Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up

Figures & data

Table 1 Description of training contents according to the FITT principles

Frequency	Intensity	Time	Type
Two sessions of 1 hour/wk (26 weeks)	Moderate to vigorous (RPE 5–7 points on ten-point Borg-scale)	20 min	Aerobic endurance with (DANCE, MEMORY) or without (PHYS) cognitive-motor coordination aspect: DANCE: virtual reality video game dancing. 2–3 min/game/song, 1–2 min rest periods only if required or MEMORY: continuous flat or inclined treadmill walking with simultaneous verbal memory training or PHYS: continuous flat or inclined treadmill walking (or running)
		20 min	Muscular strength (complement to each intervention): Examples of lower body exercises: seated leg extensions with 2 kg ankle weights, chair rises, split leg squats, calf raises (all with or without 5–10 kg weight vest), standing toe raises; two exercises per session Examples of upper-body exercises: standing arm row, biceps curls (both with resistive rubber bands), standing wall push-ups. knee push-ups; 1–2 exercises per session Examples of trunk stabilization exercises: incline seated single-leg raises, crunches, front plank; 1–2 exercises per session One to three sets with eight to 12 repetitions, progressing from slow to fast movement speed, ~1 min rest between sets
		20 min	Balance (complement to each intervention): Examples: tandem stand, two-leg stand on foam pad, walking over a skipping rope on the floor, single-leg stand on air pad, single-leg stand with eyes closed Two to four sets of four to five different exercises per session, 20–60 s per exercise, ~30–60 s rest

Notes: Training programs were created based on current recommendations for physical fitness and fall prevention for the elderly persons. Data from Sherrington et al,¹² Granacher et al,³³ and Nelson et al.⁶³

Abbreviations: DANCE, virtual reality video game dancing; FITT, frequency, intensity, time, and type of exercise; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; RPE, rate of perceived exertion.

Figure 1 Simultaneous cognitive–physical training components: video game dancing (A) and treadmill memory training (B).

Notes: In (A), two participants perform steps on a pressure sensitive platform to the rhythm of the music. Step timing and direction are cued with arrows on a screen. In (B), a participant is walking on a treadmill while performing verbal memory exercises presented on a computer screen.

Figure 2 Examples of complementary balance (A) and strength (B) exercises.

Notes: The participant in (A) steps from one object to the next, trying to maintain balance under assistance of an instructor (objects are soft rubber “stones”, skipping ropes, and balance pads). (B) Shows one participant performing chair rises (squats) and another participant holding the “plank” position for global trunk stability, which was an exercise for the elderly with higher fitness level.

Table 2 Baseline demographic characteristics and training compliance

Variable	DANCE	MEMORY	PHYS	P-value, two tailed
N	24	22	25
Sex, female	14, 58.3%	16, 72.7%	16, 64.0%	0.602
Age, years	77.3 (6.3)	78.5 (5.1)	80.8 (4.7)	0.079t
Height, cm	165.1 (7.7)	163.9 (8.5)	162.0 (8.9)	0.425
Weight, kg	75.8 (12.3)	73.6 (9.4)	69.5 (14.1)	0.198
BMI, kg/m^2	23.0 (3.6)	22.4 (2.2)	21.4 (3.9)	0.259
MMSE, score	28.4 (1.4)	28.3 (1.2)	28.0 (1.7)	0.533
Total training compliance	84.3% (12.7%)	86.1% (9.1%)	87.1% (7.9%)	0.633
(52 sessions)
Home-training compliance	79.9% (23.0%)	90.0% (14.8%)	83.5% (18.4%)	0.201
(eight sessions)

Notes: Data are means (± standard deviations in brackets) or numbers. Bold values indicate significance or trend.

t P<0.10 trend.

Abbreviations: BMI, body mass index; DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; MMSE, Mini-Mental State Examination; PHYS, treadmill walking.

Figure 3 Trial design and participants’ flow.

Notes: Participants were randomly assigned to one of the two multicomponent simultaneous cognitive–physical training groups (DANCE and MEMORY) or an exclusive physical exercise group (PHYS) and were trained over 6 months twice weekly for 1 hour. Gait variables, functional fitness, and fall frequency were assessed at pretest, 3-month and 6-month test, and at 1-year follow-up (except 6-MWT not repeated at follow-up). Fall frequency was additionally assessed 6 months after training.
Abbreviations: DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; 6-MWT, 6-minute walk test.

