Effects of Physical Exercise Interventions on Gait-Related Dual-Task Interference in Older Adults: A Systematic Review and Meta-Analysis

Abstract

Dual-task interference during walking can substantially limit mobility and increase the risk of falls among community-dwelling older adults. Previous systematic reviews examining intervention effects on dual-task gait and mobility have not assessed relative dual-task costs (DTC) or investigated whether there are differences in treatment-related changes based on the type of dual task or the type of control group. The purpose of this systematic review was to examine the effects of physical exercise interventions on dual-task performance during walking in older adults. A meta-analysis of randomized controlled trials (RCTs) compared treatment effects between physical exercise intervention and control groups on single- and dual-task gait speed and relative DTC on gait speed. A systematic search of the literature was conducted using the electronic databases PubMed, CINAHL, EMBASE, Web of Science, and PsycINFO searched up to September 19, 2014. Randomized, nonrandomized, and uncontrolled studies published in English and involving older adults were selected. Studies had to include a physical exercise intervention protocol and measure gait parameters during continuous, unobstructed walking in single- and dual-task conditions before and after the intervention. Of 614 abstracts, 21 studies met the inclusion criteria and were included in the systematic review. Fourteen RCTs were included in the meta-analysis. The mean difference between the intervention and control groups significantly favored the intervention for single-task gait speed (mean difference: 0.06 m/s, 95% CI: 0.03, 0.10, p < 0.001), dual-task gait speed (mean difference: 0.11 m/s, 95% CI 0.07, 0.15, p < 0.001), and DTC on gait speed (mean difference: 5.23%, 95% CI 1.40, 9.05, p = 0.007). Evidence from subgroup comparisons showed no difference in treatment-related changes between cognitive-motor and motor-motor dual tasks, or when interventions were compared to active or inactive controls. In summary, physical exercise interventions can improve dual-task walking in older adults primarily by increasing the speed at which individuals walk in dual-task conditions. Currently, evidence concerning whether physical exercise interventions reduce DTC or alter the self-selected dual-task strategy during unobstructed walking is greatly lacking, mainly due to the failure of studies to measure and report reciprocal dual-task effects on the non-gait task.

Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study

“…Similarly, one recent study showed improved gait speed after balance training (Halvarsson et al, 2015). Furthermore, physical exercise positively influences dual-task walking by increasing the walking speed (Plummer et al, 2015). On the other hand, the exergame group showed significant within-group improvements for gait parameters under dual-task conditions.…”

“…The crucial point is that the exergame does not only require well-coordinated leg movements, but also requires cognitive work, e.g., sensing of stimuli, paying attention, and making quick decisions (de Bruin et al, 2010). Thus, a repeated practice of exergaming (dual-tasking), using task-specific training, might improve dual-task interference (Plummer et al, 2015). A transfer of the trained cognitive abilities on the concurrent performance of multiple tasks might happen (Bherer et al, 2005).…”

Fatores preditores de quedas em mulheres praticantes de exercício físico

“…O fato pode ser assumido como possível indicativo dos benefícios da prática regular de exercícios físicos na prevenção de quedas. Estudos demonstraram os efeitos positivos do EF praticado com regularidade sobre a velocidade da marcha, o controle da postura corporal, os níveis de força dos membros inferiores e medo de quedas (24,25) . Segundo a literatura especializada, o aumento da idade exerce forte papel na ocorrência de quedas (4,5,10) .…”

“…Uma possível explicação pode ser a característica da população avaliada, a qual era praticante regular de EF. Analisando a questão por esse lado, pode-se dizer que os achados de Petrolina confirmam os resultados de estudos de revisão sistemática na área de queda (24,25) . Conforme estudo anterior (27) , observou-se, no presente estudo, maior prevalência de queda entre idosas sexagenárias (64,7%), seguidas pelas septuagenárias (33,3%).…”

Retraining Automaticity: Recovering the Procedural Memory of Walking after Stroke

“…This must be carried out using reasonable expectations based on lesion size and location, age, learning style, and personality [59][60][61][62][63][64][65][66][67][68][69]. As McIsaac and colleagues [21] wrote, "In aging and disease states, declines in sensorimotor and cognitive functions may lead to reduced postural reserve and cognitive reserve creating overall greater demands for attention to the task.…”