Does dual task training improve walking performance of older adults with concern of falling? The Effects of EnhanceFitness (EF) Training on Dual-Task Walking in Older Adults Dual-task performances can be improved in patients with dementia Effects of a DVD-based seated dual-task stepping exercise on the fall risk factors among community-dwelling elderly adults. Effects of Physical-Cognitive Dual Task Training on Executive Function and Gait Performance in Older Adults: A Randomized Controlled Trial Seated stepping exercise in a dual-task condition improves ambulatory function with a secondary task: a randomized controlled trial. Group-based exercise combined with dual-task training improves gait but not vascular health in active older adults without dementia. Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: a preliminary investigation. Impact of Exercise to Improve Gait Efficiency on Activity and Participation in Older Adults With Mobility Limitations: A Randomized Controlled Trial Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial. Quantitative gait analysis under dual-task in older people with mild cognitive impairment: a reliability study Effects of dual-task switch exercise on gait and gait initiation performance in older adults: preliminary results of a randomized controlled trial. Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Single and dual task gait training in people with Parkinson's Disease: A protocol for a randomised controlled trial
Background Older adults with concerns of falling show decrements of gait stability under single ( ST ) and dual task ( DT ) conditions . To compare the effects of a DT training integrating task managing strategies for independent living older adults with and without concern about falling ( CoF ) to a non-training control group on walking performance under ST and DT conditions . Methods Single center parallel group single blind r and omized controlled trial with group-based interventions ( DT-managing balance training ) compared to a control group ( Ninety-five independent living older adults ; 71.5 ± 5.2 years).A  progressive DT training ( 12 sessions ; 60 min each ; 12 weeks ) including task-managing strategies was compared to a non-training control group . Setting : group based intervention for independent living elderly in a gym .  ST and DT walking ( visual verbal Stroop task ) were measured on a treadmill . Gait parameters ( step length , step width , and gait line ) and cognitive performance while walking were compared with a 2x2x2 Repeated Measures Analyses of Variance . Results Participants in the intervention group showed an increased step length under ST and DT conditions following the intervention , for both people with and without CoF compared to their respective control groups . Foot rolling movement and cognitive performance while walking however only improved in participants without CoF. Conclusions The results showed that DT managing training can improve walking performance under ST and DT conditions in people with and without CoF. Additional treatment to directly address CoF , such as cognitive behavioural therapy , should be considered to further improve the cautious gait pattern ( as evidence d by reduced foot rolling movements).Trial registration The study was retrospectively registered in the German Clinical Trials Register ( DRKS ; Identification number DRKS00012382 , 11.05.2017 ) Decline in dual-task walking performance is associated with increased risk of falls among older adults . The objective of this study is to determine whether 18 hr of participation in EnhanceFitness ( EF ) , an evidence -based group exercise program , improves dual-task walking performance among community-dwelling older adults . Twenty-eight healthy , community-dwelling older adults were evaluated before participating in EF and after 18 hr of participation . Gait speed was evaluated under single task and dual tasks using the TUG ( Timed Up and Go ) and 1-min walk tests . Dual-task costs ( DTC ) , the relative cost of dual-task performance compared to single-task performance , were calculated for both cognitive and motor tasks . Postural control and executive functions were evaluated as well . After 18 hr of EF , dual-task walking performance improved . Single-task performance improved as well as postural control and executive function . There was no significant change in DTC across all measurements , except for the cognitive task of the TUG Background : Deficits in attention-related cognitive performance measured as dual-task performance represent early markers of dementia and are associated with motor deficits and increased risk of falling . The purpose of this study was to examine the effect of a specific dual-task training in patients with mild to moderate dementia . Methods : Sixty-one geriatric patients with confirmed dementia took part in a 12-week r and omized , controlled trial . Subjects in the intervention group ( IG ) underwent dual-task – based exercise training . The control group ( CG ) performed unspecific low-intensity exercise .  