Motor-cognitive dual-task training improves local dynamic stability of normal walking in older individuals

doi:10.1016/j.clinbiomech.2015.11.021

Clinical Biomechanics

Volume 32, February 2016, Pages 138-141

https://doi.org/10.1016/j.clinbiomech.2015.11.021 Get rights and content

Highlights

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Gait stability and gait variability are associated with risk of falling.
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We examined the effect of a dancing programme on gait stability/variability in old individuals.
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A dancing programme enhances gait stability more than conventional exercise.
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A dancing programme does not reduce gait variability.
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Gait stability is able to measure subtle improvements of walking performance.

Abstract

Background

Extreme levels of gait variability and local dynamic stability of walking are associated with risk of falling and reduced executive functions. However, it is not sufficiently investigated how gait variability and local dynamic stability of human walking develop in the course of a motor-cognitive intervention. As dancing implies high demands on (and therewith trains) executive functioning and motor control, it might increase local dynamic stability or reduce gait variability.

Methods

32 older healthy participants were randomly assigned to either a health-related exercise group (age: mean = 68.33 years, standard deviation = 3.17 years; BMI: mean = 27.46, standard deviation = 2.94; female/male: 10/6) or a dancing group (age: mean = 66.73 years, standard deviation = 3.33 years; BMI: mean = 26.02, standard deviation = 3.55; female/male: 11/5). Based on angular velocity data of trunk kinematics, local dynamic stability and stride-to-stride variability in level overground walking were assessed prior to and after the specific intervention. The data were analysed by a blinded observer using two-way repeated measures ANOVAs. Based on one-way ANOVAs, time and group effects were determined.

Findings

Regarding the variability of trunk movements, no interaction effect was observed (F _1,30 = 0.506, P = .482; η2 = 0.017). For local dynamic stability of trunk movements, an interaction effect in favour of the dancing group was observed (F _1,30 = 5,436; P = .026; η2 = 0.146).

Interpretation

Our data indicate that a dancing programme (which combines cognitive and motor efforts) might increase local dynamic stability in older people.

Introduction

A healthy status and motor skills go along with an optimal level of movement variability while this variability has form and a chaotic structure (Stergiou and Decker, 2011, Stergiou et al., 2006). Older healthy individuals show higher levels of walking variability than a young and healthy cohort (Buzzi et al., 2003, Hamacher et al., 2011). Many efforts were also made to identify older people at risk of falling with the aid of linear and non-linear gait variability measures. In an older population, great amounts of variability, which quantifies the magnitude of trial-to-trial variations, and low local dynamic stability (lds, indicated by high values of Lyapunov Exponents), which quantifies the system's sensitivity to extremely small perturbations (Stergiou, 2004), derived from kinematic gait data are parameters that were positively correlated with risk of falling and might therefore predict future fallers (Rispens et al., 2015, Toebes et al., 2012, van Schooten et al., 2015, Weiss et al., n.d). This, in turn, suggests that in older individuals, an increase in lds and a decrease of gait variability can be used to validate the efficacy of fall prevention programmes. To date, however, it is still unknown how different exercise programmes affect/improve these measures of gait. While most fall prevention programmes focus on physical exercise and sensorimotor training, Segev-Jacubovski et al. (2011) suggest that multimodality interventions which combine motor and cognitive training would be more effective with respect to reducing risk of falling. Also, the capability of executive functions is associated with increased gait variability (Beauchet et al., 2012) and demented people show lower magnitudes of lds (Ijmker and Lamoth, 2012). Furthermore, the risk of future falls can be predicted from the performance of executive functions and attention (Mirelman et al., 2012). Cognitive training programmes (not including any physical elements) can remediate executive functions and attention and positively affect gait speed in sedentary seniors (Verghese et al., 2010). Furthermore, pure cognitive interventions non-significantly reduce gait variability in patients with Parkinson's disease (Milman et al., 2014). Dancing, in particular, poses high demands on executive functions (updating and cognitive processing speed due to time pressure), on attentive functioning (remembering of dancing sequences) and on the sensorimotor system (Bläsing et al., 2012). Furthermore, regular participation in dancing lessons is accompanied with higher performance in cognitive functions (Kattenstroth et al., 2013). Thus, it can be inferred that dancing incorporates a cognitive element into a physical exercise programme (Pichierri et al., 2012a, Pichierri et al., 2012b) which demonstrates its motor-cognitive dual-task character. Given that dancing interventions are also reported to improve aerobic power, lower body muscle endurance, strength and flexibility, balance, agility, and gait in older individuals (Keogh et al., 2009), dancing could depict an efficient falls prevention strategy which might be superior to an intervention programme that only targets physical activity. If so, gait variability and lds in an older cohort would be improved in a higher extent by a dancing programme as compared to a pure physical exercise programme.

