Effects of Training on Fall Risk and Balance Performances

Study Overview
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Brief Summary
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Dual task training has been shown to reduce the risk of falls more than single task training. However, there have been no studies which compared the effects of single task training, dual task training and asynchronous cognitive, balance exercise training during same day on the risk of falls among healthy older individuals. Therefore, the aim of this study was to investigate differences among the effects of single task training, dual task training and exercise-cognitive activity combined training on balance and gait performances and fall risk in elderly at risk of fall.

Detailed Description
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The term dual task refers to the ability of performing 2 tasks simultaneously, for example, a cognitive and a motor task. Previous studies demonstrated that dual task training is more effective than single task training in reducing falls among elderly. These studies demonstrated that the improvements in balance and gait speed resulted in a decrease of fall frequency. Although dual task training has been shown to reduce the risk of falls more than single task training, to date, there have been no studies which compared the effects of single task training, dual task training and asynchronous cognitive, balance exercise training during same day on the risk of falls among healthy older individuals. Therefore, the aim of this study was to investigate differences among the effects of single task training, dual task training and exercise-cognitive activity combined training on balance and gait performances and fall risk in elderly at risk of fall.

Official Title
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Effects of Dual-Task Training and Exercise-Cognitive Activity Combined Training on Fall Risk and Balance Performance in Elderly at Risk of Falls: A Randomised Controlled Trial Study

Conditions
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Accidental Falls

Intervention / Treatment
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* Behavioral: Single task training
* Behavioral: dual task training
* Behavioral: exercise-cognitive activity combined training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 65 years or older literate having a fall incident during the past year ability to walk 10 meter without any support getting more than 13.5 seconds at Timed up and Go test getting less than 24 points at Standardized Mini-Mental State Examination Exclusion Criteria: neurological or musculoskeletal diagnosis such as Parkinson's or Alzheimer's disease, orthopaedic involvement or significant visual and auditory impairments

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 83 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Exercise training The volunteers were assigned to one of three interventions for 4 weeks. Group 1 performed balance and gait exercises. Group 2 performed cognitive activity simultaneously with balance and gait exercises. Group 3 performed cognitive, balance and gait activity training asynchronously at different times during the same day.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Single Task Training<br>Performed balance and gait exercises | Behavioral: Single task training<br>* The participants in single task training received 30 minutes single task balance and gait exercises, 3 times a week for 4 weeks. The program included static and dynamic balance exercises. Static balance exercises involved body stability (e.g., standing legs open and closed, standing with eyes closed, tandem standing, standing on foam surface and one leg standing, standing while throwing and catching a ball ), forward and backward weight shifting and keeping standing position while being disturbed by external perturbation. Dynamic balance exercises included tandem walking, walking to different direction (backward, side to side), transfer activities (from 1 chair to another) and sit to stand 5 times<br>|
| Experimental: Dual task training<br>Performed cognitive activity simultaneously with balance and gait exercises | Behavioral: dual task training<br>* The participants practiced 30 minutes balance and gait exercises while simultaneously performing cognitive tasks. The program included static and dynamic balance exercises. Static balance exercises involved body stability, forward and backward weight shifting and keeping standing position while being disturbed by external perturbation. Dynamic balance exercises included tandem walking, walking to different direction, transfer activities and sit to stand 5 times. The participants practiced cognitive tasks while simultaneously performing balance and gait exercises. The cognitive tasks included visual attention, auditory attention, planning, verbal fluency, simple mental math and maze activities. At each week, participants performed different type of activities which were designed to foster the executive functions: (1) Visual and auditory attention, (2) Planning and verbal fluency, (3) Simple math problems (4) Visual and auditory attention, planning, verbal fluency, math problems<br>|
| Experimental: Exercise-Cognitive Activity Combined Training<br>Performed cognitive, balance and gait activity training asynchronously at different times during the same day | Behavioral: exercise-cognitive activity combined training<br>* The participants first practiced 30 min of cognitive activities then performed 30 min of balance and gait exercises after 5 min of resting.The program included static and dynamic balance exercises. Static balance exercises involved body stability, forward and backward weight shifting and keeping standing position while being disturbed by external perturbation. Dynamic balance exercises included tandem walking, walking to different direction, transfer activities and sit to stand 5 times. The cognitive tasks included visual attention, auditory attention, planning, verbal fluency, simple mental math and maze activities. At each week, participants performed different type of activities which were designed to foster the executive functions: (1) Visual and auditory attention, (2) Planning and verbal fluency, (3) Simple math problems (4) Visual and auditory attention, planning, verbal fluency, math problems.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gait speed under single task condition | The participants walked 10 meter at their comfortable speed and the time to complete the task was recorded | 4 weeks | 
| Gait speed under dual task condition | The participants walked 10 meter while producing words which started with letter K | 4 weeks | 
| Timed Up and Go test | Timed Up and Go Test is a simple test used to measure mobility. The time required to stand up from a chair, walk 3 m to the line on the floor at a normal pace, walk back to the chair and sit down is measured (Thrane et al 2007) | 4 weeks | 
| Berg Balance Scale | The Berg Balance Scale (BBS) consists of 14 simple balance related tasks that measure the static, dynamic, and functional balance skills (Sahin et al 2008) | 4 weeks | 
| Falls Efficacy Scale | Tinetti's Falls Efficacy Scale (FES), which was used to assess fall-related self-efficacy, is a 10-questions scale (Scheffer et al 2008). | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Balance, Dual-task interference, Falls, Gait, Older Adults