Motor performance ( gait speed , cadence , stride length , stride time , single support ) and cognitive performance ( serial 2 forward calculation [ S2 ] , serial 3 backward calculation [ S3 ] ) were examined as single and dual tasks . Decrease in performance during dual tasks compared to single task expressed as motor , cognitive , and combined motor/cognitive dual-task cost ( DTC ) was calculated before and after intervention . Primary outcome was defined as DTC for gait speed under complex S3 conditions . Results : Specific training significantly improved dual-task performance under complex S3 conditions compared to the CG ( reduction of DTC : gait speed 21.7 % IG , 2.6 % CG , p < 0.001 ; other gait variables : 8.7 % to 41.1 % IG , −0.9 % to 8.1 % CG , p ≤ 0.001 to 0.056 ; combined motor/cognitive : 20.6 % IG , 2.2 % CG , p = 0.026 ) . No significant effects were found under less challenging dual-task S2 conditions or for cognitive dual-task S3 performance . Conclusions : The specific exercise program was effective to improve dual-task performance in patients with dementia . Classification of evidence : This study provides Class II evidence that specific dual-task training  improves dual-task performance during walking under complex S3 conditions in geriatric patients with mild to moderate dementia OBJECTIVE The purpose of this r and omized control trial study was to evaluate the effectiveness of a digital video disc (DVD)-based seated dual-task ( DT ) stepping exercise to improve the DT walking capability  in elderly people . In the DT exercise , participants were asked to perform a verbal fluency task while stepping as quickly as possible . METHODS Eight clusters ( n=93 ) r and omized into a DVD group ( 4 clusters , n=48 ) and a nonexercise control group ( 4 clusters , n=45 ) participated in this trial . In the DVD group , participants received 20 min of group training twice a week for 24 weeks . The exercise class used an exercise DVD that included a 15-min basic exercise and a 5-min DT exercise . No exercise program was prescribed for the control group . The measurements were based on the difference in physical function , including DT walking , between the DVD and control groups . In the DT walking test , participants walked individually at a comfortable speed while carrying a ball on a tray . The relative DT lag was calculated by using simple walking as the comparison condition . The Timed Up and Go test and the 5-chair st and test were also performed . RESULTS The median relative adherence to the study was 87.5 % ( 25th-75th percentile , 83.3%-95.8 % ) in the DVD group . The outcome measurements , including the DT walking time and DT time lag ( p<0.05 ) , among participants in the DVD group were significantly improved . However , other outcome measurements were not significantly different between the two groups ( p>0.05 ) . CONCLUSION The current study reports the effectiveness of a DVD-based exercise for the improvement of the DT walking capability . A larger study is needed to confirm the present results . Study of a Web-based exercise regime would be valuable to identify the most effective exercise for prevention of falls and fall-related fractures Physical and cognitive training seem to counteract age-related decline in physical and mental function . Recently , the possibility of integrating cognitive dem and s into physical training has attracted attention . The purpose of this study was to evaluate the effects of twelve weeks of design ed physical-cognitive training on executive cognitive function and gait performance in older adults . Thirty-six healthy , active individuals aged 72.30 ± 5.84 years were assigned to two types of physical training with major focus on physical single task ( ST ) training ( n = 16 ) and physical-cognitive dual task ( DT ) training ( n = 20 ) , respectively . They were tested before and after the intervention for executive function ( inhibition , working memory ) through R and om Number Generation and for gait ( walking with/without negotiating hurdles ) under both single and dual task ( ST , DT ) conditions . Gait performance improved in both groups , while inhibitory performance decreased after exercise training with ST focus but tended to increase after training with physical-cognitive DT focus . Changes in inhibition performance were correlated with changes in DT walking performance with group differences as a function of motor task complexity ( with/without hurdling ) . The study supports the effectiveness of group exercise classes for older individuals to improve gait performance  , with physical-cognitive DT training selectively counteracting the age-related decline in a core executive function essential for daily living BACKGROUND AND AIMS A close relationship exists between dual-task (DT)-related gait changes and the risk of falling in the elderly . However , the impact of DT training on the incidence of falls in the elderly remains unclear . We aim ed to evaluate the effects of a seated stepping exercise in DT conditions to improve walking ability in community-dwelling elderly . METHODS This was a r and omized controlled trial ( RCT ) in community-dwelling elderly in Japan . Fifty-three participants were