The participation in best practice exercise to prevent falls is relatively low (Merom et al., 2012), however, dancing seems to be a very feasible treatment, which could be easily implemented in senior centres. Therefore, the current randomized controlled trial aims to investigate whether an additional cognitive demand in an exercise intervention (6-months dancing programme), increases lds and decreases stride-to-stride variability of trunk movements in normal overground walking in older healthy individuals. It was hypothesised that the dancing intervention increases lds and decreases gait variability to a higher extent than a conventional health related exercise programme.

Section snippets

Participants

32 older healthy participants of a larger study (Hamacher et al., 2015a) were included. The subjects were randomly assigned to either a health-related exercise group (age: 68.33 (SD 3.17) years; BMI: 27.46 (SD 2.94); female/male: 10/6) or a dancing group (age: 66.73 (SD 3.33) years; BMI: 26.02 (SD 3.55); female/male: 11/5). The research protocol complied with the principles of the Declaration of Helsinki. The contents of the study were reviewed and approved by the ethical committee of Otto von

Results

We did not find any differences regarding age (P = .149) and BMI (P = .180) between groups.

Regarding the variability of trunk movements (Fig. 1), no interaction effect was observed (F 1,30 = 0.506, P = .482; η2 = 0.017). We found a main effect of time (two-way ANOVA) indicating lower variability in the post-test as compared to the pre-test (F 1,30 = 8.129, P = .008; η2 = 0.213) and a time effect (post hoc; one-way ANOVA) in the health-related exercise group, only, showing lower variability in the post-test (F

Discussion

We aimed to investigate whether a dancing intervention (physical exercise with additional cognitive load) would increase lds and reduce gait variability in normal walking to a higher extent as compared to a conventional health-related exercise training. However, as dancing affects not only motor-related parameters such as balance and posture but also improves cognitive and sensory functions (Kattenstroth et al., 2013), we assumed that gait performance would be affected to a higher extent by a

Conclusions

Our study provides first data with respect to the effect of specific training interventions on lds of walking time series. The results indicate that a training which includes physical and cognitive elements might reduce λ calculated based on kinematic trunk data in normal overground walking in older people. However, it should be evaluated in future studies 1) if dancing really reduces fall risk and 2) if lds is be a suited marker to evaluate the effectiveness of motor-cognitive intervention

Conflict of interest

None of the authors have any financial or personal relationships with other people or organizations that could have inappropriately influenced or biased the work.

Acknowledgements

None to declare.