Table 3 Gait performance data

Variable	Condition	DANCE (N = 24, follow-up N =15)								MEMORY (N= 22, follow-up N =17)								PHYS (N =25, follow-up N =15)
		Pretest		3-month test		6-month test		Follow-up		Pretest		3-month test		6-month test		Follow-up		Pretest		3-month test		6-month test		Follow-up
		Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE
Velocity (cm/s)	Pref-ST	123.0	5.3	127.1	4.3	133.4	5.2	130.0	8.6	109.4	3.8	122.8	5.5	126.3	5.4	127.5	5.9	115.8	5.4	128.8	5.3	131.1	4.7	127.5	7.5
	Pref-DT	113.8	6.0	123.0	5.5	124.7	7.0	129.1	8.3	102.1	5.9	107.6	6.9	117.0	6.0	126.3	6.6	100.4	5.6	110.3	6.1	115.3	6.1	117.1	9.1
	Pref-DTC	−8%	3%	−4%	2%	−7%	3%	0%	3%	−6%	5%	−13%	4%	−7%	2%	−1%	3%	−13%	3%	−14%	3%	−12%	3%	−8%	4%
	Fast-ST	157.3	7.2	168.7	6.7	179.0	7.1	161.3	10.7	156.3	5.1	167.7	7.3	168.8	6.8	166.7	8.4	151.9	5.5	162.7	6.9	169.5	6.1	167.1	9.5
	Fast-DT	130.5	5.9	137.6	8.6	144.8	7.2	143.3	10.7	125.5	6.0	128.7	6.9	139.9	6.7	143.1	7.7	115.6	6.3	122.9	6.1	134.2	5.5	135.0	8.9
	Fast-DTC	−16%	2%	−20%	4%	−19%	2%	−11%	2%	−20%	3%	−23%	3%	−17%	2%	−14%	2%	−24%	3%	−24%	2%	−20%	2%	−18%	5%
Step length (cm)	Pref-ST	65.3	2.1	66.3	1.8	67.4	1.9	65.8	3.1	62.0	1.8	64.9	2.4	66.2	2.3	66.4	2.7	62.1	1.9	66.2	1.7	66.0	1.6	66.7	2.3
	Pref-DT	63.5	1.8	64.9	1.9	65.8	2.0	65.4	2.8	60.5	2.4	60.9	2.8	64.7	2.6	66.2	2.7	59.2	1.9	63.4	2.0	64.5	2.0	65.8	2.9
	Pref-DTC	−2%	2%	−2%	1%	−2%	1%	0%	2%	−3%	2%	−6%	2%	−2%	1%	0%	2%	−5%	1%	−4%	2%	−2%	1%	−2%	2%
	Fast-ST	72.5	2.7	74.3	2.4	74.8	2.2	70.6	3.6	71.9	2.3	73.4	2.7	75.0	2.7	73.6	2.8	69.2	1.9	71.9	2.2	73.0	2.2	73.4	2.7
	Fast-DT	67.2	2.1	69.2	2.2	69.9	2.3	68.0	3.3	67.1	2.4	66.6	2.8	69.9	2.7	69.9	2.9	63.7	1.9	66.0	2.1	68.5	1.9	70.2	2.6
	Fast-DTC	−7%	1%	−7%	1%	−7%	1%	−3%	1%	−7%	2%	−9%	2%	−7%	2%	−5%	1%	−8%	1%	−8%	1%	−6%	1%	−4%	3%
Step length variability (cm)	Pref-ST	3.0	0.2	2.7	0.2	2.2	0.2	2.5	0.2	3.3	0.3	2.6	0.2	2.4	0.1	2.5	0.2	3.0	0.2	2.2	0.1	2.4	0.2	2.7	0.3
	Pref-DT	3.4	0.2	3.1	0.2	3.2	0.3	2.9	0.1	4.2	0.5	3.5	0.4	3.1	0.2	3.3	0.5	3.3	0.3	3.2	0.3	2.7	0.2	2.8	0.3
	Pref-DTC	27%	11%	24%	14%	57%	15%	35%	16%	44%	23%	40%	14%	35%	9%	41%	18%	17%	11%	51%	14%	36%	16%	16%	15%
	Fast-ST	3.2	0.2	2.5	0.2	2.8	0.2	2.5	0.3	3.2	0.3	2.6	0.2	2.8	0.2	2.6	0.2	2.8	0.2	2.5	0.2	2.7	0.2	2.6	0.3
	Fast-DT	3.2	0.2	3.5	0.3	3.4	0.3	3.2	0.2	3.9	0.4	3.3	0.3	3.5	0.3	3.3	0.3	3.8	0.2	3.1	0.2	3.4	0.3	3.1	0.4
	Fast-DTC	12%	9%	64%	22%	30%	13%	44%	15%	33%	13%	34%	11%	31%	14%	28%	10%	52%	12%	44%	14%	38%	16%	34%	18%
Step time (s)	Pref-ST	0.53	0.01	0.52	0.01	0.51	0.01	0.51	0.01	0.57	0.01	0.54	0.01	0.54	0.01	0.53	0.01	0.56	0.02	0.54	0.02	0.51	0.01	0.54	0.02
	Pref-DT	0.58	0.03	0.54	0.01	0.57	0.04	0.52	0.02	0.62	0.02	0.60	0.03	0.57	0.01	0.53	0.01	0.62	0.03	0.60	0.03	0.58	0.02	0.58	0.03
	Pref-DTC	7%	4%	3%	2%	10%	6%	0%	2%	8%	4%	10%	3%	6%	2%	1%	2%	12%	4%	13%	4%	14%	4%	8%	4%
	Fast-ST	0.46	0.01	0.45	0.01	0.42	0.01	0.44	0.01	0.47	0.01	0.45	0.01	0.45	0.01	0.44	0.01	0.46	0.01	0.45	0.01	0.44	0.01	0.45	0.01
	Fast-DT	0.52	0.02	0.49	0.02	0.49	0.02	0.48	0.02	0.54	0.01	0.53	0.02	0.51	0.01	0.49	0.01	0.55	0.01	0.55	0.02	0.52	0.01	0.55	0.02
	Fast-DTC	13%	2%	11%	2%	17%	3%	8%	2%	17%	4%	20%	3%	14%	2%	12%	2%	19%	3%	23%	4%	19%	3%	21%	5%
Step time variability (s)	Pref-ST	0.03	0.00	0.02	0.00	0.02	0.00	0.03	0.01	0.03	0.00	0.02	0.00	0.02	0.00	0.03	0.01	0.03	0.00	0.02	0.00	0.02	0.00	0.03	0.01
	Pref-DT	0.04	0.01	0.03	0.00	0.03	0.01	0.03	0.01	0.05	0.01	0.04	0.01	0.03	0.01	0.03	0.00	0.05	0.01	0.05	0.01	0.04	0.01	0.05	0.01
	Pref-DTC	52%	19%	64%	25%	113%	39%	48%	21%	88%	28%	92%	25%	64%	25%	38%	20%	78%	27%	138%	38%	145%	46%	169%	71%
	Fast-ST	0.03	0.01	0.02	0.00	0.02	0.00	0.02	0.01	0.02	0.00	0.02	0.00	0.02	0.00	0.03	0.01	0.03	0.00	0.02	0.00	0.02	0.00	0.03	0.01
	Fast-DT	0.03	0.00	0.03	0.00	0.03	0.00	0.04	0.01	0.04	0.01	0.04	0.01	0.03	0.00	0.02	0.00	0.03	0.00	0.04	0.01	0.03	0.00	0.04	0.01
	Fast-DTC	34%	15%	90%	17%	70%	19%	153%	61%	119%	42%	121%	39%	83%	29%	30%	29%	42%	11%	139%	45%	117%	31%	98%	57%

