The Effects of EnhanceFitness (EF) Training on Dual-Task Walking in Older Adults Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Physical training-related changes in gait variability while single and dual tasking in older adults: magnitude of gait variability at baseline matters. Does Change in Gait while Counting Backward Predict the Occurrence of a First Fall in Older Adults? Dual-task performances can be improved in patients with dementia Transfer effects of fall training on balance performance and spatiotemporal gait parameters in healthy community-dwelling older adults: a pilot study. Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: a preliminary investigation. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial Effects of dual-task switch exercise on gait and gait initiation performance in older adults: preliminary results of a randomized controlled trial. Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: Part 2 of a Phase II Preclinical Exploratory Trial Mental Fatigue Increases Gait Variability During Dual-task Walking in Old Adults Effect of a Dual-Task Net-Step Exercise on Cognitive and Gait Function in Older Adults Effects of Physical-Cognitive Dual Task Training on Executive Function and Gait Performance in Older Adults: A Randomized Controlled Trial Quantitative gait analysis under dual-task in older people with mild cognitive impairment: a reliability study Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking, and falling. Multitasking: association between poorer performance and a history of recurrent falls. Single and dual task gait training in people with Parkinson's Disease: A protocol for a randomised controlled trial Group-based exercise combined with dual-task training improves gait but not vascular health in active older adults without dementia. Recurrent falls and dual task-related decrease in walking speed: is there a relationship? Effects of the Addition of a Dual Task to a Supervised Physical Exercise Program on Older Adults' Cognitive Performance. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Training of balance under single- and dual-task conditions in older adults with balance impairment. Brain activation in high-functioning older adults and falls A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: a randomized controlled trial Functional benefits of tai chi training in senior housing facilities. Executive Function and Falls in Older Adults: New Findings from a Five-Year Prospective Study Link Fall Risk to Cognition
Decline in dual-task walking performance is associated with increased risk of falls among older adults . The objective of this study is to determine whether 18 hr of participation in EnhanceFitness ( EF ) , an evidence -based group exercise program , improves dual-task walking performance among community-dwelling older adults . Twenty-eight healthy , community-dwelling older adults were evaluated before participating in EF and after 18 hr of participation . Gait speed was evaluated under single task and dual tasks using the TUG ( Timed Up and Go ) and 1-min walk tests . Dual-task costs ( DTC ) , the relative cost of dual-task performance compared to single-task performance , were calculated for both cognitive and motor tasks . Postural control and executive functions were evaluated as well . After 18 hr of EF , dual-task walking performance improved . Single-task performance improved as well as postural control and executive function . There was no significant change in DTC across all measurements , except for the cognitive task of the TUG Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov OBJECTIVES Few studies have examined the effects of physical training programs on gait variability while single and dual tasking , and they reported mixed results . The aim of this study was to compare the stride time variability while single and dual tasking before and after a physical training program developed to improve gait stability in French community-dwelling older adults . DESIGN A prospect i ve pre-post interventional cohort study . SETTING The community-dwelling area of " Pays de la Loire " , France . POPULATION Forty-eight older adults ( mean age ± st and ard deviation 72.2±8 years ; 75 % female ) . METHODS Physical training program consisted in 12 sessions scheduled to attend physical exercises 1 time a week with total time duration of 3 months . Coefficient of variation ( CoV ) of stride time under three walking conditions ( i.e. , walking alone , walking while backward counting , and while performing a verbal fluency task ) was determined while steady-state walking using the SMTEC ® footswitches system before and after the physical training program . Participants were separated into two groups based on being or not in the highest tertile ( i.e. , worst performance with cutpoint > 4.4 % ) of the CoV of stride time while walking alone . RESULTS After physical training compared to before period , a significant decrease in CoV of stride time ( i.e. , better gait performance ) while walking alone ( 2.8±2.8 % versus 7±7.1 % , P=0.001 ) but not while dual tasking ( P=0.600 for counting backward and P=0.105 for verbal fluency task ) was shown in participants who had highest ( i.e. , worst ) gait variability at baseline . In addition , physical training modified the strategy of dual tasking in participants with highest gait variability at baseline compared to the other participants . Before training , a significant decrease in CoV of stride time ( 7±7.1 % versus 4.9±4.6 % , P=0.017 ) while counting backward was shown , but there was a significant increase after training ( 2.8±2.8 % versus 5.4±5.8 % , P=0.007 ) . CONCLUSIONS Physical training  reduced gait variability while walking alone in participants with gait instability , and influenced their strategy for dual tasking . CLINICAL REHABILITATION IMPACT Physical program training developed in the community to improve gait stability should included participants with high gait variability