Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Quantitative gait analysis under dual-task in older people with mild cognitive impairment: a reliability study Mental Fatigue Increases Gait Variability During Dual-task Walking in Old Adults Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Dual-task performances can be improved in patients with dementia Does Change in Gait while Counting Backward Predict the Occurrence of a First Fall in Older Adults? Transfer effects of fall training on balance performance and spatiotemporal gait parameters in healthy community-dwelling older adults: a pilot study. 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 Physical-Cognitive Dual Task Training on Executive Function and Gait Performance in Older Adults: A Randomized Controlled Trial Evidence for motor learning in Parkinson's disease: Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: a preliminary investigation. Tai Chi Training may Reduce Dual Task Gait Variability, a Potential Mediator of Fall Risk, in Healthy Older Adults: Cross-Sectional and Randomized Trial Studies Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? Transcranial Direct Current Stimulation to Enhance Dual-Task Gait Training in Parkinson’s Disease: A Pilot RCT Executive function, memory, and gait speed decline in well-functioning older adults. Greater Fall Risk in Elderly Women Than in Men Is Associated With Increased Gait Variability During Multitasking. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews The Effects of EnhanceFitness (EF) Training on Dual-Task Walking in Older Adults Effect of a Dual-Task Net-Step Exercise on Cognitive and Gait Function in Older Adults Motor Imagery during Action Observation of Locomotor Tasks Improves Rehabilitation Outcome in Older Adults after Total Hip Arthroplasty Physical training-related changes in gait variability while single and dual tasking in older adults: magnitude of gait variability at baseline matters. Dual-task exercise improves walking ability in chronic stroke: 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
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 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 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 OBJECTIVE To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment . DESIGN A double-blind , r and omized controlled trial . SETTING University research laboratory . PARTICIPANTS Older adults ( N=23 ) with balance impairment ( mean age , 74.8y ) . They scored 52 or less on the Berg Balance Scale ( BBS )  and /or walked with a self-selected gait speed of 1.1 m/s or less . INTERVENTIONS Participants were r and omly assigned to 1 of 3 interventions : single-task training , dual-task training with fixed-priority instructions , and dual-task training with variable-priority instructions . Participants received 45-minute individualized training sessions , 3 times a week for 4 weeks . MAIN OUTCOME MEASURES Gait speed under single-task and dual-task conditions was obtained at baseline , the second week , the end of training , and the twelfth week after the end of training . Other measures , including the BBS and the Activities-specific Balance Confidence ( ABC ) Scale , were collected at baseline and after training . RESULTS Participants in all groups improved on the BBS ( P<.001 ; effect size [ES]=.72 ) , and walked significantly faster after training ( P=.02 ; ES=.27 ) . When a cognitive task was added , however , only participants who received dual-task training with fixed-priority instructions and dual-task training with variable-priority instructions exhibited significant improvements in gait speed ( P<.001 , ES=.57 ; and P<.001 , ES=.46 , respectively ) . In addition , only the dual-task training with variable-priority instructions group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up . Only the single-task training group showed a significant increase on the ABC after training ( P<.001 ; ES=.61 ) . CONCLUSIONS Dual-task training is effective in improving gait speed under dual-task conditions in elderly participants with balance impairment . Training balance under single-task conditions may not generalize to balance control during dual-task context s. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect 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 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 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 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 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 People with Parkinson 's disease ( PD ) have difficulty learning new motor skills . Evidence suggests external stimuli ( cues ) may enhance learning ; however , this may be specific to cued rather than non-cued performance . We aim ed to test effects of cued training on motor learning in PD . We defined motor learning as acquisition ( single task ) , automaticity ( dual task ) and retention of single- and dual-task performance ( follow-up ) . 153 subjects with PD received 3 weeks cued gait training as part of a r and omised trial ( the RESCUE trial ) . We measured changes in  cued gait performance  with three external rhythmical cues ( ERC ) ( auditory , visual and somatosensory ) during single and dual tasks after training and 6 weeks follow-up . Gait was tested without cues to compare specificity of learning ( transfer ) . Subjects were ' on ' medication and were cued at preferred step frequency during assessment . Accelerometers recorded gait and walking speed , step length and step frequency were determined from raw data . Data were analysed with SAS using linear regression models . Walking speed and step length significantly increased with all cues after training during both single- and dual-task gait and these effects were retained . Training effects were not specific to cued gait and were observed in dual-task step length , and walking speed however was more limited in single-task non-cued gait . These results support the use of ERC to enhance motor learning in PD as defined by increased acquisition , automaticity and retention . They also highlight the potential for sustained improvement in walking and complex task performance 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 Background Tai Chi ( TC ) exercise improves balance and reduces falls in older , health-impaired adults .  