different types of motor-cognitive training interventions (e.g., sequential and simultaneous) on selected functional outcomes in healthy older adults.

Methods

Six online academic databases were used to retrieve eligible RCTs up to April 2021, following PRISMA guidelines and PICO criteria. A random-effects model was used for all meta-analyses conducted on selected functional outcomes: single- and dual-task gait speed, the Timed Up and Go Test (TUG), and Berg Balance Scale (BBS) score. Effect size (ES) was calculated as Hedges' g and interpreted as: trivial: <0.20, small: 0.20–0.60, moderate: 0.61–1.20, large: 1.21–2.00, very large: 2.01–4.00 or extremely large >4.00.

Results

From 2,546 retrieved records, 91 RCTs were included for meta-analysis (n = 3,745 participants; 64.7–86.9 years). The motor-cognitive interventions included differed according to the type of training (e.g., sequential, simultaneous with additional cognitive task or exergame training. The results showed that motor-cognitive interventions can improve gait speed under single-task conditions (small ES = 0.34, P = 0.003). The effect of the intervention was moderated by the type of control group (Q = 6.203, P = 0.013): passive (moderate ES = 0.941, P = 0.001) vs. active controls (trivial ES = 0.153, P = 0.180). No significant effect was found for dual-task walking outcomes (P = 0.063). Motor-cognitive intervention had a positive effect on TUG (small ES = 0.42, P < 0.001), where the effect of intervention was moderated by control group [passive (moderate ES = 0.73, P = 0.001) vs. active (small ES = 0.20, P = 0.020)], but not by the type of training (P = 0.064). Finally, BBS scores were positively affected by motor-cognitive interventions (small ES = 0.59, P < 0.001) with however no significant differences between type of control group (P = 0.529) or intervention modality (P = 0.585).

Conclusions

This study provides evidence for the effectiveness of various types of motor-cognitive interventions on performance-based measures of functional mobility in healthy older adults. With respect to significant effects, gait speed under single-task condition was improved by motor-cognitive interventions, but the evidence shows that this type of intervention is not necessarily more beneficial than motor training alone. On the other hand, motor-cognitive interventions are better at improving multicomponent tasks of dynamic balance and mobility function, as measured by the TUG. Because of substantial heterogeneity and the current limited availability of different types of interventions, the conclusions should be interpreted with caution.

The Effects of Combined Cognitive-Physical Interventions on Cognitive Functioning in Healthy Older Adults: A Systematic Review and Multilevel Meta-Analysis

Research has shown that both physical exercise and cognitive training help to maintain cognition in older adults. The question is whether combined training might produce additive effects when the group comparisons are equated in terms of exercise intensity and modality. We conducted a systematic electronic search in MEDLINE, PsycInfo, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify relevant studies published up to February 2021. Seven hundred and eighty-three effect sizes were obtained from 50 published intervention studies, involving 6,164 healthy older adults, and submitted to a three-level meta-analysis. Results showed that combined training produced a small advantage in comparison to single cognitive training on executive functions, whereas both types of training achieved similar effects on attention, memory, language, processing speed, and global cognition. Combined training achieved higher training gains in balance than single physical training, indicating a transfer from cognitive training to balance. Performing cognitive and physical exercise simultaneously, and interactive training (e.g., exergames, square stepping) produced the largest gains in executive functions, speed, and global cognition, as well as the largest improvements in physical functions. Aerobic training was associated with higher effects in attention and fitness, whereas non-aerobic training produced larger effects in global cognition and balance. For all cognitive and physical outcomes, training resulted more advantageous when performed in a social context, even though individual training obtained similar results in balance as group training.

Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier: CRD42020175632.

Quasi-stiffness of the knee joint is influenced by walking on a destabilising terrain

BACKGROUND

Predictive models have been devised to estimate the necessary quasi-stiffness that a transfemoral prosthesis should be set to aligning the body and gait parameters of the user. Current recommendations exist only for walking over level ground. This study aimed to ascertain whether walking across destabilising terrain influences the quasi-stiffness of the knee joint thus influencing prosthetic engineering.

METHODS

Ten healthy males (age: 25.1 ± 2.5 years; mean ± sd, height: 1.78 ± 0.05 m, weight: 84.40 ± 11.02 kg) performed 14 gait trials. Seven trials were conducted over even ground and seven over 20 mm ballast. Three-dimensional motion capture and ground reaction force were collected. Paired samples t-tests and Wilcoxon signed ranked test compared variables including; quasi-stiffness, gait speed, stride length and stride width.

RESULTS

Quasi-stiffness (d = 0.562, P = 0.001) and stride width (d = 0.909, P < 0.001) were significantly greater in the destabilising terrain condition. Gait speed (r = -0.731, P = 0.001) was significantly greater in the control condition. No significant difference was seen in stride length (d = 0.583, P = 0.016).

CONCLUSIONS

An increase in quasi-stiffness when walking across destabilising terrain was attributed to a magnified shock absorption mechanism, facilitating an increased flexion angle during the stance phase. This causes a lower centre of mass resulting in the musculoskeletal system having to produce a greater knee extensor moment to prevent the knee collapsing. Therefore, transfemoral prostheses should be tuned to apply increased extension moments if ambulation is to occur on a destabilising terrain.

A comparison of the impact of physical exercise, cognitive training and combined intervention on spontaneous walking speed in older adults

BACKGROUND

Spontaneous walking speed (SWS) is one of the most important indicators of health in older adults. Studies have shown benefits of physical trainings on SWS in older adults but the impact of cognitive training and multidomain interventions remains understudied.

AIMS

This original study aimed at comparing the impact of aerobic/resistance exercise, computerized cognitive training and the combination of both interventions compared with active control conditions on SWS in healthy older adults.

METHODS

Ninety community-dwelling older adults were randomly assigned to four different combinations composed of two active interventions: physical aerobic/resistance and cognitive dual-task trainings, and two active control conditions: stretching exercises and computer lessons. The four combinations were the following: (1) aerobic/resistance and cognitive dual task (n = 28), (2) aerobic/resistance and computer lessons (n = 21), (3) stretching exercises and cognitive dual task and (n = 23), (4) stretching exercises and computer lessons (n = 18). Training sessions were held three times/week for three months. SWS for 30 s was assessed before and after the intervention.

RESULTS

Repeated-measures ANOVA showed a main effect of time and a significant three-way interaction suggesting differential improvement in SWS according to training combinations. A clinical meaningful improvement in SWS was observed in groups 1-3 (0.08-0.14 m/s; effect sizes: small to moderate) but not in the active control group 4.

DISCUSSION

Results of this study suggest that aerobic/resistance exercise and computerized dual-task training are two non-pharmacological interventions by which SWS, a functional vital sign, can be clinically improved in older adults.

CONCLUSION

This original study pointed out different tools to prevent functional decline in older people.