Background : Dual-task-based assessment tests failed to establish a dependable relationship between dual-task-related gait changes and the risk of falls in the elderly . Objective : The aim of this study was to examine whether changes in gait while counting backward could be associated with the occurrence of a  first fall among older adults . Methods : Walking while counting backward was investigated prospect ively in a cohort of 187 older adults living independently in senior housing facilities . During enrollment , walking time , number of steps , and frequency of lateral line stepping-over and stops were measured while walking only and while walking with backward counting aloud . Information on the incident falls during the follow-up year was collected monthly . Results : Walking time and the number of steps increased significantly under the dual-task condition compared to the single-task condition among fallers and non-fallers ( p < 0.001 ) . Compared to non-fallers , fallers had significantly lower scores in the Mini-Mental State Examination ( p = 0.029 ) and higher scores in the 15-item Geriatric Depression Scale ( p = 0.003 ) and Timed Up & Go Test ( p = 0.006 ) and increased walking time under both walking conditions ( p = 0.030 for single-task condition and p = 0.007 for dual-task condition ) . After adjusting for these variables , depressive symptoms ( adjusted OR = 2.6 with p = 0.041 and adjusted OR = 2.5 with p = 0.045 when walking time while walking only and walking with backward counting is considered , respectively ) and walking time while walking only ( OR = 2.3 with p = 0.032 ) were significantly associated with falls . Conclusion : Dual-task-related gait changes were poorly associated with the occurrence of a first fall and provided no additional predictive value compared to gait performance under a single task , suggesting that changes in basic clinical gait parameters while counting backward are unsuccessful to predict the first fall among older adults Background : Deficits in attention-related cognitive performance measured as dual-task performance represent early markers of dementia and are associated with motor deficits and increased risk of falling . The purpose of this study was to examine the effect of a specific dual-task training in patients with mild to moderate dementia . Methods : Sixty-one geriatric patients with confirmed dementia took part in a 12-week r and omized , controlled trial . Subjects in the intervention group ( IG ) underwent dual-task – based exercise training . The control group ( CG ) performed unspecific low-intensity exercise .  Motor performance ( gait speed , cadence , stride length , stride time , single support ) and cognitive performance ( serial 2 forward calculation [ S2 ] , serial 3 backward calculation [ S3 ] ) were examined as single and dual tasks . Decrease in performance during dual tasks compared to single task expressed as motor , cognitive , and combined motor/cognitive dual-task cost ( DTC ) was calculated before and after intervention . Primary outcome was defined as DTC for gait speed under complex S3 conditions . Results : Specific training significantly improved dual-task performance under complex S3 conditions compared to the CG ( reduction of DTC : gait speed 21.7 % IG , 2.6 % CG , p < 0.001 ; other gait variables : 8.7 % to 41.1 % IG , −0.9 % to 8.1 % CG , p ≤ 0.001 to 0.056 ; combined motor/cognitive : 20.6 % IG , 2.2 % CG , p = 0.026 ) . No significant effects were found under less challenging dual-task S2 conditions or for cognitive dual-task S3 performance . Conclusions : The specific exercise program was effective to improve dual-task performance in patients with dementia . Classification of evidence : This study provides Class II evidence that specific dual-task training  improves dual-task performance during walking under complex S3 conditions in geriatric patients with mild to moderate dementia This study examined transfer effects of fall training on fear of falling ( Falls Efficacy Scale-International [ FES-I ] ) , balance performance , and spatiotemporal gait characteristics in older adults . Eighteen community-dwelling older adults ( ages 65 - 85 ) were r and omly assigned to an intervention or control group . The intervention group completed 12 training sessions ( 60 min , 6 weeks ) . During pre- and posttesting , we measured FES-I , balance performance ( double limb , closed eyes ; single limb , open eyes ; double limb , open eyes with motor-interfered task ) , and gait parameters ( e.g. , velocity ; cadence ; stride time , stride width , and stride length ; variability of stride time and stride length ) under single- and motor-interfered tasks . Dual tasks were applied to appraise improvements of cognitive processing during balance and gait . FES-I ( p = .33 ) and postural sway did not significantly change ( 0.36 < p < .79 ) . Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task ( p = .05 , ηp 2 = .22 ) . Fall training did not sufficiently improve fear of falling , balance , or gait performance under single- or dual-task conditions in healthy older adults The present study highlights the effects of the dual-task cognitive-gait intervention ( CGI ) on working memory and gait functions in older adults with a history of falls . Thirteen older adults with a history of falls were recruited from local community centers and r and omly stratified into either the control ( n = 5 ) or experimental ( n = 8) group . The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor ( walking ) and cognitive ( memory recall ) task whereas the control group received a placebo treatment ( walking with simple music ) . The intervention was provided 30 minutes per session , over a 6-week period . Memory measures included a combination of word recall and arithmetic task . Gait function measures included velocity and center of pressure ( COP ) stability . Non-parametric tests were used at p < 0.05 . The experimental group showed a greater memory performance than the control ( p < 0.05 ) . However , no significant intervention-related changes in gait velocity and stability were observed . Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition Objective : To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy , fear of falling , gait and balance performance , and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects . Design : R and omized controlled trial , including three groups : two intervention groups ( Training , or Training+Physical activity ) and one Control group , with a 12-week follow-up . Setting : Stockholm County , Sweden . Participants : Ninety-six older adults , aged 66 - 87 , with verified osteoporosis . Interventions : A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks , and physical activity for 30 minutes , three times/week . Main measures : Fall-related self-efficacy ( Falls Efficacy Scale-International ) , fear of falling ( single-item question – ‘ In general , are you afraid of falling ? ’ ) , gait speed with and without a cognitive dual-task at preferred pace and fast walking ( GAITRite ® ) , balance performance tests ( one-leg stance , and modified figure of eight ) , and physical function ( Late-Life Function and Disability Instrument ) . Results : Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls ( p ≤ 0.034 , 4 points ) and improved their balance performance . Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task ( p=0.003 ) , at fast walking speed ( p=0.008 ) , and for advanced lower extremity physical function ( p=0.034 ) . Conclusions : This balance training program , including dual- and multi-task , improves fall-related self-efficacy , gait speed , balance performance , and physical function in older adults with osteoporosis Few studies have reported the effect of exercise intervention for improving postural control deficit in older adults at high risk of falling . We have developed a " Dual-task Switch Exercise ( DSE ) " program that focuses on gait initiation performance under the dual-task condition . The purpose of this study was to evaluate whether gait initiation performance could be improved by a specific exercise intervention .  Eighteen participants were r and omly assigned to either DSE or control groups . The DSE group received focused training to improve the ability to initiate movements quickly under the dual-task condition . The control group received steady-state walking training . After 30-min of seated training sessions , participants received 5-min individualized training sessions once a week for 24 weeks . In the pre- and post-training period , performance of the steady-state gait ( 10-m walking time ) and gait initiation ( reaction time , backward center of pressure ( COP ) displacement ) were measured under the single- and dual-task conditions . The results of a r and omized clinical trial showed that both groups showed improvement of steady-state walking time under the dual-task condition ( main effect of time ; p=0.018 ) . However , DSE was more effective in improving both the reaction time and backward COP displacement during gait initiation under the dual-task condition than control ( interaction effect of time × group ; reaction time , p=0.015 ; COP displacement , p=0.011 ) . There were no significant differences in steady-state gait and gait initiation performance under the single-task condition between pre- and post-training in both groups . Only the specific exercise intervention  improved gait initiation performance under the dual-task condition Background Home-based exercise programs can improve physical functioning and health status of elderly people . Successful implementation of exercise interventions for older people presents major challenges and supporting elderly people properly while doing their home-based exercises is essential for training success . We developed a tablet-based system — ActiveLifestyle — that offers older adults a home-based strength-balance training program with incorporated motivation strategies and support features . Objective The goal was to compare 3 different home-based training programs with respect to their effect on measures of gait quality and physical performance through planned comparisons between ( 1 ) tablet-based and brochure-based interventions , ( 2 ) individual and social motivation strategies , and ( 3 ) active and inactive participants . Methods A total of 44 autonomous-living elderly people ( mean 75 , SD 6 years ) were assigned to 3 training groups : social ( tablet guided , n=14 ) , individual ( tablet guided , n=13 ) , and brochure ( brochure guided , n=17 ) . All groups joined a 12-week progressive home-based strength-balance training program . Outcome measures were gait performance under single and dual task conditions , dual task costs of walking , falls efficacy , and physical performance as measured by the Short Physical Performance Battery ( SPPB ) . Furthermore , active ( ≥75 % program compliance ) and inactive ( < 75 % program compliance ) individuals were compared based on their characteristics and outcome measures . Results The tablet groups showed significant improvements in single and dual task walking , whereas there were no significant changes observable in the brochure group . Between-groups comparisons revealed significant differences for gait velocity ( U=138.5 ; P=.03 , r=.33 ) and cadence ( U=138.5 , P=.03 r=.34 ) during dual task walking at preferred speed in favor of the tablet groups . The brochure group had more inactive participants , but this did not reach statistical significance ( U=167 , P=.06 , r=.29 ) . The active participants outperformed the inactive participants in single and dual task walking , dual task costs of walking , and SPPB scores . Significant between-groups differences were seen between the tablet groups and the brochure group , in favor of the tablet groups . Conclusions A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program . Social or individual motivation