Dual-Task Exercise Reduces Cognitive-Motor Interference in Walking and Falls After Stroke

Abstract

Background and Purpose— Functional community ambulation requires the ability to perform mobility and cognitive task simultaneously (dual-tasking). This single-blinded randomized controlled study aimed to examine the effects of dual-task exercise in chronic stroke patients. Methods— Eighty-four chronic stroke patients (24 women; age, 61.2±6.4 years; time since stroke onset, 75.3±64.9 months) with mild to moderate motor impairment (Chedoke-McMaster leg motor score: median, 5; interquartile range, 4–6) were randomly allocated to the dual-task balance/mobility training group, single-task balance/mobility group, or upper-limb exercise (control) group. Each group exercised for three 60-minute sessions per week for 8 weeks. The dual-task interference effect was measured for the time to completion of 3 mobility tests (forward walking, timed-up-and-go, and obstacle crossing) and for the correct response rate during serial-3-subtractions and verbal fluency task. Secondary outcomes included the Activities-specific Balance Confidence Scale, Frenchay Activities Index, and Stroke-specific Quality of Life Scale. The above outcomes were measured at baseline, immediately after, and 8 weeks after training. Fall incidence was recorded for a 6-month period posttraining. Results— Only the dual-task group exhibited reduced dual-task interference in walking time posttraining (forward walking combined with verbal fluency [9.5%, P =0.014], forward walking with serial-3-subtractions [9.6%, P =0.035], and the timed-up-and-go with verbal fluency [16.8%, P =0.001]). The improvements in dual-task walking were largely maintained at the 8-week follow-up. The dual-task cognitive performance showed no significant changes. The dual-task program reduced the risk of falls and injurious falls by 25.0% (95% CI, 3.1%–46.9%; P =0.037) and 22.2% (95% CI, 4.0%–38.4%; P =0.023), respectively, during the 6-month follow-up period compared with controls. There was no significant effect on other secondary outcomes ( P >0.05). Conclusions— The dual-task program was effective in improving dual-task mobility, reducing falls and fall-related injuries in ambulatory chronic stroke patients with intact cognition. It had no significant effect on activity participation or quality of life. Clinical trial registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02270398.

Cognitive-Locomotor Dual-Task Interference in Stroke Survivors and the Influence of the Tasks: A Systematic Review

“…All except one study ( 38 ) had a cross-sectional design. The methodological quality scores ranged from 70 to 100% (mean ± standard deviation: 86.1% ± 8.8; Table 1 ).…”

“…One hundred and eighteen (118) full texts were read, and 98 articles did not meet the inclusion criteria. Twenty articles were therefore included in this systematic review Figure 1; (20,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). Among these, 17 studies were considered for the first and second objectives, while 7 studies contributed to the third objective.…”

“…Seventeen studies (20,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(39)(40)(41)(42) out of 20 contributed to reach the first and second objectives of this systematic review, i.e., to examine cognitive-locomotor DTI magnitude and pattern while walking in people who sustained a stroke and explore the impact of the nature of the tasks on DTI ( Table 3). Three studies that were not considered (24,37,38) due to the absence of statistical comparison between single-and dual-task conditions.…”

The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials

“…The health conditions of participants comprised osteoporosis (exercise vs control: 2756 vs 2400), high risk of falling (923 vs 887), and stroke survivors (55 vs 55). The included studies were delivered both in community settings [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and in institutions [12,[32][33][34][35][36][37][38][39][40][41]. The studies were carried out in US, UK, Germany, Australia, Sweden, New Zealand, France, China, Japan, Finland, Switzerland, and Netherlands (Table 1).…”

“…We then explored if the trials showing small-study effects affected summary effects estimates. After removing three trials [28,33,35] with obvious small-study effects, it resulted in a significant reduction of Begg's test value (p = 0.063), and the intervention effects were still significant (0.881, 0.834-0.931). It was suggested though there existed in smallstudy effects, it did not affect the results much.…”