Abbreviations: DANCE, virtual reality video game dancing; DT, dual-task; DTC, dual-task cost; fast, fast walking speed; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; pref, preferred walking speed; SE, ± standard error; ST, single-task.

Figure 4 Development of the gait variables that showed time × intervention contrasts from pretest to 6-month test.

Notes: (A) Depicts a significant first contrast with unchanged DTC in the two cognitive–physical interventions (DANCE and MEMORY) due to parallel improvements in ST and DT and rising DTC in PHYS due to improvement in ST and no change in DT (P=0.044, one tailed). (B–D) Illustrate significant or trend to significant second contrasts (DANCE versus MEMORY): (B) in favor of DANCE (P=0.007, two tailed) and (C and D) in favor of MEMORY (trend P=0.062, two tailed and trend P=0.062, two tailed, respectively). Performance from 6 months until 1-year follow-up remained unchanged in (A, C, and D; all P>0.10), whereas “step time fast-ST” increased (B; trend P=0.077, two tailed). Error bars indicate ± standard error of the mean.
Abbreviations: DTC, dual-task cost; DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; ST, single-task; DT, dual-task; PHYS, treadmill walking.

Figure 5 Development of fall frequency over 2 years.

Notes: A significant reduction over the first three 6-month periods (P<0.001, one tailed) and a subsequent trend for an increase after the fourth period was shown (trend P=0.059, two-tailed). Error bars indicate ± standard error of the mean.
Abbreviations: DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking.

Table 4 Functional fitness, GDS, and FES-I performance data

Variable	DANCE (N= 24, follow-up N =15)								MEMORY (N =22, follow-up N =17)								PHYS (N =25, follow-up N = 15)
	Pretest		3-month test		6-month test		Follow-up		Pretest		3-month test		6-month test		Follow-up		Pretest		3-month test		6-month test		Follow-up
	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE	Mean	SE
SPPB total score	10.5	0.4	11.2	0.4	11.6	0.2	10.7	0.6	10.5	0.3	11.4	0.2	11.8	0.1	11.8	0.2	10.5	0.4	11.5	0.2	11.7	0.2	11.5	0.3
SPPB adapted balance test score	4.8	0.4	5.0	0.3	5.1	0.3	4.9	0.5	4.5	0.4	5.1	0.2	5.2	0.3	5.0	0.2	4.5	0.3	5.0	0.3	5.2	0.2	5.4	0.3
SPPB five chair-rises (s)	12.0	1.0	9.3	0.7	8.7	0.5	10.0	1.7	11.8	0.7	9.7	0.7	8.5	0.3	8.7	0.6	11.4	1.0	8.5	0.5	8.5	0.5	8.0	0.9
SPPB 3 m-walk (s)	3.3	0.2	3.1	0.1	2.8	0.1	3.0	0.2	3.4	0.1	3.2	0.1	2.8	0.1	2.6	0.1	3.3	0.2	3.2	0.1	2.8	0.1	2.9	0.2
6-MWT (m)	505	25	522	21	560	21	–	–	489	16	510	19	530	20	–	–	506	18	514	19	538	21	–	–
6-MWT RPE	3.3	0.3	3.5	0.3	4.4	0.4	–	–	3.7	0.3	4.1	0.3	4.3	0.4	–	–	3.4	0.2	3.9	0.3	5.0	0.4	–	–
GDS	3.3	0.6	2.7	0.4	3.1	0.6	3.2	0.8	3.1	0.5	3.6	0.8	3.3	0.7	3.6	0.7	4.3	0.7	4.5	0.7	4.2	0.7	3.1	0.6
FES-I	20.1	1.1	19.6	0.8	19.2	0.7	19.9	0.9	19.6	0.7	19.8	0.7	20.1	0.9	20.5	1.2	21.2	1.2	19.6	0.9	20.7	1.0	18.3	0.7