r and omly assigned to a DT group ( stepping exercise in DT conditions , n=26 ) and a singletask ( ST ) group ( stepping exercise in ST conditions , n=27 ) . All participants received 50 min group training sessions , once a week for 24 weeks . Outcome measures were based on differences in walking ability in singletask ( ST ) , cognitive-task ( CT ) , and manual-task ( MT ) conditions between DT and ST groups . RESULTS Participants in the DT group showed significantly greater improvement in outcome measures , including 10-m gait speed , walking cadence , and cost during cognitive and manual tasks . The number of enumerated figures during CT , as well as the numbers of steps taken and of enumerated figures during stepping with MT demonstrated significant Group × Time interactions ( p<0.05 ) . CONCLUSIONS This RCT suggests that the seated stepping exercise is more effective at improving ambulatory function in DT conditions than in ST conditions BACKGROUND Gait abnormalities and vascular disease risk factors are associated with cognitive impairment in aging . OBJECTIVE To determine the impact of group-based exercise and dual-task training on gait and vascular health , in active community-dwelling older adults without dementia . METHODS Participants [ n=44 , mean ( SD ) age : 73.5 ( 7.2 ) years , 68 % female ] were r and omized to either  intervention ( exercise+dual-task ; EDT ) or control ( exercise only ; EO ) . Each week , for 26 weeks , both groups accumulated 50 or 75 min of aerobic exercise from group-based classes and 45 min of beginner-level square stepping exercise ( SSE ) . Participants accumulating only 50 min of aerobic exercise were instructed to participate in an additional 25 min each week outside of class . The EDT group also answered cognitively challenging questions  while performing SSE ( i.e. , dual-task training ) . The effect of the interventions on gait and vascular health was compared between groups using linear mixed effects models . RESULTS At 26 weeks , the EDT group demonstrated increased dual-task ( DT ) gait velocity [ difference between groups in mean change from baseline ( 95 % CI ) : 0.29 m/s ( 0.16 - 0.43 ) , p<0.001 ] , DT step length [ 5.72 cm ( 2.19 - 9.24 ) , p = 0.002 ] , and carotid intima-media thickness [ 0.10 mm ( 0.003 - 0.20 ) , p=0.04 ] , as well as reduced DT stride time variability [ 8.31 coefficient of variation percentage points ( -12.92 to -3.70 ) , p<0.001 ] , when compared to the EO group . CONCLUSIONS Group-based exercise combined with dual-task training can improve DT gait characteristics in active older adults without dementia The present study highlights the effects of the dual-task cognitive-gait intervention ( CGI ) on working memory and gait functions in older adults with a history of falls . Thirteen older adults with a history of falls were recruited from local community centers and r and omly stratified into either the control ( n = 5 ) or experimental ( n = 8) group . The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor ( walking ) and cognitive ( memory recall ) task whereas the control group received a placebo treatment ( walking with simple music ) . The intervention was provided 30 minutes per session , over a 6-week period . Memory measures included a combination of word recall and arithmetic task . Gait function measures included velocity and center of pressure ( COP ) stability . Non-parametric tests were used at p < 0.05 . The experimental group showed a greater memory performance than the control ( p < 0.05 ) . However , no significant intervention-related changes in gait velocity and stability were observed . Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition Background Definitive evidence that exercise interventions that improve gait also reduce disability is lacking . A task-oriented , motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed , but whether the intervention also improves activity and participation has not been demonstrated . Objective The objective of this study was to compare the impact of a task-oriented , motor sequence learning exercise ( TO ) intervention and the impact of an impairment-oriented , multicomponent exercise ( IO ) intervention on activity and participation outcomes in older adults with mobility limitations . The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined . Design This study was a single-blind , r and omized controlled trial . Setting The study was conducted in an ambulatory clinical research training center . Participants The study participants were 47 older adults ( mean age=77.2 years , SD=5.5 ) with slow and variable gait . Intervention The intervention was a 12-week , physical therapist – guided program of TO or IO . Measurements Measures of activity ( gait speed over an instrumented walkway ; daily physical activity measured with an accelerometer ; confidence in walking determined with the Gait Efficacy Scale ; and physical function determined with the total , basic lower-extremity , and advanced lower-extremity components of the Late-Life Function and Disability Instrument [ Late-Life FDI ] ) and participation ( disability limitation dimension