strategies were equally effective . The most prominent differences were observed between active and inactive participants . These findings suggest that in older adults a tablet-based intervention enhances training compliance ; hence , it is an effective way to improve gait Background Mental fatigue is a psychobiological state induced by sustained periods of dem and ing cognitive activity and is characterized by feelings of tiredness which are common in everyday life . Recently , it has been hypothesized that mental fatigue might have an impact on gait performance in old adults . Therefore , the effect of mental fatigue on gait performance under single- and dual-task conditions was investigated in young and old participants . Methods Spatio-temporal gait parameters of 16 young and 16 old healthy participants were measured using a photoelectric system during single- and dual-task walking before and after a r and omly assigned mental fatigue ( performing a stop-signal task for 90 minutes ) and control intervention ( watching a video for 90 minutes ) , respectively . Changes in subjective fatigue , wakefulness , mood , arousal , and psychophysiological workload ( heart rate variability indices ) were assessed . Results Psychometric measures indicated increased subjective fatigue and arousal as well as decreased mood and wakefulness after the mental fatigue task . Heart rate variability indices revealed a higher psychophysiological workload during the mental fatigue intervention in old compared to young participants . Gait measures ( coefficient of variation of speed , stride length , and stance time ) revealed impaired dual-task walking performance following the mental fatigue intervention only in old participants . Conclusion Data indicate that mental fatigue , induced by sustained cognitive activity , can impair gait performance during dual-task walking in old adults . The susceptibility to mental fatigue could be a new intrinsic risk factor for falls in older people and should be taken into account when dual-task gait analyses are performed Background and Purpose : Participation in generally recommended aerobics or strength exercises may be challenging for older adults . Therefore , it is necessary to consider the types and levels of physical activities suited for them to improve their cognitive and gait function and adherence to exercise programs . This has prompted efforts to identify exercises that require less physical strength and frequency of performance , while still offering cognitive and health benefits . Here , we aim ed to assess the effect of a novel dual-task net-step exercise ( NSE ) performed once a week for 8 consecutive weeks on improvements in cognitive performance and gait function in an older population . Methods : In this pretest/posttest experimental case control study , 60 healthy older adults ( mean age 76.4 years ) were recruited from community-dwelling people and separated r and omly into 2 groups : a dual-task NSE group and a control group . The NSE group was asked to walk across a net without stepping on the ropes or being caught in the net . Two computer panel-type cognitive functional assessment s , the Touch-M and Touch Panel-Type Dementia Assessment Scale , were administered at baseline and after 8 weeks of intervention to determine the effects of NSE . Improvements in gait function were also evaluated using Timed Up and Go test scores . Mixed-effect models with repeated measures ( group × time ) ( analysis of variance , F test ) were used to test the effects of NSE . Adjustments were made for covariates including age and sex ( analysis of covariance ) . Results : The NSE group showed significant improvement in cognitive performance ( 6.8 % change ; total Touch-M score 5.4 points ; P = .04 ) and gait performance ( 11.5 % change ; Timed Up and Go time −0.98 second ; P < .001 ) over the 8-week period . In the control group , there was no significant improvement . Conclusions : This study shows that dual-task NSE is capable of improving cognitive and gait performance in healthy older adults . Our results indicate that NSE offers an option for a large segment of the older population who need an easier way to maintain their cognitive health and gait function Physical and cognitive training seem to counteract age-related decline in physical and mental function . Recently , the possibility of integrating cognitive dem and s into physical training has attracted attention . The purpose of this study was to evaluate the effects of twelve weeks of design ed physical-cognitive training on executive cognitive function and gait performance in older adults . Thirty-six healthy , active individuals aged 72.30 ± 5.84 years were assigned to two types of physical training with major focus on physical single task ( ST ) training ( n = 16 ) and physical-cognitive dual task ( DT ) training ( n = 20 ) , respectively . They were tested before and after the intervention for executive function ( inhibition , working memory ) through R and om Number Generation and for gait ( walking with/without negotiating hurdles ) under both single and dual task ( ST , DT ) conditions . Gait performance improved in both groups , while inhibitory performance decreased after exercise training with ST focus but tended to increase after training with physical-cognitive DT focus . Changes in inhibition performance were correlated with changes in DT walking performance with group differences as a function of motor task complexity ( with/without hurdling ) . The study supports the effectiveness of group exercise classes for older individuals to improve gait performance  , with physical-cognitive DT training selectively counteracting the age-related decline in a core executive function essential for daily living Background Reliability of quantitative gait assessment while dual-tasking ( walking while doing a secondary task such as talking ) in people with cognitive impairment is unknown . Dual-tasking gait assessment