Abbreviations: DANCE, virtual reality video game dancing; FES-I, Falls Efficacy Scale-International; GDS, Geriatric Depression Scale; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; RPE, rate of perceived exertion; SE, ± standard error; SPPB, Short Physical Performance Battery; 6-MWT, 6-minute walk test.

Figure 6 Development of functional fitness.

Notes: (A) and (B) illustrate significant enhancements in two functional fitness measures from pretest to 6-month test (P<0.001, one tailed). Additionally (A) shows attenuated performance after 1-year follow-up (P=0.027, two-tailed). No differences between interventions were found. Six-minute walk test was not repeated at follow-up. Error bars indicate ± standard error of the mean.
Abbreviations: PHYS, treadmill walking; DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training.

Figure 7 Performance developments for sexes.

Notes: (A) and (B) depict time × sex interactions from pretest to 6-month test in favor of the male participants in two measures related to muscular power (P=0.049, two tailed and trend P=0.061, two tailed, respectively). No significant interaction was found from 6-month test to 1-year follow-up. Error bars indicate ± standard error of the mean.
Abbreviation: ST, single-task.

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”

Dependent variable	Predictor	b	95% CI		SE b	β	P two tailed	R^2-change
Velocity preferred	Linear global time effect	7.10	5.19	9.01	0.97	0.23	<0.001***	0.053
	Quadratic global time effect	−1.03	−2.13	0.08	0.56	−0.06	0.068t	0.003
	Linear interaction AB × C	−0.26	−1.60	1.07	0.67	−0.01	0.695	0.000
	Linear interaction A × B	−1.63	−4.00	0.75	1.20	−0.04	0.178	0.002
Velocity fast	Linear global time effect	8.64	6.35	10.92	1.16	0.22	<0.001***	0.048
	Quadratic global time effect	−0.86	−2.18	0.47	0.67	−0.04	0.203	0.001
	Linear interaction AB × C	−0.08	−1.68	1.51	0.81	0.00	0.919	0.000
	Linear interaction A × B	2.27	−0.57	5.11	1.44	0.05	0.116	0.002
Velocity preferred DT	Linear global time effect	6.79	4.60	8.99	1.11	0.18	<0.001***	0.033
	Quadratic global time effect	−0.48	−1.74	0.79	0.64	−0.02	0.456	0.000
	Linear interaction AB × C	−0.33	−1.85	1.20	0.77	−0.01	0.674	0.000
	Linear interaction A × B	−1.00	−3.72	1.72	1.38	−0.02	0.468	0.000
Velocity fast DT	Linear global time effect	7.90	5.40	10.39	1.26	0.20	<0.001***	0.039
	Quadratic global time effect	0.67	−0.77	2.11	0.73	0.03	0.361	0.001
	Linear interaction AB × C	−0.69	−2.43	1.05	0.88	−0.03	0.431	0.001
	Linear interaction A × B	−0.03	−3.13	3.07	1.57	0.00	0.985	0.000
Velocity preferred DTC	Linear global time effect	0.00	−0.02	0.02	0.01	0.00	0.930	0.000
	Quadratic global time effect	0.00	−0.01	0.01	0.01	0.03	0.480	0.001
	Linear interaction AB × C	0.00	−0.01	0.01	0.01	−0.01	0.858	0.000
	Linear interaction A × B	0.00	−0.02	0.03	0.01	0.02	0.717	0.000
Velocity fast DTC	Linear global time effect	0.01	−0.01	0.02	0.01	0.04	0.461	0.002
	Quadratic global time effect	0.01	0.00	0.02	0.01	0.10	0.065t	0.011
	Linear interaction AB × C	−0.01	−0.02	0.01	0.01	−0.06	0.258	0.004
	Linear interaction A × B	−0.01	−0.04	0.01	0.01	−0.07	0.213	0.005

Notes: Bold values indicate significance or trend.

*** P<0.001.

t P<0.10 trend.

