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Abstract
Background
About one-third of people older than 65 years fall at least once a year. Physical exercise has been previously demonstrated to improve gait, enhance physical fitness, and prevent falls. Nonetheless, the addition of cognitive training components may potentially increase these effects, since cognitive impairment is related to gait irregularities and fall risk. We hypothesized that simultaneous cognitive–physical training would lead to greater improvements in dual-task (DT) gait compared to exclusive physical training.
Methods
Elderly persons older than 70 years and without cognitive impairment were randomly assigned to the following groups: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Gait variables, functional fitness (Short Physical Performance Battery, 6-minute walk), and fall frequencies were assessed at baseline, after 3 months and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were carried out.
Results
Eighty-nine participants were randomized to three groups initially; 71 completed the training and 47 were available at 1-year follow-up. DANCE/MEMORY showed a significant advantage compared to PHYS in DT costs of step time variability at fast walking (P=0.044). Training-specific gait adaptations were found on comparing DANCE and MEMORY: DANCE reduced step time at fast walking (P=0.007) and MEMORY reduced gait variability in DT and DT costs at preferred walking speed (both trend P=0.062). Global linear time effects showed improved gait (P<0.05), functional fitness (P<0.05), and reduced fall frequency (−77%, P<0.001). Only single-task fast walking, gait variability at preferred walking speed, and Short Physical Performance Battery were reduced at follow-up (all P<0.05 or trend).
Conclusion
Long-term multicomponent cognitive–physical and exclusive physical training programs demonstrated similar potential to counteract age-related decline in physical functioning.
Acknowledgments
This work was supported by the Zürcher Kantonalbank within the framework of sponsoring of Movement Sciences, Sports and Nutritional Sciences at ETH Zurich. Zürcher Kantonalbank had no influence on the study design and the analyses presented in this paper, had no access to the data, and did not contribute to this manuscript in any way. The authors would like to thank PD Dr med Thomas Münzer, chief physician, and the management of Geriatrische Klinik, St Gallen, Switzerland, for supporting the study and providing room for training and data acquisition. Furthermore, we thank our postgraduate students, Marius Angst, Fabienne Hüppin, Manuela Kobelt, Alexandra Schättin, and Sara Tomovic for instructing trainings and helping with data acquisition. We very much appreciated the support of the team of physiotherapists at Geriatrische Klinik, St Gallen. Last but not least, we would like to thank all participants for their enthusiasm, kindness, and patience during our extensive training and testing interventions.
Author contributions
PE contributed to study preparation and conception, participants’ recruitment, data acquisition, statistical analysis, data interpretation, and drafting the manuscript. NT contributed to study conception, conception of serial position training, supporting statistical analysis, data interpretation, and revising manuscript. SH contributed to study preparation, training instruction, data acquisition and interpretation, and revising manuscript. VS contributed to study conception, data interpretation, and revising manuscript. EDB contributed to study conception, data interpretation, and critically revising the manuscript. All authors read and approved the final manuscript.
Disclosure
The authors report no conflicts of interest in this work.
Supplementary materials
Table S1 Multiple regression for the linear global time effect (from pretest to 6-month test, N=71) and the interaction between orthogonal contrasts and time effect for gait variable “velocity”
Table S2 Multiple regression for the linear global time effect (from pretest to 6-month test, N=71) and the interaction between orthogonal contrasts and time effect for gait variable “step length”
Table S3 Multiple regression for the linear global time effect (from pretest to 6-month test, N=71) and the interaction between orthogonal contrasts and time effect for gait variable “step length variability”
Table S4 Multiple regression for the linear global time effect (from pretest to 6-month test, N=71) and the interaction between orthogonal contrasts and time effect for gait variable “step time”
Table S5 Multiple regression for the linear global time effect (from pretest to 6-month test, N=71) and the interaction between orthogonal contrasts and time effect for gait variable “step time variability”
Table S6 Repeated-measures ANOVA from 6 months to follow-up test for gait variables, N=47
Table S7 Multiple regression for the linear global time effect (from the 6-month period before training, to training, to 6 months after training, N=66) and the interaction between orthogonal contrasts and time effect for fall frequency
Table S8 Multiple regression for the linear global time effect (from pretest to 6-month test, N=71) and the interaction between orthogonal contrasts and time effect for functional fitness variables
Table S9 Repeated-measures ANOVA from 6 months to follow-up test for SPPB variables, N=47