A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults

Abstract

Background: Balance impairment causes frequent falls in older adults, and preventing falls remains challenging. Dual-task (DT) training reduces falls by improving balance, but the precise theory is not fully understood. This review aims to explore the theories underlying the effectiveness of DT in improving balance and reducing falls in older adults. Methods: Eleven electronic databases were searched from database inception to June 2022. Two reviewers independently performed study screening and data extraction. The risk of bias (RoB) in the included studies was assessed using the Cochrane Collaboration RoB 2 tool. Results: The searches yielded 1478 citations, of which 30 studies met the inclusion criteria and were included in the review. Twenty-two of the 30 included studies utilized the motor-cognitive type of DT for training, while six used motor-motor and two utilized cognitive–cognitive DT. The included studies reported 20 different theories to explain the effectiveness of DT for improving balance and reducing falls in older adults. The predominant theory identified in the included studies was attention theory (n = 14). Overall, 26 studies reported improved balance and five studies found a reduction in fall incidence following DT training. Balance and falls improved significantly in 15 motor-cognitive DT intervention studies. Conclusion: Attention shifting between two tasks is reported to occur following DT training. Motor-cognitive DT training improves balance and reduces fall incidence in older adults by shifting attention based on the difficulty and priority of a task from the motor to the cognitive task.

Effectiveness and cost of integrated cognitive and balance training for balance and falls in cerebellar ataxia: a blinded two-arm parallel group RCT

“…This improvement can be accounted to the contribution of the cerebellum in shifting an additionally demanding task such as dual-tasking to an automatic task with repeated practice (40,41). The attention theory helps understand this concept where repeated practice results in an improved capacity to shift attention to the secondary task during dual-tasking (42,43). We found some immediate effects of the intervention on the dynamic balance assessed using the SARAbal.…”

Spatiotemporal gait characteristics during single- and dual-task walking are associated with the burden of cerebral small vessel disease

“…Furthermore, despite the prevalence of gait disorders and falls among patients with CSVD (11,12,15), a definitive cure remains elusive. Previous studies have indicated that cognitive dual-task training is both safe and effective in improving various spatiotemporal gait parameters (52). Additionally, another systematic review confirmed that cognitive DTW training improves balance and reduces the incidence of falls in older adults (53).…”

Uncorking the limitation—improving dual tasking using transcranial electrical stimulation and task training in the elderly: a systematic review

“…Such evidence provides a basis for the argument that task training, including both ST and DT training, can be used for promoting DT performance ( De Freitas et al, 2020 ; Chiaramonte et al, 2022 ). However, only few reviews discussed its effects in old participants ( Gallou-Guyot et al, 2020 ; Khan et al, 2022 ). Besides, it has been hypothesized that the combination of these two methods may provide greater efficacy and feasibility for DT improvement in the elderly.…”