Abbreviations: A, DANCE; B, MEMORY; C, PHYS; CI, confidence interval; DANCE, virtual reality video game dancing; DT, dual-task; DTC, dual-task cost; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; SE, ± standard error.

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”

Dependent variable	Predictor	b	95% CI		SE b	β	P two tailed	R^2-change
Step length preferred	Linear global time effect	1.71	1.12	2.30	0.30	0.15	<0.001***	0.022
	Quadratic global time effect	−0.31	−0.65	0.03	0.17	−0.05	0.072t	0.002
	Linear interaction AB × C	−0.12	−0.54	0.29	0.21	−0.02	0.551	0.000
	Linear interaction A × B	−0.54	−1.27	0.19	0.37	−0.04	0.147	0.001
Step length fast	Linear global time effect	1.55	0.97	2.13	0.30	0.11	<0.001***	0.012
	Quadratic global time effect	−0.16	−0.50	0.18	0.17	−0.02	0.352	0.000
	Linear interaction AB × C	−0.19	−0.60	0.21	0.21	−0.02	0.346	0.000
	Linear interaction A × B	−0.19	−0.92	0.53	0.37	−0.01	0.600	0.000
Step length preferred DT	Linear global time effect	1.98	1.37	2.60	0.31	0.15	<0.001***	0.024
	Quadratic global time effect	−0.02	−0.37	0.34	0.18	0.00	0.920	0.000
	Linear interaction AB × C	−0.34	−0.77	0.09	0.22	−0.04	0.119	0.001
	Linear interaction A × B	−0.49	−1.25	0.28	0.39	−0.03	0.209	0.001
Step length fast DT	Linear global time effect	1.69	1.06	2.33	0.32	0.13	<0.001***	0.016
	Quadratic global time effect	0.16	−0.21	0.52	0.19	0.02	0.400	0.000
	Linear interaction AB × C	−0.33	−0.78	0.11	0.22	−0.04	0.136	0.001
	Linear interaction A × B	−0.03	−0.81	0.76	0.40	0.00	0.947	0.000
Step length preferred DTC	Linear global time effect	0.00	−0.01	0.01	0.01	0.04	0.482	0.001
	Quadratic global time effect	0.00	0.00	0.01	0.00	0.08	0.127	0.006
	Linear interaction AB × C	0.00	−0.01	0.00	0.00	−0.06	0.293	0.003
	Linear interaction A × B	0.00	−0.01	0.01	0.01	−0.01	0.858	0.000
Step length fast DTC	Linear global time effect	0.00	−0.01	0.01	0.00	0.03	0.494	0.001
	Quadratic global time effect	0.01	0.00	0.01	0.00	0.09	0.049*	0.009
	Linear interaction AB × C	0.00	−0.01	0.00	0.00	−0.05	0.264	0.003
	Linear interaction A × B	0.00	−0.01	0.01	0.01	0.00	0.983	0.000

Notes: Bold values indicate significance or trend.

* P<0.05.

*** P<0.001.

t P<0.10 trend.

Abbreviations: A, DANCE; B, MEMORY; C, PHYS; CI, confidence interval; DANCE, virtual reality video game dancing; DT, dual-task; DTC, dual-task cost; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; SE, ± standard error.

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”

Dependent variable	Predictor	b	95% CI		SE b	β	P two tailed	R^2-change
Step length variability preferred	Linear global time effect	−0.39	−0.50	−0.27	0.06	−0.35	<0.001***	0.118
	Quadratic global time effect	0.08	0.01	0.15	0.03	0.12	0.020*	0.015
	Linear interaction AB × C	−0.03	−0.11	0.06	0.04	−0.03	0.548	0.001
	Linear interaction A × B	0.01	−0.13	0.16	0.07	0.01	0.866	0.000
Step length variability fast	Linear global time effect	−0.15	−0.31	0.01	0.08	−0.11	0.059t	0.013
	Quadratic global time effect	0.13	0.04	0.22	0.05	0.17	0.005**	0.029
	Linear interaction AB × C	−0.05	−0.16	0.06	0.06	−0.05	0.377	0.003
	Linear interaction A × B	0.01	−0.18	0.21	0.10	0.01	0.911	0.000
Step length variability preferred DT	Linear global time effect	−0.32	−0.50	−0.13	0.09	−0.18	0.001**	0.030
	Quadratic global time effect	0.03	−0.07	0.14	0.05	0.03	0.549	0.001
	Linear interaction AB × C	−0.02	−0.14	0.11	0.07	−0.01	0.817	0.000
	Linear interaction A × B	0.22	−0.01	0.45	0.12	0.10	0.062t	0.009
Step length variability fast DT	Linear global time effect	−0.10	−0.30	0.09	0.10	−0.06	0.286	0.004
	Quadratic global time effect	0.07	−0.04	0.19	0.06	0.07	0.192	0.005
	Linear interaction AB × C	0.05	−0.09	0.18	0.07	0.04	0.490	0.002
	Linear interaction A × B	0.14	−0.10	0.38	0.12	0.06	0.262	0.004
Step length variability preferred DTC	Linear global time effect	0.07	−0.04	0.17	0.05	0.08	0.229	0.006
	Quadratic global time effect	−0.01	−0.07	0.05	0.03	−0.02	0.811	0.000
	Linear interaction AB × C	−0.02	−0.09	0.06	0.04	−0.03	0.693	0.001
	Linear interaction A × B	0.10	−0.04	0.23	0.07	0.09	0.150	0.008
Step length variability fast DTC	Linear global time effect	0.00	−0.11	0.12	0.06	0.00	0.962	0.000
	Quadratic global time effect	−0.05	−0.11	0.02	0.03	−0.10	0.141	0.010
	Linear interaction AB × C	0.04	−0.04	0.11	0.04	0.06	0.375	0.004
	Linear interaction A × B	0.05	−0.09	0.19	0.07	0.05	0.468	0.002