is becoming highly important for mobility research with older adults since better reflects their performance in the basic activities of daily living . Our purpose was to establish the test-retest reliability of assessing quantitative gait variables using an electronic walkway in older adults with mild cognitive impairment ( MCI ) under single and dual-task conditions . Methods The gait performance of 11 elderly individuals with MCI was evaluated using an  electronic walkway ( GAITRite ® System ) in two sessions , one week apart . Six gait parameters ( gait velocity , step length , stride length , step time , stride time , and double support time ) were assessed under two conditions : single-task ( sG : usual walking ) and dual-task ( dG : counting backwards from 100 while walking ) . Test-retest reliability was determined using intra-class correlation coefficient ( ICC ) . Gait variability was measured using coefficient of variation ( CoV ) . Results Eleven participants ( average age = 76.6 years , SD = 7.3 ) were assessed . They were high functioning ( Clinical Dementia Rating Score = 0.5 ) with a mean Mini-Mental Status Exam ( MMSE ) score of 28 ( SD = 1.56 ) , and a mean Montreal Cognitive Assessment ( MoCA ) score of 22.8 ( SD = 1.23 ) . Under dual-task conditions , mean gait velocity ( GV ) decreased significantly ( sGV = 119.11 ± 20.20 cm/s ; dGV = 110.88 ± 19.76 cm/s ; p = 0.005 ) . Additionally , under dual-task conditions , higher gait variability was found on stride time , step time , and double support time . Test-retest reliability was high ( ICC>0.85 ) for the six parameters evaluated under both conditions . Conclusion In older people with MCI  , variability of time-related gait parameters increased with dual-tasking suggesting cognitive control of gait performance . Assessment of quantitative gait variables using an electronic walkway is highly reliable under single and dual-task conditions . The presence of cognitive impairment did not preclude performance of dual-tasking in our sample supporting that this methodology can be reliably used in cognitive impaired older individuals BACKGROUND Falls occur mainly while walking or performing concurrent tasks . We determined whether a music-based multitask exercise program improves gait and balance and reduces fall risk  in elderly individuals . METHODS We conducted a 12-month r and omized controlled trial involving 134 community-dwelling individuals older than 65 years , who are at increased risk of falling . They were r and omly assigned to an intervention group ( n = 66 ) or a delayed intervention control group scheduled to start the program 6 months later ( n = 68 ) . The intervention was a 6-month multitask exercise program performed to the rhythm of piano music .  Change in gait variability under dual-task condition from baseline to 6 months was the primary end point . Secondary outcomes included changes in balance , functional performances , and fall risk . RESULTS At 6 months , there was a reduction in stride length variability ( adjusted mean difference , -1.4 % ; P < .002 ) under dual-task condition in the intervention group , compared with the delayed intervention control group . Balance and functional tests improved compared with the control group . There were fewer falls in the intervention group ( incidence rate ratio , 0.46 ; 95 % confidence interval , 0.27 - 0.79 ) and a lower risk of falling ( relative risk , 0.61 ; 95 % confidence interval , 0.39 - 0.96 ) . Similar changes occurred in the delayed intervention control group during the second 6-month period with intervention . The benefit of the intervention on gait variability persisted 6 months later . CONCLUSION In community-dwelling older people at increased risk of falling , a 6-month music-based multitask exercise program improved gait under dual-task condition , improved balance , and reduced both the rate of falls and the risk of falling . Trial Registration clinical trials.gov Identifier : NCT01107288 Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = .041 , r = .45 ) and for single support time ( U = 24 , P = .029 , r = .48 ) during the fast walking dual task condition in favor of the dance group . No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy . Conclusions There was a significant interaction in favor of the dance video game group for improvements in step time . Significant improved fast walking performance under dual task conditions ( velocity , double support time , step length ) was observed for the dance video game group only . These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program . Trial registration This trial has been registered under IS RCT N05350123 ( http://www.controlled-trials.com BACKGROUND Executive function ( EF ) deficits may increase fall risk , even among older adults with no overt cognitive impairment . Indeed , the effects of dual tasking ( DT ) on gait , a challenge to executive control , are more exaggerated in persons with a history of falls . Prospect i ve evidence is , however , lacking . METHODS We prospect ively evaluated whether EF predicts falls over a 2-year period among 262 community-living , healthy , and well-functioning older adults , focusing on the 201 who reported no falls during the previous year . At baseline , participants completed a computerized cognitive battery that generated an index of EF and other cognitive domains .  