The effect of a cognitive-motor intervention on voluntary step execution under single and dual task conditions in older adults: a randomized controlled pilot study

Figures & data

Figure 1 Dance video game: (A) participant on the dance pad secured by ropes fixed on the ceiling; (B–D) screenshots of the dance video game.

Table 1 Physical activities of the control group during intervention

Participant	Activity	Duration (minutes)/ frequency
1	Walking	30–60/daily
	Social dancing	120/weekly
2	Walking	60/daily
	Exercise program at care home*	45/irregularly
3	Walking	90/weekly
	Exercise program at care home*	45/irregularly
4	Walking	45/daily
	Aqua gym	45/weekly
5	Walking	90/daily
	Exercise program at care home*	45/weekly
6	No activities	–

Notes:

* Exercise program at the care home: Exercise is conducted seated or/and in a standing position. Trained factors are flexibility, coordination of movements, strength, endurance, fine and gross motor skills, posture and memory.

Figure 2 Voluntary step execution test: (A) participant standing on the force platform and executing a backward step after tap cue on the heel by the supervisor; (B) example of force platform data for a single step to determine the occurrence of the step parameters.

Abbreviations: COPx, mediolateral deviation of body’s center of pressure in millimeters; Fy, anteroposterior ground force in Newton; Fz, vertical ground force in Newton.

Table 2 Demographic baseline data of participants

Group	Intervention group	Control group
No of participants	9	6
Age (mean, SD)	83.6, 3.4	86.2, 4.8
Sex (female/male)	6/3	3/3
Height in cm (mean, SD)	160.3, 9.9	160.9, 9.4
Weight in kg (mean, SD)	68.0, 17.5	65.5, 9.4
Mini-mental statusa (median, range)	28, 27–30	25.2, 22–29
Walking assistance
None/cane or crutches	5/4	5/1
Number of falls in the last 6 monthsb
None	7	4
One	1	1
>One	1	1
Diabetes	0	1
Hypertension	2	3
Cardiac insufficiency	3	1
Arthropathy	5	1
Osteoporosis	4	2

Notes:

a Minimum score = 0, maximum score = 30 (higher scores indicate better functioning);

b a fall was defined as an event, which results in a person coming to rest on the ground or other lower level.³³

Abbreviation: SD, standard deviation.

Figure 3 The study flow chart.

Table 3 Temporal data in seconds and statistical evaluation of the voluntary step execution test

Temporal parameters	Intervention group (n = 9)			Control group (n = 6)
	Pre	Post	Pinner	Pre	Post	Pinner	Pbetween	r
Initiation
Forward ST	0.162 (0.144; 0.253)	0.163 (0.143; 0.186)	0.260	0.190 (0.174; 0.213)	0.180 (0.166; 0.194)	0.249	0.906	0.03
Forward DT	0.301 (0.269; 0.496)	0.265 (0.195; 0.404)	0.051°	0.259 (0.196; 0.335)	0.291 (0.247; 0.355)	0.600	0.034+	0.55″
Backward ST	0.197 (0.144; 0.208)	0.168 (0.138; 0.201)	0.066°	0.175 (0.174; 0.190)	0.170 (0.149; 0.185)	0.345	0.637	0.12
Backward DT	0.273 (0.219; 0.392)	0.265 (0.204; 0.323)	0.110	0.241 (0.214; 0.363)	0.248 (0.209; 0.359)	0.600	0.289	0.27
Sideway ST	0.179 (0.148; 0.197)	0.161 (0.147; 0.181)	0.173	0.187 (0.171; 0.198)	0.195 (0.173; 0.212)	0.463	0.289	0.27
Sideway DT	0.272 (0.192; 0.360)	0.261 (0.244; 0.282)	0.374	0.259 (0.205; 0.410)	0.278 (0.211; 0.413)	0.753	0.480	0.18
Foot off
Forward ST	0.489 (0.438; 0.986)	0.437 (0.391; 0.618)	0.015*	0.602 (0.505; 0.777)	0.611 (0.483; 0.744)	0.345	0.239	0.30
Forward DT	0.716 (0.652; 0.879)	0.603 (0.530; 0.776)	0.028*	0.897 (0.586; 0.934)	0.709 (0.614; 0.890)	0.345	0.346	0.24
Backward ST	0.538 (0.409; 0.838)	0.445 (0.387; 0.605)	0.028*	0.629 (0.588; 0.661)	0.577 (0.487; 0.632)	0.345	0.724	0.09
Backward DT	0.723 (0.570; 1.155)	0.644 (0.556; 0.800)	0.066°	0.782 (0.583; 0.847)	0.683 (0.575; 0.830)	0.917	0.157	0.37′
Sideway ST	0.431 (0.298; 0.645)	0.338 (0.289; 0.541)	0.051°	0.461 (0.396; 0.545)	0.468 (0.406; 0.522)	0.917	0.239	0.30′
Sideway DT	0.615 (0.492; 0.879)	0.560 (0.506; 0.631)	0.260	0.733 (0.465; 0.852)	0.612 (0.504; 0.717)	0.249	1.000	0.00
Foot contact
Forward ST	0.836 (0.674; 1.576)	0.676 (0.627; 1.057)	0.015*	0.906 (0.813; 1.122)	0.975 (0.717; 1.151)	0.600	0.157	0.37′
Forward DT	1.163 (0.890; 1.245)	0.799 (0.765; 1.256)	0.028*	1.231 (0.899; 1.296)	0.989 (0.906; 1.195)	0.345	0.346	0.24
Backward ST	0.782 (0.662; 1.246)	0.738 (0.641; 1.056)	0.066°	0.966 (0.727; 1.083)	0.894 (0.789; 1.110)	0.917	0.480	0.18
Backward DT	1.045 (0.925; 1.523)	0.918 (0.843; 1.158)	0.086°	1.096 (0.876; 1.307)	1.113 (0.984; 1.360)	0.116	0.045+	0.52″
Sideway ST	0.941 (0.510; 1.110)	0.619 (0.497; 0.911)	0.051°	0.820 (0.743; 0.901)	0.767 (0.588; 0.961)	0.917	0.556	0.15
Sideway DT	0.883 (0.685; 1.344)	0.989 (0.760; 1.058)	0.859	1.039 (0.786; 1.313)	0.991 (0.780; 1.101)	0.463	0.906	0.03

Notes: Values are in seconds and displayed as group medians with interquartile ranges (q1; q3) due to non-normal distribution of data.

* Significant inner-group differences pre-post (P_inner ≤ 0.05) calculated with Wilcoxon signed rank test;

°trend to significance (P_inner ≤ 0.10);

+ significant between-group differences after intervention phase (P_between ≤ 0.05) calculated with Mann-Whitney U-test.

Abbreviations: P_between, P-value for between-groups comparison; P_inner, P-value for inner-group comparison; DT, dual task; r, effect size (r = 0.1: small effect, ′r = 0.3: medium effect, ″r = 0.5: large effect); ST, single task.

The Kellogg International Work Group on the Prevention of Falls by the ElderlyThe prevention of falls in later life. A reportDanish medical bulletin198734Suppl 4124

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