and instrumental role [ home and community task performance ] domain components of the Late-Life FDI ) were recorded before and after the intervention . The energy cost of walking was determined from the rate of oxygen consumption during self-paced treadmill walking at the physiological steady state st and ardized by walking speed . An adjusted comparison of activity and participation outcomes in the treatment arms was made by use of an analysis of covariance model , with baseline and change in energy cost of walking added to the model to test for mediation . Tests were used to determine the significance of the mediating effects . Results Activity improved in TO but not in IO for confidence in walking ( Gait Efficacy Scale ; mean adjusted difference=9.8 [ SD=3.5 ] ) and physical function ( Late-Life FDI basic lower-extremity component ; mean adjusted difference=3.5 [ SD=1.7 ] ) . Improvements in TO were marginally greater than those in IO for gait speed , physical activity , and total physical function . Participation improved marginally more in TO than in IO for disability limitations and instrumental role . Limitations The older adults were r and omized to the intervention group , but differences in baseline measures had to be accounted for in the analyses . Conclusions A TO intervention that improved gait also led to improvements in some activity and participation outcomes in older adults with mobility limitations Background Exercise interventions often do not combine physical and cognitive training . However , this combination is assumed to be more beneficial in improving walking and cognitive functioning compared to isolated cognitive or physical training . Methods A multicenter parallel r and omized controlled trial was conducted to compare a motor to a cognitive-motor exercise program .  A total of 182 eligible residents of homes-for-the-aged ( n = 159 ) or elderly living in the vicinity of the homes ( n = 23 ) were r and omly assigned to either strength-balance ( SB ) or strength-balance-cognitive ( SBC ) training . Both groups conducted similar strength-balance training during 12 weeks . SBC additionally absolved computerized cognitive training . Outcomes were dual task costs of walking , physical performance , simple reaction time , executive functions , divided attention , fear of falling and fall rate . Participants were analysed with an intention to treat approach . Results The 182 participants ( mean age ± SD : 81.5 ± 7.3 years ) were allocated to either SB ( n = 98 ) or SBC ( n = 84 ) . The attrition rate was 14.3 % . Interaction effects were observed for dual task costs of step length ( preferred walking speed : F(1,174 ) = 4.94 , p = 0.028 , η2 = 0.027 , fast walking speed : F(1,166 ) = 6.14 , p = 0.009 , η2 = 0.040 ) and dual task costs of the st and ard deviation of step length ( F(1,166 ) = 6.14 , p = 0.014 , η2 = 0.036 ) , in favor of SBC . Significant interactions in favor of SBC revealed for in gait initiation ( F(1,166 ) = 9.16 , p = 0.003 , η2 = 0.052 ) , ‘ reaction time ’ ( F(1,180 ) = 5.243 , p = 0.023 , η2 = 0.028 ) & ‘ missed answers ’ ( F(1,180 ) = 11.839 , p = 0.001 , η2 = 0.062 ) as part of the test for divided attention . Within-group comparison revealed significant improvements in dual task costs of walking ( preferred speed ; velocity ( p = 0.002 ) , step time ( p = 0.018 ) , step length ( p = 0.028 ) , fast speed ; velocity ( p < 0.001 ) , step time ( p = 0.035 ) , step length ( p = 0.001 ) ) , simple reaction time ( p < 0.001 ) , executive functioning ( Trail making test B ; p < 0.001 ) , divided attention ( p < 0.001 ) , fear of falling ( p < 0.001 ) , and fall rate ( p < 0.001 ) . Conclusions Combining strength-balance training with specific cognitive training has a positive additional effect on dual task costs of walking , gait initiation , and divided attention . The findings further confirm previous research showing that strength-balance training improves executive functions and reduces falls . Trial registration This trial has been registered under IS RCT The purpose of this study was to compare the efficiency of three different balance training strategies in an effort to underst and the mechanisms underlying training-related changes in dual-task balance performance of older adults with balance impairment . Elderly individuals with balance impairment , age 65 and older , were r and omly assigned to one of three individualized training programs : single-task ( ST ) balance training ; dual-task training with fixed-priority ( FP ) instruction ; and dual-task training with variable-priority ( VP ) instruction .  Balance control during gait , under practice d and novel conditions , was assessed by calculating the center of mass and ankle joint center inclination angles in the frontal plane . A smaller angle indicated better balance performance . Other outcomes included gait velocity , stride length , verbal reaction time , and rate of response . All measures were collected at baseline and the end of the 4-week training . Results indicated that all training strategies were equally effective ( P>.05 ) at improving balance performance ( smaller inclination angle ) under single-task context s. However , the VP training strategy was more effective ( P=.04 ) in improving both balance and cognitive performance under dual-task conditions than either the ST or the FP training strategies . Improved dual-task processing skills did not transfer to a novel dual-task condition . Results support Kramer et al. 