TC ’s impact on dual task ( DT ) gait parameters predictive of falls , especially in healthy active older adults , however , is unknown . Purpose To compare differences in usual and DT gait between long-term TC-expert practitioners and age-/gender-matched TC-naïve adults , and to determine the effects of short-term TC training on gait in healthy , non-sedentary older adults . Methods A cross-sectional study compared gait in healthy TC-naïve and TC-expert ( 24.5 ± 12 years experience ) older adults . TC-naïve adults then completed a 6-month , two-arm , wait-list r and omized clinical trial of TC training . Gait speed and stride time variability ( Coefficient of Variation % ) were assessed during 90 s trials of undisturbed and cognitive DT ( serial subtractions ) conditions . Results During DT , gait speed decreased ( p < 0.003 ) and stride time variability increased ( p < 0.004 ) in all groups . Cross-sectional comparisons indicated that stride time variability was lower in the TC-expert vs. TC-naïve group , significantly so during DT ( 2.11 vs. 2.55 % ; p = 0.027 ) ; by contrast , gait speed during both undisturbed and DT conditions did not differ between groups . Longitudinal analyses of TC-naïve adults r and omized to 6 months of TC training or usual care identified improvement in DT gait speed in both groups . A small improvement in DT stride time variability ( effect size = 0.2 ) was estimated with TC training , but no significant differences between groups were observed . Potentially important improvements after TC training could not be excluded in this small study . Conclusion In healthy active older adults , positive effects of short- and long-term TC were observed only under cognitively challenging DT conditions and only for stride time variability . DT stride time variability offers a potentially sensitive metric for monitoring TC ’s impact on fall risk with healthy older adults BACKGROUND Gait and cognitive disturbances are common in Parkinson 's disease ( PD ) . These deficits exacerbate fall risk and difficulties with mobility , especially during complex or dual-task walking . Traditional gait training generally fails to fully address these complex gait activities . Virtual reality ( VR ) incorporates principles of motor learning while delivering engaging and challenging training in complex environments . We hypothesized that VR may be applied to address the multifaceted deficits associated with fall risk in PD . METHODS Twenty patients received 18 sessions ( 3 per week ) of progressive intensive treadmill training with virtual obstacles ( TT + VR ) . Outcome measures included gait under usual-walking and dual-task conditions and while negotiating physical obstacles . Cognitive function and functional performance were also assessed . RESULTS Patients were 67.1 ± 6.5 years and had a mean disease duration of 9.8 ± 5.6 years . Posttraining , gait speed significantly improved during usual walking , during dual task , and while negotiating overground obstacles . Dual-task gait variability decreased ( ie , improved ) and Trail Making Test times ( parts A and B ) improved . Gains in functional performance measures and retention effects , 1 month later , were also observed . CONCLUSIONS To our knowledge , this is the first time that TT + VR has been used for gait training in PD . The results indicate that TT + VR is viable in PD and may significantly improve physical performance , gait during complex challenging conditions , and even certain aspects of cognitive function . These findings have important implication s for underst and ing motor learning in the presence of PD and for treating fall risk in PD , aging , and others who share a heightened risk of falls Objective To investigate the feasibility and safety of a combined anodal transcranial direct current stimulation ( tDCS ) and dual task gait training intervention in people with Parkinson ’s Disease ( PD ) and to provide data to support a sample size calculation for a fully powered trial should trends of effectiveness be present . Design A pilot , r and omized , double-blind , sham-controlled parallel group trial with 12 week follow-up . Setting A university physiotherapy department . Interventions Sixteen participants diagnosed with PD received nine dual task gait training sessions over 3 weeks . Participants were r and omized to receive either active or sham tDCS applied for the first 20 minutes of each session . Main Measures The primary outcome was gait speed while undertaking concurrent cognitive tasks ( word lists , counting , conversation ) . Secondary measures included step length , cadence , Timed Up and Go , bradykinesia and motor speed . Results Gait speed , step length and cadence improved in both groups , under all dual task conditions . This effect was maintained at follow-up . There was no difference between the active and sham tDCS groups . Time taken to perform the TUGwords also improved , with no difference between groups . The active tDCS group did however increase their correct cognitive response rate during the TUGwords and TUGcount . Bradykinesia improved after training in both groups . Conclusion Three weeks of dual task gait training result ed in improved gait under dual task conditions , and bradykinesia , immediately following training and at 12 weeks follow-up . The only parameter enhanced by tDCS was the number of correct responses while performing the dual task TUG . tDCS applied to M1 may not be an effective adjunct to dual task gait training in PD . Trial Registration Australia-New Zeal and Clinical Trials Registry BACKGROUND In community-dwelling older adults , global cognitive function predicts longitudinal gait speed decline . Few prospect i ve studies have evaluated whether specific executive cognitive deficits in aging may account for gait slowing over time . METHODS Multiple cognitive tasks were administered at baseline in 909 participants in the Health , Aging , and Body Composition Study Cognitive Vitality Sub study ( mean age 75.2 ± 2.8 years , 50.6 % women , 48.4 % black ) . Usual gait speed ( m/s ) over 20 minutes was assessed at baseline and over a 5-year follow-up . RESULTS Poorer performance in each cognitive task was cross-sectionally associated with slower gait independent of demographic and health characteristics . In longitudinal analyses , each 1 SD poorer performance in global function , verbal memory , and executive function was associated with 0.003 - 0.004 m/s greater gait speed decline per year ( p = .03-.05 ) after adjustment for baseline gait speed , demographic , and health characteristics . CONCLUSIONS In this well-functioning cohort , several cognitive tasks were associated with gait speed cross-sectionally and predicted longitudinal gait speed decline . These data are consistent with a shared pathology underlying cognitive and motor declines but do not suggest that specific executive cognitive deficits account for slowing of usual gait in aging OBJECTIVE As 90 % of fractures are caused by falls , and as fractures are more common in elderly women than in elderly men , a better underst and ing of potential sex differences in fall rates and underlying mechanisms is needed . The purpose of this study was to determine whether women are more prone than men to falling , and to evaluate whether the risk of falling is associated with variations in gait patterns . DESIGN , SETTING , AND PARTICIPANTS The cohort for this prospect i ve observational study consisted of 1390 community-dwelling men and women aged 70 years , examined in a health survey between July 2012 and November 2014 . MEASUREMENTS  Gait patterns  were measured using a computerized walkway system during normal-speed , fast-speed , and dual-task trials . Triaxial accelerometers were used to collect objective data on  physical activity  , and  self-reported fall data  were collected by telephone 6 and 12 months after examination . Incident low-energy falls were defined as unexpected events in which participants came to rest on the ground . RESULTS During the follow-up period , 148 study participants ( 88 women , 60 men ; P = .01 ) reported falls . After adjusting for multiple confounders , including objective measures of physical activity , socioeconomic factors , cardiovascular disease , and cognitive function , the odds ratio for falling in women was 1.49 ( 95 % confidence interval [ CI ] 1.02 - 2.19 ) . Variations in gait pattern were significantly ( 20%-40 % ) increased in fallers compared with nonfallers during the dual-task trial for step width , step length , stride length , step time , stance time , stride velocity , and single support time ( all P < .05 ) . Furthermore , women showed 15 % to 35 % increased variability in all of these gait parameters during the dual-task trial compared with men ( all P < .01 ) . CONCLUSION In the present cohort , 70-year-old women were at greater risk of falls compared with their male counterparts . This increased risk was associated with increased variation in gait pattern during dual-task activities , and may contribute to women 's greater fracture risk compared with men 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 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 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 This study aim ed at determining whether the combination of action observation and motor imagery ( AO + MI ) of locomotor tasks could positively affect rehabilitation outcome  after hip replacement surgery . Of initially 405 screened participants , 21 were r and omly split into  intervention group ( N = 10 ; mean age = 64 y ; AO + MI of locomotor tasks : 30 min/day in the hospital , then 3 × /week in their homes for two months ) and  control group ( N = 11 , mean age = 63 y , active controls ) . The functional outcomes ( Timed Up and Go , TUG ; Four Step Square Test , FSST ; and single- and dual-task gait and postural control ) were measured before ( PRE ) and 2 months after surgery ( POST ) . Significant interactions indicated better rehabilitation outcome for the intervention group as compared to the control group : at POST , the intervention group revealed faster TUG ( p = 0.042 ) , FSST ( p = 0.004 ) , and dual-task fast-paced gait speed ( p = 0.022 ) , reduced swing-time variability ( p = 0.005 ) , and enhanced cognitive performance during dual tasks while walking or balancing ( p < 0.05 ) . In contrast , no changes were observed for body sway parameters ( p ≥ 0.229 ) . These results demonstrate that AO + MI is efficient to improve motor-cognitive performance after hip surgery . Moreover , only parameters associated with locomotor activities improved whereas balance skills that were not part of the AO + MI intervention were not affected , demonstrating the specificity of training intervention . Overall , utilizing AO + MI during rehabilitation is advised , especially when physical practice is limited 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 OBJECTIVE To examine the effectiveness of a dual-task-based exercise program on walking ability in subjects with chronic stroke . DESIGN Single-blind r and omized controlled trial . SETTING General community . PARTICIPANTS Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects ( a minimum gait velocity , 58cm/s ) . INTERVENTIONS Participants were r and omized into a  control group ( n=12 ) or experimental group ( n=13 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group underwent a 4-week ball exercise program . MAIN OUTCOME MEASURES Gait performance was measured under single task ( preferred walking ) and tray-carrying task . Gait parameters of interest were walking speed , cadence , stride time , stride length , and temporal symmetry index . RESULTS The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions . In the control group , there were no significant changes over the 4-week period for all selected measures . There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions . CONCLUSIONS The dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke 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
Gait speed significantly reduced with the addition of a dual task , with increasing complexity showing greater decrements .
Cadence , stride time , and measures of gait variability were all negatively affected under the dual-task condition .
In older adults , the addition of a dual task significantly reduces gait speed and cadence , with possible implication s for the assessment of older people , as the addition of a dual task may expose deficits not observed under single-task assessment
This review examines the effect of a dual task on the gait parameters of older adults with a mean gait speed of 1.0 m/s or greater , and the effect of type and complexity of task .