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

Biomechanical characteristics and neuromuscular action control mechanism of single-dual-task walking-conversion training in stroke patients

Background and purposeThis study aimed to explore the biomechanical characteristics of patients with stroke and neuromuscular action control mechanisms in single-dual-task walking-conversion training.Materials and methodsPatients with stroke from four centers were enrolled and randomly divided into the cognitive combined treadmill-walking and exercise combined treadmill-walking groups (n = 30 per group). The gait spatiotemporal parameters, walking function, and fall risk of the two experimental groups were compared before and after 4 and 6 weeks of training. Surface electromyography (sEMG) and functional near-infrared spectroscopy (fNIRS) were performed to analyze neuromuscular action control mechanisms in different task phases.ResultsAfter 6 weeks of training, the gait spatiotemporal parameters, walking function, integral electromyogram (iEMG) values, and root mean square (RMS) of the affected lower limb muscles of the two experimental groups significantly improved (P < 0.01), while the fall risk was reduced (P < 0.01). fNIRS analysis showed that in both the single- and dual-task phases, HbO signal concentrations in the brain functional regions of the two experimental groups significantly increased after training (P < 0.01). These indicators were not significantly different between the two experimental groups after 6 weeks of training (P > 0.05). In addition, during the dual-task phase, the blood oxygen signal concentrations and functional connectivity in the functional brain regions of the two experimental groups were lower than those of healthy controls.ConclusionCognitive or motor tasks combined with treadmill-walking training can promote the recovery of physical function in patients with stroke.Clinical trial registration: This study was registered in the Chinese Clinical Trial Registry (ChiCTR; registration number: ChiCTR2200060864).

Improving serum redox balance, inflammatory status, physical function, and cognitive ability through dual-task resistance training and detraining in nursing home residents

OBJECTIVE

This study investigated the effects of dual-task resistance training (RT) and detraining on physical function, cognitive capacity, lipid profile, renal function, oxidative stress markers, and chronic inflammation of institutionalized older adults.

METHODS

The study involved 11 older adults (83.09 ± 8.1 years) residing in a long-term care institution, spanning 42 weeks with assessments at weeks 1, 14-15, 28, and 42. The initial 12 weeks following the first assessment (weeks 2-13) served as a baseline, during which participants maintained their routine activities. A dual-task resistance training protocol was implemented from weeks 16 to 27, followed by a detraining period from weeks 29 to 41. Assessments included clinical characteristics, physical function, cognitive ability, blood samples for biochemical parameters, oxidative stress, and chronic inflammation.

RESULTS

Dual-task RT significantly enhanced balance (p = 0.027) and 4 m walking speed (p = 0.027) post-training compared to the baseline. It also decreased the completion time for the sit-and-stand test both post-training (p = 0.008) and post-detraining (p = 0.015) relative to baseline. Cognitive ability showed significant improvements (p < 0.05). The CAT/TBARS ratio increased significantly post-training (p < 0.001) and remained elevated post-detraining. Nitric Oxide levels increased post-training (p < 0.05) and stayed higher post-detraining. The IL-10/TNF-α ratio significantly increased post-training (p < 0.05).

CONCLUSION

Dual-task RT performed over 12 weeks improved physical function, cognitive capacity, muscular strength, oxidative stress markers, and chronic inflammation in institutionalized older adults. Furthermore, these benefits were sustained even after a period of detraining.

Overview of Effects of Motor Learning Strategies in Neurologic and Geriatric Populations: A Systematic Mapping Review

Objective

To provide a broad overview of the current state of research regarding the effects of 7 commonly used motor learning strategies to improve functional tasks within older neurologic and geriatric populations.

Data Sources

PubMed, CINAHL, and Embase were searched.

Study Selection

A systematic mapping review of randomized controlled trials was conducted regarding the effectiveness of 7 motor learning strategies-errorless learning, analogy learning, observational learning, trial-and-error learning, dual-task learning, discovery learning, and movement imagery-within the geriatric and neurologic population.

Data Extraction

Two thousand and ninety-nine articles were identified. After screening, 87 articles were included for further analysis. Two reviewers extracted descriptive data regarding the population, type of motor learning strategy/intervention, frequency and total duration intervention, task trained, movement performance measures, assessment time points, and between-group effects of the included studies. The risk of bias 2 tool was used to assess bias; additionally, papers underwent screening for sample size justification.

Data Synthesis

Identified articles regarding the effects of the targeted motor learning strategies started around the year 2000 and mainly emerged in 2010. Eight populations were included, for example, Parkinson's and stroke. Included studies were not equally balanced: analogy learning (n=2), errorless learning and trial-and-error learning (n=5), mental practice (n=19), observational learning (n=11), discovery learning (n=0), and dual-tasking (n=50). Overall studies showed a moderate-to-high risk of bias. Four studies were deemed sufficiently reliable to interpret effects. Positive trends regarding the effects were observed for dual-tasking, observational learning, and movement imagery.

Conclusions

Findings show a skewed distribution of studies across motor learning interventions, especially toward dual-tasking. Methodological shortcomings make it difficult to draw firm conclusions regarding the effectiveness of motor learning strategies to improve functional studies. Future researchers are strongly advised to follow guidelines that aid in maintaining methodological quality. Moreover, alternative designs fitting the complex practice situation should be considered.