's proposal that VP training improves both single-task automatization and the development of task-coordination skills Background Reliability of quantitative gait assessment while dual-tasking ( walking while doing a secondary task such as talking ) in people with cognitive impairment is unknown . Dual-tasking gait assessment is becoming highly important for mobility research with older adults since better reflects their performance in the basic activities of daily living . Our purpose was to establish the test-retest reliability of assessing quantitative gait variables using an electronic walkway in older adults with mild cognitive impairment ( MCI ) under single and dual-task conditions . Methods The gait performance of 11 elderly individuals with MCI was evaluated using an  electronic walkway ( GAITRite ® System ) in two sessions , one week apart . Six gait parameters ( gait velocity , step length , stride length , step time , stride time , and double support time ) were assessed under two conditions : single-task ( sG : usual walking ) and dual-task ( dG : counting backwards from 100 while walking ) . Test-retest reliability was determined using intra-class correlation coefficient ( ICC ) . Gait variability was measured using coefficient of variation ( CoV ) . Results Eleven participants ( average age = 76.6 years , SD = 7.3 ) were assessed . They were high functioning ( Clinical Dementia Rating Score = 0.5 ) with a mean Mini-Mental Status Exam ( MMSE ) score of 28 ( SD = 1.56 ) , and a mean Montreal Cognitive Assessment ( MoCA ) score of 22.8 ( SD = 1.23 ) . Under dual-task conditions , mean gait velocity ( GV ) decreased significantly ( sGV = 119.11 ± 20.20 cm/s ; dGV = 110.88 ± 19.76 cm/s ; p = 0.005 ) . Additionally , under dual-task conditions , higher gait variability was found on stride time , step time , and double support time . Test-retest reliability was high ( ICC>0.85 ) for the six parameters evaluated under both conditions . Conclusion In older people with MCI  , variability of time-related gait parameters increased with dual-tasking suggesting cognitive control of gait performance . Assessment of quantitative gait variables using an electronic walkway is highly reliable under single and dual-task conditions . The presence of cognitive impairment did not preclude performance of dual-tasking in our sample supporting that this methodology can be reliably used in cognitive impaired older individuals Few studies have reported the effect of exercise intervention for improving postural control deficit in older adults at high risk of falling . We have developed a " Dual-task Switch Exercise ( DSE ) " program that focuses on gait initiation performance under the dual-task condition . The purpose of this study was to evaluate whether gait initiation performance could be improved by a specific exercise intervention .  Eighteen participants were r and omly assigned to either DSE or control groups . The DSE group received focused training to improve the ability to initiate movements quickly under the dual-task condition . The control group received steady-state walking training . After 30-min of seated training sessions , participants received 5-min individualized training sessions once a week for 24 weeks . In the pre- and post-training period , performance of the steady-state gait ( 10-m walking time ) and gait initiation ( reaction time , backward center of pressure ( COP ) displacement ) were measured under the single- and dual-task conditions . The results of a r and omized clinical trial showed that both groups showed improvement of steady-state walking time under the dual-task condition ( main effect of time ; p=0.018 ) . However , DSE was more effective in improving both the reaction time and backward COP displacement during gait initiation under the dual-task condition than control ( interaction effect of time × group ; reaction time , p=0.015 ; COP displacement , p=0.011 ) . There were no significant differences in steady-state gait and gait initiation performance under the single-task condition between pre- and post-training in both groups . Only the specific exercise intervention  improved gait initiation performance under the dual-task condition Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov OBJECTIVE To examine the effectiveness of a dual-task-based exercise program on walking ability in subjects with chronic stroke . DESIGN Single-blind r and omized controlled trial . SETTING General community . PARTICIPANTS Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects ( a minimum gait velocity , 58cm/s ) . INTERVENTIONS Participants were r and omized into a  control group ( n=12 ) or experimental group ( n=13 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group underwent a 4-week ball exercise