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Does combined physical and cognitive training improve dual-task balance and gait outcomes in sedentary older adults?
Fraser SA, Li KZ-H, Berryman N, Desjardins-Crepeau L, Lussier M, Vadaga K, Lehr L, Vu TTM, Bosquet L, Bherer L
Frontiers in Human Neuroscience 2017 Jan 18;10(688):Epub
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

Everyday activities like walking and talking can put an older adult at risk for a fall if they have difficulty dividing their attention between motor and cognitive tasks. Training studies have demonstrated that both cognitive and physical training regimens can improve motor and cognitive task performance. Few studies have examined the benefits of combined training (cognitive and physical) and whether or not this type of combined training would transfer to walking or balancing dual-tasks. This study examines the dual-task benefits of combined training in a sample of sedentary older adults. Seventy-two older adults (> 60 years) were randomly assigned to one of four training groups: aerobic plus cognitive training (CT), aerobic plus computer lessons (CL), stretch plus CT and stretch plus CL. It was expected that the aerobic plus CT group would demonstrate the largest benefits and that the active placebo control (stretch plus CL) would show the least benefits after training. Walking and standing balance were paired with an auditory n-back with two levels of difficulty (0- and 1-back). Dual-task walking and balance were assessed with: walk speed (m/s), cognitive accuracy (% correct) and several mediolateral sway measures for pre- to post-test improvements. All groups demonstrated improvements in walk speed from pre- (mean 1.33 m/s) to post-test (mean 1.42 m/s, p < 0.001) and in accuracy from pre- (mean 97.57%) to post-test (mean 98.57%, p = 0.005). They also increased their walk speed in the more difficult 1-back (mean 1.38 m/s) in comparison to the 0-back (mean 1.36 m/s, p < 0.001) but reduced their accuracy in the 1-back (mean 96.39%) in comparison to the 0-back (mean 99.92%, p < 0.001). Three out of the five mediolateral sway variables (peak, SD, RMS) demonstrated significant reductions in sway from pre to post test (p-values < 0.05). With the exception of a group difference between aerobic+CT and stretch plus CT in accuracy, there were no significant group differences after training. Results suggest that there can be dual-task benefits from training but that in this sedentary sample aerobic plus CT training was not more beneficial than other types of combined training.

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