Effect of Feldenkrais exercises on dual task postural control in older adults.

Abstract

Dear editor Agmon et al1 recently published an interesting systematic review of interventions to improve dual-task postural control in older adults. Given that many everyday activities (eg, walking and carrying groceries) require dual-task postural control, this is an important topic. This type of research is integral to expanding scientific knowledge in the field of interventions. The authors describe the methods of the review process clearly. However, in our opinion, adherence to the stated methods is not always evident. First, in the abstract, the authors claim to select randomized and nonrandomized controlled studies. In contrast with the stated study selection, Table 1 shows that not all of the 22 studies included are in compliance with these design requirements; several uncontrolled studies were examined, including an earlier uncontrolled study by the authors. Second, at least one randomized controlled trial that fulfills the selection and inclusion criteria has not been considered in the review. Our randomized controlled trial examined the effects of a Feldenkrais intervention on balance, gait, and single-task and dual-task mobility.2 This study can be found in electronic databases with several of the mentioned search terms. Our research met all inclusion and selection criteria: participants were healthy, community-dwelling older adults aged 65 years and older; the intervention was conducted in a clinical setting; the one-hour Feldenkrais sessions were held three times per week for 5 weeks; one of the outcome measures was mobility under dual-task conditions (in our Feldenkrais study we used the Timed Up and Go with an added cognitive [TUGc]3 task, and several studies included in Agmon’s review used the same TUGc measure for examining dual-task performance, see Table 4 of the systematic review1); the article was published in English; and the randomized controlled trial excluded participants with neurologic disorders. After completion of the Feldenkrais intervention, participants improved significantly on balance (P=0.030), mobility under single-task conditions (P=0.042), and showed positive changes in mobility under dual-task conditions (P=0.067).2 The authors of the review underline in their discussion the prominence of dual-task training for improving dual-task performance. However, an important outcome of our publication is that a broad spectrum of activities that are part of the Feldenkrais method can result in improvements in both single-task performances and dual-task performance. From our perspective, this is an important piece of the puzzle and should be noted if we want to design evidence-based interventions based on current scientific knowledge.