Impact of Motor-Cognitive Interventions on Selected Gait and Balance Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundEfficient performance of most daily activities requires intact and simultaneous execution of motor and cognitive tasks. To mitigate age-related functional decline, various combinations of motor and cognitive training have shown promising results. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy of different types of motor-cognitive training interventions (e.g., sequential and simultaneous) on selected functional outcomes in healthy older adults.MethodsSix online academic databases were used to retrieve eligible RCTs up to April 2021, following PRISMA guidelines and PICO criteria. A random-effects model was used for all meta-analyses conducted on selected functional outcomes: single- and dual-task gait speed, the Timed Up and Go Test (TUG), and Berg Balance Scale (BBS) score. Effect size (ES) was calculated as Hedges' g and interpreted as: trivial: <0.20, small: 0.20–0.60, moderate: 0.61–1.20, large: 1.21–2.00, very large: 2.01–4.00 or extremely large >4.00.ResultsFrom 2,546 retrieved records, 91 RCTs were included for meta-analysis (n = 3,745 participants; 64.7–86.9 years). The motor-cognitive interventions included differed according to the type of training (e.g., sequential, simultaneous with additional cognitive task or exergame training. The results showed that motor-cognitive interventions can improve gait speed under single-task conditions (small ES = 0.34, P = 0.003). The effect of the intervention was moderated by the type of control group (Q = 6.203, P = 0.013): passive (moderate ES = 0.941, P = 0.001) vs. active controls (trivial ES = 0.153, P = 0.180). No significant effect was found for dual-task walking outcomes (P = 0.063). Motor-cognitive intervention had a positive effect on TUG (small ES = 0.42, P < 0.001), where the effect of intervention was moderated by control group [passive (moderate ES = 0.73, P = 0.001) vs. active (small ES = 0.20, P = 0.020)], but not by the type of training (P = 0.064). Finally, BBS scores were positively affected by motor-cognitive interventions (small ES = 0.59, P < 0.001) with however no significant differences between type of control group (P = 0.529) or intervention modality (P = 0.585).ConclusionsThis study provides evidence for the effectiveness of various types of motor-cognitive interventions on performance-based measures of functional mobility in healthy older adults. With respect to significant effects, gait speed under single-task condition was improved by motor-cognitive interventions, but the evidence shows that this type of intervention is not necessarily more beneficial than motor training alone. On the other hand, motor-cognitive interventions are better at improving multicomponent tasks of dynamic balance and mobility function, as measured by the TUG. Because of substantial heterogeneity and the current limited availability of different types of interventions, the conclusions should be interpreted with caution.

Benefits of a Dual-Task Training on Motor and Cognitive Functions in Community-Dwelling Older Adults

“…Previous studies have shown the effectiveness of cognitivemotor interventions in enhancing multicomponent balance tasks, further supporting the potential of DT training in improving postural stability. 10,22 It is important to note that in the present study, which assessed postural stability in a relatively simple static task, improvements in the center of pressure area and balance speed resulting from DT training might not have been fully captured in healthy older adults. Therefore, further research is needed to comprehensively explore the benefits of DT training in the center of pressure area and balance speed.…”

“…21 However, despite this potential harm, when applying DT stimulation to older individuals in clinical practice, the physiological effects can be different, leading to an improvement in their reaction time within their daily activities. 9,10 In this study, the participants in the experimental group engaged in a variety of DT exercises. The exercises were strategically designed to enhance participants' overall postural stability.…”

Sex Differences in Falls: The Mediating Role of Gait Stability Ratio and Body Balance in Vulnerable Older Adults

“…However, it is known that gait changes may indicate some executive dysfunction [ 71 , 72 ]. On the other hand, gait parameters such as speed, cadence and step width can benefit from properly structured interventions [ 73 , 74 ]. Moreover, depending on the type of physical training [ 75 , 76 ], it is possible to simultaneously improve gait and balance and promote neural plasticity [ 77 , 78 ].…”

The Effects of 12-Week Dual-Task Physical–Cognitive Training on Gait, Balance, Lower Extremity Muscle Strength, and Cognition in Older Adult Women: A Randomized Study

“…The literature also highlights that falls are more prevalent among women [ 52 , 54 ]. Although review and meta-analysis studies have highlighted the benefits of the DT methodology as a useful strategy to activate brain structures [ 42 , 55 ] and concomitantly GP and BB [ 56 , 57 ], as well as LEMS [ 44 ], there are still gaps, in addition to the fact that definitive conclusions were limited by the lack of studies that have investigated the reciprocal effects between all the variables [ 58 , 59 ]. Thus, to date, no studies have specifically examined the effects of physical–cognitive DT training on GP, BB, LEMS, and cognitive vulnerability in a population of cognitively normal older adult women.…”