Notes: Bold values indicate significance or trend.

* P<0.05.

** P<0.01.

*** P<0.001.

t P<0.10 trend.

Abbreviations: A, DANCE; B, MEMORY; C, PHYS; CI, confidence interval; DANCE, virtual reality video game dancing; DT, dual-task; DTC, dual-task cost; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; SE, ± standard error.

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”

Dependent variable	Predictor	b	95% CI		SE b	β	P two tailed	R^2-change
Step time preferred	Linear global time effect	−0.02	−0.024	−0.011	0.00	−0.21	<0.001***	0.043
	Quadratic global time effect	0.00	−0.002	0.005	0.00	0.03	0.452	0.001
	Linear interaction AB × C	0.00	−0.002	0.007	0.00	0.04	0.331	0.001
	Linear interaction A × B	0.00	−0.004	0.012	0.00	0.03	0.373	0.001
Step time fast	Linear global time effect	−0.01	−0.017	−0.009	0.00	−0.23	<0.001***	0.054
	Quadratic global time effect	0.00	−0.001	0.003	0.00	0.04	0.264	0.001
	Linear interaction AB × C	0.00	−0.003	0.002	0.00	−0.01	0.735	0.000
	Linear interaction A × B	−0.01	−0.011	−0.002	0.00	−0.09	0.007**	0.009
Step time preferred DT	Linear global time effect	−0.02	−0.027	−0.005	0.01	−0.10	0.006**	0.011
	Quadratic global time effect	0.00	−0.003	0.010	0.00	0.04	0.323	0.001
	Linear interaction AB × C	0.00	−0.006	0.009	0.00	0.02	0.680	0.000
	Linear interaction A × B	0.01	−0.003	0.024	0.01	0.06	0.136	0.003
Step time fast DT	Linear global time effect	−0.02	−0.022	−0.008	0.00	−0.16	<0.001***	0.026
	Quadratic global time effect	0.00	−0.005	0.003	0.00	−0.02	0.662	0.000
	Linear interaction AB × C	0.00	−0.004	0.005	0.00	0.01	0.898	0.000
	Linear interaction A × B	0.00	−0.008	0.008	0.00	0.00	0.993	0.000
Step time preferred DTC	Linear global time effect	0.00	−0.016	0.024	0.01	0.02	0.690	0.000
	Quadratic global time effect	0.00	−0.009	0.014	0.01	0.02	0.667	0.000
	Linear interaction AB × C	0.00	−0.016	0.012	0.01	−0.01	0.808	0.000
	Linear interaction A × B	0.01	−0.012	0.038	0.01	0.05	0.295	0.002
Step time fast DTC	Linear global time effect	0.00	−0.015	0.017	0.01	0.01	0.901	0.000
	Quadratic global time effect	−0.01	−0.014	0.004	0.01	−0.05	0.287	0.002
	Linear interaction AB × C	0.00	−0.009	0.013	0.01	0.02	0.726	0.000
	Linear interaction A × B	0.02	−0.001	0.038	0.01	0.08	0.069t	0.006

Notes: Bold values indicate significance or trend.

** P<0.01.

*** P<0.001.

t P<0.10 trend.

Abbreviations: A, DANCE; B, MEMORY; C, PHYS; CI, confidence interval; DANCE, virtual reality video game dancing; DT, dual-task; DTC, dual-task cost; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; SE, ± standard error.