program . MAIN OUTCOME MEASURES Gait performance was measured under single task ( preferred walking ) and tray-carrying task . Gait parameters of interest were walking speed , cadence , stride time , stride length , and temporal symmetry index . RESULTS The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions . In the control group , there were no significant changes over the 4-week period for all selected measures . There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions . CONCLUSIONS The dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke OBJECTIVE To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment . DESIGN A double-blind , r and omized controlled trial . SETTING University research laboratory . PARTICIPANTS Older adults ( N=23 ) with balance impairment ( mean age , 74.8y ) . They scored 52 or less on the Berg Balance Scale ( BBS )  and /or walked with a self-selected gait speed of 1.1 m/s or less . INTERVENTIONS Participants were r and omly assigned to 1 of 3 interventions : single-task training , dual-task training with fixed-priority instructions , and dual-task training with variable-priority instructions . Participants received 45-minute individualized training sessions , 3 times a week for 4 weeks . MAIN OUTCOME MEASURES Gait speed under single-task and dual-task conditions was obtained at baseline , the second week , the end of training , and the twelfth week after the end of training . Other measures , including the BBS and the Activities-specific Balance Confidence ( ABC ) Scale , were collected at baseline and after training . RESULTS Participants in all groups improved on the BBS ( P<.001 ; effect size [ES]=.72 ) , and walked significantly faster after training ( P=.02 ; ES=.27 ) . When a cognitive task was added , however , only participants who received dual-task training with fixed-priority instructions and dual-task training with variable-priority instructions exhibited significant improvements in gait speed ( P<.001 , ES=.57 ; and P<.001 , ES=.46 , respectively ) . In addition , only the dual-task training with variable-priority instructions group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up . Only the single-task training group showed a significant increase on the ABC after training ( P<.001 ; ES=.61 ) . CONCLUSIONS Dual-task training is effective in improving gait speed under dual-task conditions in elderly participants with balance impairment . Training balance under single-task conditions may not generalize to balance control during dual-task context s. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect Background Difficulty performing more than one task at a time ( dual tasking ) is a common and disabling problem experienced by people with Parkinson disease ( PD ) . If asked to perform another task when walking , people with PD often take shorter steps or walk more slowly . Currently there is uncertainty about whether clinicians should teach people with PD to avoid dual tasking or whether they should encourage them to practice dual tasking with the hope that practice will lead to enhanced performance . This study will address this issue by comparing single to dual task gait training . Methods and design A prospect i ve r and omised clinical trial is being conducted . Sixty participants with idiopathic PD will be recruited , provided they score I-IV on the modified Hoehn and Yahr ( 1967 ) scale , and fulfil other inclusion criteria . Participants will be r and omly allocated to either a single or dual task gait training group . Both groups will receive 12 hours of walking training over 4 weeks . The single task group will undertake gait training with cueing strategies to increase step length . The dual task group will train to improve step length when walking and performing a variety of added tasks . Both groups will receive a tailored home program for 6 months . Blinded assessors will conduct four assessment s : two baseline assessment s , one post intervention and one at 6 months follow-up . The primary outcome measure will be step length when dual tasking over 8 m. Secondary outcome measures include : spatiotemporal gait parameters when walking under single and dual task conditions , measures of executive function , the timed up and go test , measures of community mobility , and quality of life . All analyses will be based on intention to treat principle . Discussion This trial will examine the immediate and longer term effect of dual task walking training as compared to single task training in people with idiopathic PD , at the impairment , activity , and participation levels . It has the potential to identify a new intervention that may improve and maintain walking beyond the laboratory . The results of this trial will provide guidance for clinicians in the development of walking training programs for people with PD.Trial Registration
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
Dual-task interference during walking can substantially limit mobility and increase the risk of  falls among community-dwelling older adults .
Previous systematic review s 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 .