Abstract
BackgroundExercise 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.MethodsA multicenter parallel randomized 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 randomly 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.ResultsThe 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 standard 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).ConclusionsCombining 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 registrationThis trial has been registered under ISRCTN75134517Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2318-14-134) contains supplementary material, which is available to authorized users.
Highlights
Exercise interventions often do not combine physical and cognitive training
We demonstrated in this study an additional effect of our cognitive program in the sense that the dual task costs (DTC) of walking were minimized especially in the SBC group
Strength-balance-cognitive training reduced dual task costs of walking and improved gait initiation, and divided attention was merely improved by the cognitive-motor group
Summary
Exercise interventions often do not combine physical and cognitive training. The progressive and dynamic aging process is characterized by functional and cognitive changes that often lead to physical performance deficits and deteriorations in walking. These changes occur even in the absence of overt diseases. Potential consequences are increased risk for falls, loss of independence in activities of daily living, and poor quality of life [1,2,3,4,5]. Functional dependence in older adults is associated with increased health care costs and mortality [6,7,8]. One key factor in staying independent and maintaining mobility is, to enhance walking ability in older adults
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