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”

Dependent variable	Predictor	b	95% CI		SE b	β	P two tailed	R^2-change
Step time variability preferred	Linear global time effect	−0.004	−0.005	−0.003	0.001	−0.28	<0.001***	0.081
	Quadratic global time effect	0.000	0.000	0.001	0.000	0.05	0.318	0.003
	Linear interaction AB × C	0.001	0.000	0.002	0.000	0.11	0.034*	0.012
	Linear interaction A × B	−0.001	−0.003	0.001	0.001	−0.05	0.301	0.003
Step time variability fast	Linear global time effect	−0.006	−0.009	−0.004	0.001	−0.31	<0.001***	0.098
	Quadratic global time effect	0.001	0.000	0.003	0.001	0.12	0.067t	0.014
	Linear interaction AB × C	0.000	−0.002	0.002	0.001	0.02	0.791	0.000
	Linear interaction A × B	−0.002	−0.005	0.001	0.002	−0.08	0.204	0.007
Step time variability preferred DT	Linear global time effect	−0.003	−0.007	0.000	0.002	−0.09	0.047*	0.008
	Quadratic global time effect	0.000	−0.001	0.002	0.001	0.02	0.631	0.000
	Linear interaction AB × C	0.000	−0.002	0.002	0.001	0.00	0.949	0.000
	Linear interaction A × B	0.003	−0.001	0.007	0.002	0.06	0.165	0.004
Step time variability fast DT	Linear global time effect	−0.004	−0.007	0.000	0.002	−0.12	0.024*	0.015
	Quadratic global time effect	−0.002	−0.004	0.000	0.001	−0.11	0.047*	0.011
	Linear interaction AB × C	−0.001	−0.003	0.001	0.001	−0.04	0.438	0.002
	Linear interaction A × B	0.002	−0.002	0.006	0.002	0.05	0.339	0.003
Step time variability preferred DTC	Linear global time effect	0.194	−0.015	0.402	0.106	0.10	0.069t	0.010
	Quadratic global time effect	−0.027	−0.148	0.093	0.061	−0.03	0.657	0.001
	Linear interaction AB × C	−0.071	−0.216	0.075	0.074	−0.05	0.339	0.003
	Linear interaction A × B	0.247	−0.012	0.506	0.131	0.11	0.062t	0.011
Step time variability fast DTC	Linear global time effect	0.123	−0.083	0.329	0.104	0.07	0.241	0.005
	Quadratic global time effect	−0.131	−0.250	−0.012	0.060	−0.13	0.032*	0.016
	Linear interaction AB × C	−0.125	−0.268	0.019	0.073	−0.10	0.088t	0.010
	Linear interaction A × B	0.181	−0.075	0.437	0.129	0.08	0.165	0.007

Notes: Bold values indicate significance or trend.

* P<0.05.

*** P<0.001.

t P<0.10 trend.

Abbreviations: A, DANCE; B, MEMORY; C, PHYS; CI, confidence interval; DANCE, virtual reality video game dancing; DT, dual-task; DTC, dual-task cost; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; SE, ± standard error.

Table S6 Repeated-measures ANOVA from 6 months to follow-up test for gait variables, N=47

Dependent variable	Effect	F(2, 44)	P two tailed	r
Velocity preferred	Time	0.090	0.765	0.05
	Time × intervention	0.207	0.813	0.07
Velocity fast	Time	7.844	0.008**	0.39
	Time × intervention	2.097	0.135	0.21
Velocity preferred DT	Time	7.095	0.011*	0.37
	Time × intervention	0.094	0.910	0.05
Velocity fast DT	Time	0.073	0.789	0.04
	Time × intervention	0.299	0.743	0.08
Velocity preferred DTC	Time	11.667	0.001**	0.46
	Time × intervention	0.075	0.928	0.04
Velocity fast DTC	Time	9.498	0.004**	0.42
	Time × intervention	1.718	0.191	0.19
Step length preferred	Time	0.004	0.951	0.01
	Time × intervention	0.179	0.837	0.06
Step length fast	Time	10.23	0.003**	0.43
	Time × intervention	0.444	0.644	0.10
Step length preferred DT	Time	2.413	0.127	0.23
	Time × intervention	0.392	0.678	0.09
Step length fast DT	Time	0.04	0.842	0.03
	Time × intervention	0.552	0.580	0.11
Step length preferred DTC	Time	3.522	0.067t	0.27
	Time × intervention	0.433	0.652	0.10
Step length fast DTC	Time	5.165	0.028*	0.32
	Time × intervention	1.748	0.186	0.20
Step length variability preferred	Time	6.57	0.014*	0.36
	Time × intervention	0.658	0.523	0.12
Step length variability fast	Time	1.04	0.314	0.15
	Time × intervention	0.173	0.842	0.06
Step length variability preferred DT	Time	0.2	0.657	0.07
	Time × intervention	0.047	0.954	0.03
Step length variability fast DT	Time	0.889	0.351	0.14
	Time × intervention	0.158	0.855	0.06
Step length variability preferred DTC	Time	0.985	0.326	0.15
	Time × intervention	0.722	0.492	0.13
Step length variability fast DTC	Time	0.034	0.855	0.03
	Time × intervention	0.412	0.665	0.10
Step time preferred	Time	0.079	0.779	0.04
	Time × intervention	1.056	0.357	0.15
Step time fast	Time	3.287	0.077t	0.26
	Time × intervention	3.312	0.046*	0.26
Step time preferred DT	Time	9.355	0.004**	0.42
	Time × intervention	0.077	0.926	0.04
Step time fast DT	Time	0.124	0.727	0.05
	Time × intervention	0.67	0.517	0.12
Step time preferred DTC	Time	11.028	0.002**	0.45
	Time × intervention	0.267	0.767	0.08
Step time fast DTC	Time	3.514	0.068t	0.27
	Time × intervention	1.975	0.151	0.21
Step time variability preferred	Time	4.176	0.047*	0.29
	Time × intervention	0.074	0.929	0.04
Step time variability fast	Time	7.101	0.011*	0.37
	Time × intervention	0.204	0.816	0.07
Step time variability preferred DT	Time	1.378	0.247	0.17
	Time × intervention	0.137	0.873	0.06
Step time variability fast DT	Time	2.702	0.107	0.24
	Time × intervention	0.638	0.533	0.12
Step time variability preferred DTC	Time	2.549	0.118	0.23
	Time × intervention	0.089	0.915	0.04
Step time variability fast DTC	Time	0.105	0.747	0.05
	Time × intervention	1.393	0.259	0.18

