Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up

Abstract

BackgroundAbout one-third of people older than 65 years fall at least once a year. Physical exercise has been previously demonstrated to improve gait, enhance physical fitness, and prevent falls. Nonetheless, the addition of cognitive training components may potentially increase these effects, since cognitive impairment is related to gait irregularities and fall risk. We hypothesized that simultaneous cognitive–physical training would lead to greater improvements in dual-task (DT) gait compared to exclusive physical training.MethodsElderly persons older than 70 years and without cognitive impairment were randomly assigned to the following groups: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Gait variables, functional fitness (Short Physical Performance Battery, 6-minute walk), and fall frequencies were assessed at baseline, after 3 months and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were carried out.ResultsEighty-nine participants were randomized to three groups initially; 71 completed the training and 47 were available at 1-year follow-up. DANCE/MEMORY showed a significant advantage compared to PHYS in DT costs of step time variability at fast walking (P=0.044). Training-specific gait adaptations were found on comparing DANCE and MEMORY: DANCE reduced step time at fast walking (P=0.007) and MEMORY reduced gait variability in DT and DT costs at preferred walking speed (both trend P=0.062). Global linear time effects showed improved gait (P<0.05), functional fitness (P<0.05), and reduced fall frequency (−77%, P<0.001). Only single-task fast walking, gait variability at preferred walking speed, and Short Physical Performance Battery were reduced at follow-up (all P<0.05 or trend).ConclusionLong-term multicomponent cognitive–physical and exclusive physical training programs demonstrated similar potential to counteract age-related decline in physical functioning.

Transferability and Sustainability of Motor-Cognitive Dual-Task Training in Patients with Dementia: A Randomized Controlled Trial

“…Results of these studies are heterogeneous. While some of them reported preserved training effects for trained DT performances after 12 weeks [20,24,29], others could not demonstrate retained improvements of trained DT performances after different follow-up periods (4 weeks [28] or 12 months [27]). …”

“…Of the few studies that investigated sustainability of trained DTs in people without CI [20,24,[27][28][29], only three studies showed maintained improvements in trained DTs after a follow-up of 3 months [24,29] and 2-3 months [20]. Within the studies that did not find long-term effects, the initial training effects at the end of the intervention were limited, as documented by a p value at the significance level (p = 0.05 [28]) or only moderate effects sizes for training effects (p = 0.011, effect size r = 0.37 [27]). Results of the present study stand out as sustainability of DT training was documented in a study sample with diagnostically confirmed probable dementia.…”

“…To ensure the real benefit and practical values of an intervention, it is, however, crucial to also investigate long-term effects of an intervention. First indications on long-term effects are given by some studies that investigated sustainability of trained DT performances in healthy elderly without CI [20,27], idiopathic fallers [28], or older adults with balance impairment [24,29]. Results of these studies are heterogeneous.…”

The association between gait and physical fitness in adults with intellectual disabilities

“…Higher levels of cardiorespiratory fitness, lower extremity strength, balance and reaction time were found to be associated with better gait in several populations, such as community dwelling older adults (Ploutz-Snyder et al 2002;Tiedemann et al 2005;Callisaya et al 2010), patients with multiple sclerosis (Sandroff et al 2013) and stroke survivors (Eng & Tang 2007;Taylor-Piliae et al 2012). Physical exercise has also been found effective to improve gait and walking capacity in multiple populations, such as older adults (Gill et al 2004;Eggenberger et al 2015;Bouaziz et al 2016), stroke survivors (Saunders et al 2016) and people with dementia (Bossers et al 2015;Kemoun et al 2010). Because low physical fitness levels have been demonstrated in people with ID (Lahtinen et al 2007;Hilgenkamp et al 2010), this may also influence their gait.…”

Six-Month Lower Limb Aerobic Exercise Improves Physical Function in Young-Old, Old-Old, and Oldest-Old Adults

“…Clinical studies have shown that individuals aged 65 to 84 years can benefit significantly from aerobic exercise, improving physical function parameters such as muscle mass, balance, and walking speed (Shigematsu et al 2002;Short et al 2003;Harber et al 2009). In addition, a multicomponent exercise including aerobic exercise has been reported to have a positive impact on balance, gait speed, walking distance, and mobility in older adults aged 65 years and over (Eggenberger et al 2015) or aged 79 to 90 years (Rogers et al 2003;Ansai et al 2016). Progressive moderate-to high-intensity group programs including balance, jumping, and lower limb strength exercises can maintain or even improve the physical function of healthy older women aged 65 to 80 years (Korpelainen et al 2006;Karinkanta et al 2010).…”