Regular Exercise in the Elderly Is Effective to Preserve the Speed of Voluntary Stepping under Single-Task Condition but Not under Dual-Task Condition

Abstract

Background: Stepping response may be considered the most important postural reaction to prevent a fall because it is the inability to respond effectively to a loss of balance that ultimately determines whether a fall occurs. However, very little has been studied on the effect of exercising on step execution behavior in the elderly. Objectives: To explore whether older persons who exercise regularly have faster voluntary stepping times than sedentary elderly persons. Additionally, we investigated the association between step execution behavior, self-reported physical function, and balance performance. Methods: Case-control study of 48 elderly adults aged 65–91 years who live independently in retirement homes. Participants were classified as 24 exercisers (reporting >2 exercise training activities/week) and 24 age- and gender-matched inactive elderly individuals (who do not exercise regularly). The Voluntary Step Execution Test was performed as a reaction time task while standing on a force platform under single-task and dual-task conditions. Step initiation phase, foot off time, foot contact time, preparatory, and swing phases were extracted from center of pressure and ground reaction force data. Self-reported function was examined using Late-Life Function and Disability Instrument; Berg Balance Test was also performed. Results: Exercisers had significantly faster voluntary step times in single-task condition (959 vs. 1,158 ms) but not during dual-task condition (1,170 vs. 1,303 ms). Exercisers had a significantly higher Berg Balance Test (53.7 ±3.6 vs. 49.8 ±5.3), consumed less medication (3.3 ±2.3 vs. 5.6 ±2.9), and their lower extremity function scores were higher (88.61 ±2.3 vs. 73.1 ±2.7) than those of inactive subjects. Conclusion: Exercising regularly protects from physical functioning loss in older persons and against a decrease in voluntary step execution times during single-task but not during dual-task conditions. Lack of specificity (dual-task exercises) during the training may be the cause of insignificant differences in dual-task stepping performance. Thus, adding dual-task training may improve dual-task performance in the elderly.

Training effects on motor–cognitive dual-task performance in older adults

“…Table 1 for the search strategy). Based on titles, studies in languages other than English were excluded (n=1; 78) along with case reports (n=4; [1,6,47,65]), studies not concerning motor training interventions to improve standing or walking tasks (n=17; [7, 8, 10, 13, 18, 42-44, 46, 49, 54, 64, 68, 71, 81, 90, 91, 97]), not using a pre-post test or agecomparison design, (n=4: [22,40,89,98]), not conducted with older adults (n=1; [37]) or not focusing healthy older adults (n =6; [3,22,24,82,99,100]) were also excluded (cf. Table 5 for excluded studies in the Annex).…”

Effects of regular exercise and dual tasking on spatial and temporal parameters of obstacle negotiation in elderly women

“…It is important to note that the effects of exercise can differ depending on whether or not the testing is performed under dual-task conditions. Regular exercise was associated with significantly faster voluntary step times during a single-task condition but not during a dual-task condition [5]. Similarly, dual tasking affects obstacle avoidance during gait (for further details, see [6] and [7]).…”

Analysis of Choice Stepping with Visual Interference Can Detect Prolonged Postural Preparation in Older Adults with Mild Cognitive Impairment at High Risk of Falling

“…The following events were extracted from the vertical force data: (1) APA onset: the first time when the difference in vertical force under the 2 feet increased by 5% of the participant's body weight; (2) APA errors: trials in which participants executed an APA in the incorrect direction, corrected themselves, and stepped with the correct foot [15]; (3) foot off: the first moment when the vertical force under either foot decreased to zero, and (4) foot contact: the first moment when the vertical force under the swing leg increased >10 N. Step execution time was calculated as the time from the cue to foot contact. Individual step execution phases were calculated based on the following criteria: (1) reaction phase: the time from cue to APA onset; (2) APA phase: the time from APA onset to foot off, and (3) swing phase: the time from foot off to foot contact [27,28]. …”