Mechanism-Driven Strategies for Reducing Fall Risk in the Elderly: A Multidisciplinary Review of Exercise Interventions

Falls among older adults present a major public health challenge, causing significant physical, psychological, and economic consequences. Exercise interventions are a proven strategy to reduce fall risk by targeting biomechanical, physiological, and psychological factors. This review examines evidence from 155 studies published between 2004 and 2024, including systematic reviews, meta-analyses, randomized controlled trials, and cohort studies. Data were rigorously screened and extracted using predefined criteria, with studies sourced from PubMed, MEDLINE, EBSCO (EDS), and additional gray literature identified via Google Scholar. Key findings show that balance and strength training improves postural control, gait stability, and neuromuscular coordination, while resistance training mitigates sarcopenia and enhances joint mobility. Cognitive exercises enhance attention, spatial awareness, decision-making, and psychological benefits like reduced fear of falling and greater social engagement. Multidisciplinary approaches integrating physical, cognitive, and social components deliver the most significant impact. This review underscores the value of evidence-based exercise programs in promoting active aging and enhancing the quality of life for older adults.

Comparative effects of cognitive and instability resistance training versus instability resistance training on balance and cognition in elderly women

This study investigates the effects of integrated instability resistance training and cognitive training (IRCT) versus isolated instability resistance training (IRT) on balance, gait, muscle strength, and cognitive functions in elderly women.This randomized controlled trial included 36 participants, with 18 in the IRCT group and 18 in the IRT group. The sample size was estimated to achieve a statistical power of 0.95 with a large effect size (0.40; n = 12 each group). The closed-eye single-leg stand test was measured for static balance, the closed-eye stepping test, and the Timed Up and Go Test (TUGT) were measured for dynamic balance. Dual-task balance was assessed by combining the TUGT with cognitive tasks (TUGT-C) and motor tasks (TUGT-M). Gait performance was evaluated using a gait function system. Lower limb muscle strength was measured with the 30-Second Chair Stand Test. Cognitive function was assessed through the Trail Making Test (TMT), Digit Span Test (DST), Stroop Color and Word Test (Stroop), and Digit Symbol Substitution Test (DSST). Results IRCT group showed better improvements in both cognitive (p < 0.001) and motor (p = 0.812 for baseline; p < 0.001 for post-intervention) dual-task abilities, IRCT also experienced better enhancement in certain cognitive functions, particularly in the TMT (p = 0.001) and DSST (p = 0.022) compared to the IRT group. Both groups demonstrated enhancements in walking abilities as shown on selective markers of the gait performance test (p < 0.05) and leg muscle strength via 30-Second Chair (p < 0.001 for time main effect). These results suggest that combining cognitive exercises with physical training more effectively addresses the complex challenges associated with aging in women. The study highlights the potential of comprehensive training approaches in boosting health and quality of life for the elderly, with implications for developing tailored exercise programs focused on reducing fall risks and enhancing quality of life in this population.

Virtual reality exergames for improving physical function, cognition and depression among older nursing home residents: A systematic review and meta-analysis

OBJECTIVE

To explore the effectiveness of virtual reality (VR) exergames on physical function, cognition and depression among older nursing home residents.

METHODS

A systematic review and meta-analysis were conducted. The PubMed, Ovid, Embase, Cochrane, CINAHL, and Web of Science databases were searched for relevant studies from inception until June 1, 2023. The reviewers independently completed the study selection, data extraction and quality assessment. Subgroup analyses were conducted to explore the sources of between-study heterogeneity and to determine whether participant or intervention characteristics influenced effect sizes.

RESULTS

Eighteen studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high, and the overall evidence grade was moderate. VR exergames had a large effect on physical function, including mobility [SMD=-0.66, P < 0.001], balance [SMD=0.95, P < 0.001], and lower limb strength [SMD=0.53, P = 0.0009]; and a moderate effect on cognition [SMD=0.48, P = 0.02] and depression [SMD=-0.72, P = 0.03]. Subgroup analyses revealed that a training frequency of 2 sessions per week and coordinating with physiotherapists yielded greater improvements in mobility (P = 0.009; P = 0.0001). VR exergames had especially beneficial effects on balance for physically fit participants (P = 0.03) and on cognition for participants with cognitive impairment (P = 0.01). Additionally, regarding the improvement of depression, commercial VR exergames were superior to self-made systems (P = 0.03).

CONCLUSION

VR exergames can provide a positive impact on physical function, cognition and depression among older nursing home residents. The study also demonstrated the different benefits of exergames between participants who were physically fit and those with cognitive impairment, which is considered as an innovative, cost-efficient and sustainable approach. Specifically, commercial VR exergame programs with a frequency of 2 sessions per week and coordinating with physiotherapists may be the most appropriate and effective option.

Effect of physio-cognitive dual-task training on cognition in pre-ageing and older adults with neurocognitive disorders: A meta-analysis and meta-regression of randomized controlled trial

Declines in cognitive performance, such as those seen in neurocognitive disorders (NCDs) are often associated with ageing. Both physical activity and cognitive training are common interventional strategies that can mitigate the decline in cognitive and physical performance. This review aims to (1) to evaluate the effects of Physio-Cognitive Dual-task Training (PCDT) intervention on cognition, physical performance, activities of daily living (ADL) and health-related quality of life (HRQoL) in pre-ageing and older adults with neurocognitive disorders, (2) explore the effects of covariates on intervention outcomes. A systematic search was conducted in eight databases. Cochrane's Risk of Bias Tool version 1 and GRADE criteria were used to assess risk of bias and certainty of evidence, respectively. Meta-analysis and meta-regression analyses were conducted using R software. Twenty-six randomized controlled trials involving 1,949 pre-ageing and older adults with NCDs were included in the meta-analysis. PCDT interventions had small-to-medium effect size on all cognition outcomes (g = 0.40-0.52) and instrumental ADL (g == 0.42), and a large effect size on HRQoL (g = 0.72). The quality of evidence was rated moderate to low for the outcome measures in pre-ageing and older adults with NCDs. These findings highlight the importance of PCDT interventions in preventing and slowing down cognitive impairment in pre-ageing and older adults. Registration: PROSPERO Number (CRD42020213962).