The Effect of 2 Different Dual-Task Balance Training Methods on Balance and Gait in Older Adults: A Randomized Controlled Trial

Abstract

Objective The purpose of this study was to compare the effects of integrated and consecutive cognitive dual-task balance training in older adults on balance, fear of falling, and gait performance. Methods Fifty-eight subjects (age > 65 years) were randomly assigned to an integrated dual-task training group (IDTT) (n = 29) and consecutive dual-task training group (CDTT) (n = 29). Balance exercises and cognitive tasks were performed simultaneously by the IDTT group and consecutively by the CDTT group for 8 weeks. Balance was assessed using the Berg Balance Scale (BBS) as a primary outcome measure and the Timed “Up & Go” Test (TUG) (standard-cognitive), fear of falling was assessed using the Tinetti Falls Efficacy Scale (FES), and gait speed was assessed using the 10-Meter Walk Test (10MWT) (under single-task and dual-task conditions). All tests were performed before and after the training. Results There was no difference in group-time interaction in the BBS, TUG-ST, 10MWT-ST, and 10MWT-DT tests. Group-time interaction was different in the TUG-Cog and FES scores. Also, the effect of time was significantly different in all scales except for the 10MWT-ST in both groups. Conclusion At the end of the 8 week training period, the impact of integrated and consecutive dual-task balance training on balance and gait performance in older adults was not statistically significantly different. This study suggests that consecutive dual-task balance training can be used as an alternative method to increase balance performance and gait speed in older adults who cannot perform integrated dual-task activities. Impact There were no significant differences between the effects of the 2 dual-task training methods on balance and gait speed. Suggesting that the consecutive dual-task balance training method can be used to improve the balance and gait of older adults. Consecutive dual-task training can be performed safely and considered as an alternative method for use in many rehabilitation training programs with older adults who cannot perform simultaneous activities.

A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults

“…The DT interventions delivered in the included studies were (1) motor-cognitive, (2) motor-motor, or (3) cognitive–cognitive DT, as reported in Table 1 . Among the 30 included studies, 22 studies [ 21 , 22 , 29 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ] used motor-cognitive DT training, 6 [ 23 , 28 , 30 , 45 , 59 , 64 ] used a motor-motor type of task, and 2 [ 65 , 66 ] included cognitive exercise in both tasks.…”

“…Across the 30 included studies, different types of exercises were applied. Balance exercises appeared most frequently, as they were used in 12 studies [ 21 , 22 , 30 , 47 , 50 , 51 , 54 , 58 , 61 , 62 , 63 , 64 ]. Balance exercises were performed using free-hand, low-tech systems with minimal technology support or technology-dependent, computerized balance systems.…”

“…Training sessions lasted between 3 [ 45 ] and 90 min [ 30 ] per session. Eleven studies [ 22 , 23 , 30 , 44 , 49 , 51 , 55 , 59 , 61 , 64 , 65 , 66 , 67 ] had 60 min or longer sessions. The frequency of training varied from once a week to every day and the length of training ranged from four weeks to a year [ 44 , 45 , 59 , 60 ].…”

“…One study did not specifically report pre- and post-assessment time [ 44 ]. Six studies [ 23 , 43 , 48 , 51 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ] included a follow-up assessment after the intervention phase, and the follow-up period ranged from 2 weeks [ 48 , 51 ] to 12 months [ 57 ].…”

“…Balance was assessed in 25 studies [ 21 , 22 , 23 , 28 , 29 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 54 , 55 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. Almost 30% of the studies employed the BBS [ 23 , 28 , 50 , 51 , 55 , 58 , 59 , 63 , 66 ], while six [ 45 , 49 , 52 , 60 , 62 , 65 ] used the TUG scale, and both scales were utilized in three studies [ 46 , 47 , 61 ]. Three studies [ 30 , 56 , 57 ] examined falls and reported the data as a percentage [ 57 ] or incidence rate ratio [ 30 , 56 ].…”