Gait was assessed using performance-based tests and by quantifying walking during single- and dual-task conditions . RESULTS The 262 participants ( mean age : 76.3 ± 4.3 years , 60.3 % women ) had intact cognitive function on testing , a low comorbidity index , and good mobility . The EF index predicted future falls . Among those who reported no previous falls , participants in the worst EF quartile were three times more likely to fall during the 2 years of follow-up , and they were more likely to transition from nonfaller to faller sooner . DT gait variability also predicted future falls and multiple falls , whereas other measures of cognitive function , gait , and mobility did not . CONCLUSIONS Among healthy older adults , individuals with poorer EF are more prone to falls . Higher-level cognitive functions such as those regulated by the frontal lobes are apparently needed for safe everyday navigation that dem and s multitasking . Optimal screening , early detection , and treatment of falls should , apparently , also target this cognitive domain OBJECTIVES To examine the association between poorer performance on concurrent walking and reaction time  and recurrent falls . DESIGN Cross-sectional analysis . SETTING Community . PARTICIPANTS Three hundred seventy-seven older community-dwelling adults ( mean age+/-st and ard deviation 78+/-3 ) . MEASUREMENTS Reaction times on  push-button and visual-spatial decision tasks  were assessed while seated and while walking a 20-m course ( straight walk ) and a 20-m course with a turn at 10 m ( turn walk ) .  Walking times were recorded while walking only and while performing a reaction-time response  . Dual-task performance was calculated as the percentage change in task times when done in dual-task versus single-task conditions . A history of recurrent falls ( > or = 2 vs < or = 1 falls ) in the prior 12 months was self-reported . Multivariate logistic regression models were used to predict the st and ardized odds ratios ( ORs ) of recurrent falls history . The st and ardized unit for dual-task performance ORs was interquartile range/2 . RESULTS On the push-button task during the turn walk , poorer reaction time response ( slower ) was associated with 28 % lower ( P=.04 ) odds of recurrent fall history . On the visual-spatial task , poorer walking-time response ( slower ) was associated with 34 % ( P=.02 ) and 42 % ( P=.01 ) higher odds of recurrent falls history on the straight and turn walks , respectively . CONCLUSION These findings suggest that walking more slowly in response to a visual-spatial decision task may identify individuals at risk for multiple falls . Prospect i ve studies are needed to confirm the prognostic value of poor walking responses in a dual-task setting for multiple falls Background Difficulty performing more than one task at a time ( dual tasking ) is a common and disabling problem experienced by people with Parkinson disease ( PD ) . If asked to perform another task when walking , people with PD often take shorter steps or walk more slowly . Currently there is uncertainty about whether clinicians should teach people with PD to avoid dual tasking or whether they should encourage them to practice dual tasking with the hope that practice will lead to enhanced performance . This study will address this issue by comparing single to dual task gait training . Methods and design A prospect i ve r and omised clinical trial is being conducted . Sixty participants with idiopathic PD will be recruited , provided they score I-IV on the modified Hoehn and Yahr ( 1967 ) scale , and fulfil other inclusion criteria . Participants will be r and omly allocated to either a single or dual task gait training group . Both groups will receive 12 hours of walking training over 4 weeks . The single task group will undertake gait training with cueing strategies to increase step length . The dual task group will train to improve step length when walking and performing a variety of added tasks . Both groups will receive a tailored home program for 6 months . Blinded assessors will conduct four assessment s : two baseline assessment s , one post intervention and one at 6 months follow-up . The primary outcome measure will be step length when dual tasking over 8 m. Secondary outcome measures include : spatiotemporal gait parameters when walking under single and dual task conditions , measures of executive function , the timed up and go test , measures of community mobility , and quality of life . All analyses will be based on intention to treat principle . Discussion This trial will examine the immediate and longer term effect of dual task walking training as compared to single task training in people with idiopathic PD , at the impairment , activity , and participation levels . It has the potential to identify a new intervention that may improve and maintain walking beyond the laboratory . The results of this trial will provide guidance for clinicians in the development of walking training programs for people with PD.Trial Registration BACKGROUND Gait abnormalities and vascular disease risk factors are associated with cognitive impairment in aging . OBJECTIVE To determine the impact of group-based exercise and dual-task training on gait and vascular health , in active community-dwelling older adults without dementia . METHODS Participants [ n=44 , mean ( SD ) age : 73.5 ( 7.2 ) years , 68 % female ] were r and omized to either  intervention ( exercise+dual-task ; EDT ) or control ( exercise only ; EO ) . Each week , for 26 weeks , both groups accumulated 50 or 75 min of aerobic exercise from group-based classes and 45 min of beginner-level square stepping exercise ( SSE ) . Participants accumulating only 50 min of aerobic exercise were instructed to participate in an additional 25 min each week outside of class . The EDT group also answered cognitively challenging questions  while performing SSE ( i.e. , dual-task training ) . The effect of the interventions on gait and vascular health was compared between groups using linear mixed effects models . RESULTS At 26 weeks , the EDT group demonstrated increased dual-task ( DT ) gait velocity [ difference between groups in mean change from baseline ( 95 % CI ) : 0.29 m/s ( 0.16 - 0.43 ) , p<0.001 ] , DT step length [ 5.72 cm ( 2.19 - 9.24 ) , p = 0.002 ] , and carotid intima-media thickness [ 0.10 mm ( 0.003 - 0.20 ) , p=0.04 ] , as well as reduced DT stride time variability [ 8.31 coefficient of variation percentage points ( -12.92 to -3.70 ) , p<0.001 ] , when compared to the EO group . CONCLUSIONS