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The relationship between the local dynamic stability of gait to cognitive and physical performance in older adults: A scoping review
2023, Gait and Posture
Local dynamic stability (LDS) has become accepted as a gait stability indicator. The deterioration of gait stability is magnified in older adults.
What is the current state in the field regarding rthe relationship between LDS and cognitive and/or physical function in older adults?
A scoping review design was used to search for peer-reviewed literature or conference proceedings published through May 2023 for an association between LDS and cognitive (e.g., Montreal Cognitive Assessment) or physical performance (e.g., Timed Up & Go Test) in older adults. Only studies investigating gait stability via LDS during controlled walking, when dealing with a subject group consisting of healthy older adults, and quantifying LDS relationship to cognitive and/or physical measure were included. We analysed data from the studies in a descriptive manner.
In total, 814 potentially relevant articles were selected, of which 15 met the inclusion criteria. We identified 37 LDS quantifiers employed in LDS-cognition and/or LDS-physical performance relationship assessment. Nine measures of cognitive and 20 measures of physical performance were analysed. Most studies estimated LDS quantities using triaxial acceleration data. However, there was a variance in sensor placement and signal direction. Out of the 56 studied relationships of LDS to physical performance measures, sixteen were found to be relevant. Out of 22 studied relationships between LDS and cognitive measures, only two were worthwhile.
Considering the heterogeneity of the utilized LDS (caused by different sensors locations, signals, and signal directions as well as variety of computational approaches to estimate LDS) and cognitive/physical measures, the results of this scoping review does not indicate a current need for a systematic review with meta-analysis. To assess the overall utility of LDS to reveal a relationship between LDS to cognitive and physical performance measures, an analysis of other subject groups would be appropriate.
The effect of rhythmic movement on physical and cognitive functions among cognitively healthy older adults: A systematic review and meta-analysis
2023, Archives of Gerontology and Geriatrics
To explore the effects of rhythmic movement interventions on the physical and cognitive functions among cognitively healthy older adults.
We searched PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, CBM, Wanfang Data, and VIP databases from inception to March 30, 2022. The inclusion criteria were: ① randomized controlled trials (RCTs); ② older adults (aged ≥ 60 years) without cognitive impairments or neurological or neurodegenerative diseases; ③ intervention: rhythmic movement (rhythmic exercise or physical activities performed to music); ④ outcomes: physical or cognitive function. Overall, 44 RCTs across 20 countries (n = 2752 participants) were included.
An association was found between rhythmic movement and improved physical function (mobility, cardiopulmonary endurance, muscle strength, flexibility, and balance), global cognitive function, and quality of life (QOL). The physical function outcomes suggested additional significant benefits when using control groups with no exercise than when using control groups with exercise. No significant improvement was found in executive function.
Regular rhythmic movement likely improves physical function, global cognitive function, and QOL in healthy older adults. The effect of rhythmic movement on the physical function in older adults is similar to that of routine exercise. Further studies on cognitive function of healthy older adults using larger samples of populations with more balanced sex ratios with long-term follow-up are particularly encouraged.
Effects of a 10-week multimodal dance and art intervention program leading to a public performance in persons with multiple sclerosis - A controlled pilot-trial
2020, Multiple Sclerosis and Related Disorders
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Partnered dance therapies have been studied among the elderly population and people with neurological disorders such as Parkinson disease. It can be stated that dancing is multi-model as it has characteristics of a motor, cognitive, and motor-cognitive dual task training (Hamacher et al., 2015; Hamacher et al., 2016). Indeed, regular participation in dance classes results in higher cognitive, motor and sensory functions in older individuals (Kattenstroth et al., 2013) and neurological conditions (Zhang Q et al., 2019; Patterson et al., 2018; Scheidler et al., 2018; Ng A et al., 2019; Mandelbaum et al., 2016).
: Dance therapy is increasingly reported in neurological diseases for improving several motor and cognitive functions, but was mostly studied in partner dance. No individual choreo-based dance program has ever been reported in MS.
: The aim of this pilot study is to investigate effects of a ten-week choreo-based dance intervention on different impairments in MS.
: Seventeen participants with MS were allocated to a dance group (DG) or an art group (AG) for a ten-week intervention program, with a public live performance at the end of the intervention.
: The DG received choreo-based dance courses twice a week for 90 min, while the active control AG weekly contributed to the production by painting, music, spoken word and photo- or videography. Measurements for fatigue and fatigability, physical capacity and coordination, sensory function, cognitive capacity, quality of life and dual task performance took place before and after the intervention. Differences were analysed with Wilcoxon Signed Rank test.
: Both groups improved significantly on executive cognitive performance during dual task and fatigue. Only the DG improved significantly on functional lower limb strength, hand function, coordination, self-reported balance and walking, and showed a trend towards improving on cognition (PASAT). The AG showed significant improvements in on cognitive function (SDMT).
: A ten-week multimodal dance intervention has positive effects on impact of fatigue, physical capacity and coordination, and cognitive performance during a dual task. Larger samples, follow-up measurements and research in different disability groups is recommended.
Head orientation and gait stability in young adults, dancers and older adults
2020, Gait and Posture
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This suggests that the gait stability in dancers might be less affected by changes in head orientation than in non-trained controls and that dance training could help to improve treatment for chronic dizziness. A 6-months dance training was shown to increase local dynamic stability in older adults [22]. If interactions of head movement and orientation with age and dance training are confirmed, our results would indicate the potential of dance training to counter age-related problems to maintain gait stability with constrained head orientation or while moving the head.
