Abstract
BackgroundOlder 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.MethodsSingle center parallel group single blind randomized 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.ResultsParticipants 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.ConclusionsThe 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 evidenced by reduced foot rolling movements).Trial registrationThe study was retrospectively registered in the German Clinical Trials Register (DRKS; Identification number DRKS00012382, 11.05.2017).
Highlights
Older adults with concerns of falling show decrements of gait stability under single (ST) and dual task (DT) conditions
The time × group interaction effects demonstrated a greater improvement for step length and gait line under single task (ST) and DT conditions of the intervention groups
Our results show that cognitive performance while walking did not improve in people with concern about falling (CoF), which confirms that they might require additional support through strategies such as Cognitive Behaviour Training (CBT) to minimize the interference of CoF on the capacity to perform tasks requiring attentional resources
Summary
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. Previous research [8] has demonstrated that CoF can induce gait adaptations, by manipulating the environment in a way that exacerbates the potential consequences of a fall. These experimental studies have suggested that CoF decreases walking speed and step length, and increases double support time. During the cognitive process the CoF competes for the limited resources of attentional focus to maintain balance control [11], resulting in an increased gait variability, instability and fall risk. Under DT conditions, a study by Donoghue et al [13] found reduced gait speed and step length, especially for older persons who reduced their daily physical activity due to their CoF
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