Group-based exercise combined with dual-task training can improve DT gait characteristics in active older adults without dementia OBJECTIVES To determine whether dual task-related changes in walking speed were associated with recurrent falls in frail older adults . DESIGN Twelve-month prospect i ve cohort study . SETTING Thirteen senior housing facilities . PARTICIPANTS Two hundred thirteen subjects ( mean age 84.4+/-5.5 ) . MEASUREMENTS  Usual and dual-tasking walking speeds ( m/s ) were calculated on a 10-m straight walkway at baseline . Information on incident falls during the follow-up year was collected monthly , and participants were divided into three groups based on the occurrence of falls ( 0 , 1 , and > or=2 ) . Recurrent falls were defined as two or more falls during the 12-month follow-up period . RESULTS Twenty subjects ( 9.4 % ) were classified as recurrent fallers . The occurrence of recurrent falls was associated with age ( crude odds ratio (OR)=1.11 , P=.02 ) , number of drugs ( crude OR=1.28 , P=.002 ) , and walking speed under both walking conditions ( crude OR=0.96 , P=.002 for usual walking and crude OR=0.60 , P=.005 for walking while counting backward ) . Multiple Poisson regression showed that only walking speed while  dual tasking and number of drugs were associated with incident falls ( incident rate ratio (IRR)=0.84 , P=.045 and IRR=1.10 , P=.004 ) . CONCLUSION Slower walking speed while counting backward was associated with recurrent falls , suggesting that changes in gait performance while dual tasking might be an inexpensive way of identifying frail older adults prone to falling The purpose of this study was to investigate the effects of the addition of a dual task to multicomponent training on cognition of active older adults . Eighty physically active older adults were divided into an intervention group ( IG ) and a control group ( CG ) . Both groups performed multicomponent training over 12 weeks . The IG simultaneously performed exercises and cognitive tasks . The  Mini-Mental State Examination , the Montreal Cognitive Assessment , and the Clock Drawing Test  were used for cognitive assessment s. The  Timed Up and Go Test associated with a cognitive task  was used for dual-task assessment . Significant interactions were not observed between groups in terms of the cognitive variables or the dual-task performance . An interaction was observed only for Timed Up and Go Test performance , which was better in the CG than in the IG . Active older adults showed no improvement in cognition following the addition of the dual task to the multicomponent training Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made BACKGROUND AND PURPOSE Traditionally , rehabilitation programs emphasize training balance under single-task conditions to improve balance and reduce risk for falls . The purpose of this case report is to describe 3 balance training approaches in older adults with impaired balance . CASE DESCRIPTIONS Three patients were r and omly assigned to 1 of 3 interventions : ( 1 ) single-task balance training , ( 2 ) dual-task training under a fixed-priority instructional set , and ( 3 ) dual-task training under a variable-priority instructional set . OUTCOMES The patients who received balance training under dual-task conditions showed dual-task training benefits ; these training benefits were maintained for 3 months . The patient who received variable-priority training showed improvement on novel dual tasks . DISCUSSION Older adults may be able to improve their balance under dual-task conditions only following specific types of balance training . This case report gives insight on how this intervention might be combined with more traditional physical therapy intervention Objective : To determine whether brain activity over the prefrontal cortex measured in real time during walking predicts falls in high-functioning older adults . Method : We examined166 older persons ( mean age 75 years , 51 % women ) enrolled in a prospect i ve aging study . High-functioning status defined as the absence of dementia or disability with normal gait diagnosed by study clinicians . The magnitude of task-related changes in oxygenated hemoglobin levels over the prefrontal cortex was measured with functional near-infrared spectroscopy during motor ( walking at normal pace ) and cognitive ( reciting alternate letters of the alphabet ) single tasks and a dual-task condition ( walking while reciting alternate letters of the alphabet ) . Incident falls were prospect ively assessed over a 50-month study period . Results : Over a mean follow-up of 33.9 ± 11.9 months , 116 falls occurred . Higher levels of prefrontal cortical activation during the dual-task walking condition predicted falls ( hazard ratio adjusted for age , sex , education , medical illnesses and general mental status 1.32 , 95 % confidence interval 1.03–1.70 ) . Neither behavioral outcomes ( velocity or letter rate ) on the dual task  nor brain activation patterns on the single tasks ( normal walk or talk alone ) predicted falls in this high-functioning sample . The results remained robust after accounting for multiple confounders and for cognitive status , slow gait , previous falls , and frailty . Conclusions : Prefrontal brain activity levels while performing a cognitively dem and ing walking condition predicted falls in high-functioning seniors . These findings implicate neurobiological processes early in the pathogenesis of falls Objective : To investigate whether a four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance in older adults with knee osteoarthritis . Design : A r and omized controlled trial with two groups : a walking group and a control group . Subjects : Forty older adults with knee osteoarthritis , 20 participants in each group . Intervention : The walking intervention was design ed to increase the number of steps walked daily . The walking group was instructed to increase their number of steps to 3000 steps