Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial

摘要

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 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. 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 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?