The online version of this article (doi:10.1186/1471-2318-14-134) contains supplementary material, which is available to authorized users.
Eva van het Reve and Eling D de Bruin contributed equally to this work.
The authors declare that they have no competing interests.
EVHR participated in the conception and the design, drafted the manuscript, participated in the critical revision of the manuscript for its content and approved the final version. EDDB participated in the conception and the design, drafted the manuscript, participated in the critical revision of the manuscript for its content and approved the final version. Both authors read and approved the final manuscript.
Exercise interventions often do not combine physical and cognitive training. However, this combination is assumed to be more beneficial in improving walking and cognitive functioning compared to isolated cognitive or physical training.
A multicenter parallel randomized controlled trial was conducted to compare a motor to a cognitive-motor exercise program. A total of 182 eligible residents of homes-for-the-aged (n = 159) or elderly living in the vicinity of the homes (n = 23) were randomly assigned to either strength-balance (SB) or strength-balance-cognitive (SBC) training. Both groups conducted similar strength-balance training during 12 weeks. SBC additionally absolved computerized cognitive training. Outcomes were dual task costs of walking, physical performance, simple reaction time, executive functions, divided attention, fear of falling and fall rate. Participants were analysed with an intention to treat approach.
The 182 participants (mean age ± SD: 81.5 ± 7.3 years) were allocated to either SB (n = 98) or SBC (n = 84). The attrition rate was 14.3%. Interaction effects were observed for dual task costs of step length (preferred walking speed: F(1,174) = 4.94, p = 0.028, η2 = 0.027, fast walking speed: F(1,166) = 6.14, p = 0.009, η2 = 0.040) and dual task costs of the standard deviation of step length (F(1,166) = 6.14, p = 0.014, η2 = 0.036), in favor of SBC. Significant interactions in favor of SBC revealed for in gait initiation (F(1,166) = 9.16, p = 0.003, η2 = 0.052), ‘reaction time’ (F(1,180) = 5.243, p = 0.023, η2 = 0.028) & ‘missed answers’ (F(1,180) = 11.839, p = 0.001, η2 = 0.062) as part of the test for divided attention. Within-group comparison revealed significant improvements in dual task costs of walking (preferred speed; velocity (p = 0.002), step time (p = 0.018), step length (p = 0.028), fast speed; velocity (p < 0.001), step time (p = 0.035), step length (p = 0.001)), simple reaction time (p < 0.001), executive functioning (Trail making test B; p < 0.001), divided attention (p < 0.001), fear of falling (p < 0.001), and fall rate (p < 0.001).
Combining strength-balance training with specific cognitive training has a positive additional effect on dual task costs of walking, gait initiation, and divided attention. The findings further confirm previous research showing that strength-balance training improves executive functions and reduces falls.
This trial has been registered under ISRCTN75134517
Additional file 1: Sensitivity analysis for dual task costs of walking. Dual task costs of walking of SB and SBC from pre- to post-test, between-groups differences and interaction effects for the intention to treat analysis. All outliers are included. The participants that were reallocated from the SBC to the SB group (due to vision problems) are analysed as participants from SBC group (as initially allocated). (DOCX 16 KB)
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- Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial
Eva van het Reve
Eling D de Bruin
- BioMed Central
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