more than before the intervention . Main outcome measures : Dual-task performance was computed by an automaticity index : the walking velocity under single-task condition/under dual-task conditions × 100 ( % ) , defined as automaticity . The nearer to 100 % automaticity , the better the dual-task performance . Decrease of the Trail Making Test ( TMT ) performance was defined as ΔTMT . ΔTMT was calculated as the difference between times ( part B – part A ) as a measure of executive function . In addition , functional ability was measured by the Japanese Knee Osteoarthritis Measure . Results : The walking group improved significantly in automaticity ( P < 0.001 , from 75.2 ( 7.6 ) to 86.9 ( 10.4 ) , ΔTMT ( P < 0.001 , from 63.4 ( 43.1 ) to 48.3 ( 29.6 ) ) and Japanese Knee Osteoarthritis Measure score ( P < 0.001 , from 54.4 to 51.9 ) compared with before the intervention , while the control group displayed no significant differences . Conclusions : We found that walking exercise improves executive function and dual-task performance OBJECTIVES To determine the effects of tai chi training on functional performance and walking with and without the addition of the performance of a cognitive task , in older adults living in supportive housing facilities . DESIGN Secondary data analysis comparing a single-blind , r and omized controlled trial of tai chi training with an attention-matched educational control intervention with crossover to tai chi . SETTING Two supportive housing facilities . PARTICIPANTS Sixty-six men and women living in supportive housing facilities entered the study , and 57 aged 87±7 completed all study procedures . INTERVENTION Interventions consisted of two 1-hour-long instructor-led group sessions per week for 12 weeks . Tai chi training consisted of movements based upon the Yang-style short form . Educational sessions consisted of lectures and discussion s of age-related health topics . MEASUREMENTS Subjects were tested for physical function ( Short Physical Performance Battery , SPPB ) , balance ( Berg Balance Scale , BBS ) , mobility ( timed up- and -go , TUG ) , and walking speed under normal and cognitive dual-task conditions . RESULTS The tai chi group exhibited greater improvement in SPPB scores ( baseline 8.1±2.9 , follow-up 9.0±2.6 ) than controls ( baseline 8.2±2.6 , follow-up 8.2±2.6 ) ( P=.005 ) . Tai chi also increased normal and dual-task walking speed ( P<.001 ) yet did not affect BBS ( P=.02 ) or TUG ( P=.02 ) after accounting for multiple comparisons . The dual-task cost ( percentage change ) to walking speed was unaffected . After the crossover tai chi intervention , the control group improved performance in the SPPB , BBS , and TUG , and increased walking speed under normal and dual-task conditions ( P=.008 ) . CONCLUSION Tai chi training may be a safe and effective therapy to help improve physical function and dual-task walking in very old adults living in supportive housing facilities Background Recent findings suggest that executive function ( EF ) plays a critical role in the regulation of gait in older adults , especially under complex and challenging conditions , and that EF deficits may , therefore , contribute to fall risk . The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up . Secondary objectives were to assess whether single and dual task walking abilities , an alternative window into EF , were associated with fall risk . Methodology /Main Results We longitudinally followed 256 community-living older adults ( age : 76.4±4.5 yrs ; 61 % women ) who were dementia free and had good mobility upon entrance into the study . At baseline , a computerized cognitive battery generated an index of EF , attention , a closely related construct , and other cognitive domains . Gait was assessed during single and dual task conditions . Falls data were collected prospect ively using monthly calendars . Negative binomial regression quantified risk ratios ( RR ) . After adjusting for age , gender and the number of falls in the year prior to the study , only the EF index ( RR : .85 ; CI : .74–.98 , p = .021 ) , the attention index ( RR : .84 ; CI : .75–.94 , p = .002 ) and dual tasking gait variability ( RR : 1.11 ; CI : 1.01–1.23 ; p = .027 ) were associated with future fall risk . Other cognitive function measures were not related to falls . Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up ( p<0.02 ) . Conclusions / Significance These findings demonstrate that among community-living older adults , the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier . The present results link falls among older adults to cognition , indicating that screening EF will likely enhance fall risk assessment , and that treatment of EF may reduce fall risk
Evidence from subgroup comparisons showed no difference in treatment-related changes between cognitive-motor and motor-motor dual tasks , or when interventions were compared to active or inactive controls .
In summary , physical exercise interventions can improve dual-task walking in older adults primarily by increasing the speed at which individuals walk in dual-task conditions .
Currently , evidence concerning whether physical exercise interventions reduce DTC or alter the self-selected dual-task strategy during unobstructed walking is greatly lacking , mainly due to the failure of studies to measure and report reciprocal dual-task effects on the non-gait task
Dual-task interference during walking can substantially limit mobility and increase the risk of  falls among community-dwelling older adults .
Previous systematic review s examining intervention effects on dual-task gait and mobility have not assessed relative dual-task costs ( DTC ) or investigated whether there are differences in treatment-related changes based on the type of dual task or the type of control group .
The purpose of this systematic review was to examine the effects of physical exercise interventions on dual-task performance during walking in older adults .