Notes: Bold values indicate significance or trend.

* P<0.05.

** P<0.01.

t P<0.10 trend.

Abbreviations: ANOVA, analysis of variance; DT, dual-task; DTC, dual-task cost.

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

Dependent variable	Predictor	b	95% CI		SE b	β	P two tailed	R^2-change
Fall frequency	Linear global time effect	−0.15	−0.24	−0.07	0.04	−0.24	<0.001***	0.056
	Quadratic global time effect	−0.03	−0.08	0.01	0.02	−0.09	0.165	0.009
	Linear interaction AB × C	−0.02	−0.08	0.04	0.03	−0.04	0.588	0.001
	Linear interaction A × B	0.02	−0.08	0.12	0.05	0.03	0.663	0.001

Notes: Bold values indicate significance or trend.

*** P<0.001.

Abbreviations: A, DANCE; B, MEMORY; C, PHYS; CI, confidence interval; DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; SE, ± standard error.

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

Dependent variable	Predictor	b	95% CI		SE b	β	P two tailed	R^2-change
SPPB, total score	Linear global time effect	0.60	0.46	0.74	0.07	0.34	<0.001***	0.115
	Linear interaction AB × C	0.01	−0.09	0.11	0.05	0.01	0.845	0.000
	Linear interaction A × B	−0.05	−0.22	0.13	0.09	−0.02	0.595	0.000
SPPB, adapted balance test	Linear global time effect	0.27	0.13	0.41	0.07	0.15	<0.001***	0.023
	Linear interaction AB × C	−0.04	−0.13	0.06	0.05	−0.03	0.471	0.001
	Linear interaction A × B	−0.09	−0.26	0.09	0.09	−0.04	0.333	0.002
SPPB, five chair-rises	Linear global time effect	−1.64	−1.99	−1.30	0.17	−0.38	<0.001***	0.141
	Linear interaction AB × C	−0.02	−0.26	0.22	0.12	−0.01	0.882	0.000
	Linear interaction A × B	0.02	−0.41	0.45	0.22	0.00	0.923	0.000
SPPB, 3 m-walk	Linear global time effect	−0.26	−0.32	−0.19	0.03	−0.30	<0.001***	0.090
	Linear interaction AB × C	−0.02	−0.06	0.03	0.02	−0.03	0.503	0.001
	Linear interaction A × B	0.06	−0.02	0.14	0.04	0.06	0.152	0.003
6-min-walk, distance	Linear global time effect	21.32	15.91	26.74	2.74	0.18	<0.001***	0.032
	Linear interaction AB × C	2.52	−1.26	6.29	1.91	0.03	0.190	0.001
	Linear interaction A × B	3.33	−3.40	10.06	3.40	0.02	0.329	0.001
6-min-walk, RPE	Linear global time effect	0.54	0.35	0.74	0.10	0.26	<0.001***	0.067
	Linear interaction AB × C	−0.12	−0.26	0.02	0.07	−0.08	0.083t	0.007t
	Linear interaction A × B	0.13	−0.11	0.37	0.12	0.05	0.294	0.002

Notes: Bold values indicate significance or trend.

*** P<0.001.

t P<0.10 trend.

Abbreviations: A, DANCE; B, MEMORY; C, PHYS; CI, confidence interval; DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; SE, ± standard error; SPPB, Short Physical Performance Battery; RPE, rate of perceived exertion.

Table S9 Repeated-measures ANOVA from 6 months to follow-up test for SPPB variables, N=47

Dependent variable	Effect	F(2, 44)	P two tailed	r
SPPB, total score	Time	5.260	0.027*	0.33
	Time × intervention	1.688	0.197	0.19
SPPB, adapted balance test	Time	0.591	0.446	0.12
	Time × intervention	0.336	0.716	0.09
SPPB, five chair-rises	Time	2.465	0.124	0.23
	Time × intervention	0.719	0.493	0.13
SPPB, 3 m-walk	Time	0.154	0.696	0.06
	Time × intervention	0.566	0.572	0.11

Notes: Bold values indicate significance or trend.

* P<0.05.

Abbreviations: ANOVA, analysis of variance; SPPB, Short Physical Performance Battery.

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