Control of body orientation requires head motion detection by the vestibular system and small changes with respect to the gravitational acceleration vector could cause destabilization.
We aimed to compare the effects of different head orientations on gait stability in young adults, dancers and older adults.
Three groups of 10 subjects were evaluated, the first composed of young adults (aged 18–30 years), the second composed of young healthy dancers under high performance dance training (aged 18–30 years), and the third group composed of community-dwelling older adults (aged 65–80 years). Participants walked on a treadmill at their preferred speed in four distinct head orientation conditions for four minutes each: control (neutral orientation); dynamic yaw (following a target over 45° bilaterally); up (15° neck extension), and down (40° neck flexion). Foot and trunk kinematic data were acquired using a 3D motion capture system and the gait pattern was assessed by basic gait parameters (step length, stride width and corresponding variability) and gait stability (local divergence exponents and margins of stability). Main effects of conditions and groups, as well as their interaction effects, were evaluated by repeated-measures analysis of variance.
Interactions of group and head orientation were found for both step length and stride width variability; main effects of head orientation were found for all evaluated parameters and main effects of group were found for step length and its variability and local divergence exponents in all directions.
As expected, the older adults group showed less stable gait (higher local divergence exponent), the shortest step length and greater step length variability. However, contrary to expectation, the dancers were not more stable. The yaw condition was the most challenging for all groups and the down condition seemed to be least challenging.
Gait speed is more challenging than cognitive load on the stride-to-stride variability in individuals with anterior cruciate ligament deficiency
2019, Knee
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Understanding the role of dual-tasking and gait speed on gait variability could present insights into enhancing treatment efficacy. Previous studies have demonstrated that intervention may restore gait variability, which could be effective in minimizing the risk of falling [18]. However, using higher gait speeds as well as dual-tasking in ACL-deficient patients might present a suitable therapy to affect gait variability.
Several investigations have studied gait variability of individuals with anterior cruciate ligament (ACL) deficiency; however, the effect of dual-tasking on the gait variability of these individuals remained unclear. The aim of the present study was to determine the effect of gait speed and dual-tasking on knee flexion–extension variability in subjects with and without ACL deficiency.
The knee flexion–extension Lyapunov exponent (LyE) was measured in 22 ACL-deficient (Mean±SD) (25.95 ± 4.69 years) and 22 healthy subjects (24.18 ± 3.32 years). They walked at three levels of gait speed in isolation or concurrently with a cognitive task.
Repeated-measure analyses of variance (ANOVAs) demonstrated that the interaction of group by gait speed was statistically significant. As the gait speed increased from low to high, the knee flexion–extension LyE significantly decreased for the subjects with ACL deficiency (effect size: 0.57, P = 0.01). The interaction of group by cognitive load was not statistically significant (P = 0.07). In addition, the ACL-deficient subjects had statistically slower reaction times than healthy subjects during the dual-task compared with the single-task condition.
The ACL-deficient and healthy individuals had a tendency to maintain safe gait. It seems that the ACL-deficient subjects sacrificed the cognitive task more than the healthy individuals to pay more attention toward gait. Additionally, it seems that the gait speed was more challenging than cognitive load on the stride-to-stride variability in the individuals with ACL deficiency.
Development of functional variability during the motor learning process of a complex cyclic movement
2018, Journal of Biomechanics
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This active trunk control is also discussed to improve visual and vestibular functioning (Pozzo et al., 1990; Prince et al., 1994). Thus, to analyse stability, trunk kinematics are frequently used (e.g. Bruijn et al., 2013; Hamacher et al., 2016a; Tamburini et al., 2018). Based on these findings on upright locomotion, the stabilization of the upper trunk is a parameter that is controlled with high priority.
Traditionally, movement variability is considered an indicator for sensorimotor malfunctioning. However, functional movement variability is also a result of compensation mechanisms e.g. to account for prior movement deviations and is, therefore, crucial for stable movements. The aim of this study was to analyze functional variability during motor learning of a complex cyclic task.
Thirteen young participants practised riding a Pedalo® slalom until they were able to complete the task without errors. Since trunk movements are controlled with high priority, we analyzed trunk kinematics as a result parameter. Since lower extremities affect the result parameter, foot, thigh and pelvis kinematics are considered execution parameters. The movement variability for result and execution parameters was determined for the first (poor performance), an intermediate (medium performance) and the last (good performance) training sessions. Furthermore, the variability ratio (execution/result parameter) was calculated as a measure of functional variability.
Movement variability of the result parameter decreased significantly with increasing expertise. In contrast, movement variability of all execution parameters increased significantly from measurements representing poor to medium performance. No change from medium to good performance was found. Functional variability increased over time in all execution parameters.
Since the movement variability of all execution parameters did not decrease with increasing Pedalo performance, applying a traditional interpretation approach of movement variability would have led to completely wrong conclusions. Possible mechanisms explaining the increased movement variability are discussed. The variability ratio seems to be the only parameter that can reveal improved sensorimotor functioning during all analyzed stages of motor learning.

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