title: The effect of rhythmic musical training on healthy older adults' gait and cognitive function. Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: Part 2 of a Phase II Preclinical Exploratory Trial Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Transfer effects of fall training on balance performance and spatiotemporal gait parameters in healthy community-dwelling older adults: a pilot study. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial. Effectiveness of a Targeted Exercise Intervention in Reversing Older People's Mild Balance Dysfunction: A Randomized Controlled Trial Effects of simultaneously performed cognitive and physical training in older adults A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial Meaningful change and responsiveness in common physical performance measures in older adults. Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Rhythmic stepping exercise under cognitive conditions improves fall risk factors in community-dwelling older adults: Preliminary results of a cluster-randomized controlled trial Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians The effect of a cognitive-motor intervention on voluntary step execution under single and dual task conditions in older adults: a randomized controlled pilot study A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: a randomized controlled trial Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older. Effects of a DVD-based seated dual-task stepping exercise on the fall risk factors among community-dwelling elderly adults. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Trail-walking exercise and fall risk factors in community-dwelling older adults: preliminary results of a randomized controlled trial. Physical training-related changes in gait variability while single and dual tasking in older adults: magnitude of gait variability at baseline matters. Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: a preliminary investigation. Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial A randomized controlled pilot study assessing the feasibility of combined motor–cognitive training and its effect on gait characteristics in the elderly Effects of an Interactive Computer Game Exercise Regimen on Balance Impairment in Frail Community-Dwelling Older Adults: A Randomized Controlled Trial Effects of dual-task switch exercise on gait and gait initiation performance in older adults: preliminary results of a randomized controlled trial. Functional benefits of tai chi training in senior housing facilities. The Effects of EnhanceFitness (EF) Training on Dual-Task Walking in Older Adults
abstract: PURPOSE OF THE STUDY Older adults ' gait is disturbed when a dem and ing secondary cognitive task is added . Gait training has been shown to improve older adults ' walking performance , but it is not clear how training affects their cognitive performance . This study examined the impact on gait , in terms of cost or benefit to cognitive performance , of training healthy older adults to walk to a rhythmic musical beat . DESIGN AND METHODS In a mixed model design , 45 healthy older adults aged more than 65 years ( M = 71.7 years ) were r and omly assigned to 3 groups . One group received a rhythmic musical training and their dual-task ( DT ) walking and cognitive performances were compared with a group who had music playing in the background but no training , and a third group who heard no music and received no training . Outcomes in single-task ( ST ) and DT conditions were step-time variability and velocity for gait and correct cognitive responses for the cognitive task . RESULTS The Musical Training group 's step-time variability improved in both the ST ( p < .05 ) and the DT ( p < .05 ) after training , without adversely affecting their cognitive performance . No change was seen in the control groups . IMPLICATION S Rhythmic musical training can improve gait steadiness in healthy older adults with no negative impact on concurrent cognitive functioning . This could potentially enhance " postural reserve " and reduce fall risk Background Home-based exercise programs can improve physical functioning and health status of elderly people . Successful implementation of exercise interventions for older people presents major challenges and supporting elderly people properly while doing their home-based exercises is essential for training success . We developed a tablet-based system — ActiveLifestyle — that offers older adults a home-based strength-balance training program with incorporated motivation strategies and support features . Objective The goal was to compare 3 different home-based training programs with respect to their effect on measures of gait quality and physical performance through planned comparisons between ( 1 ) tablet-based and brochure-based interventions , ( 2 ) individual and social motivation strategies , and ( 3 ) active and inactive participants . Methods A total of 44 autonomous-living elderly people ( mean 75 , SD 6 years ) were assigned to 3 training groups : social ( tablet guided , n=14 ) , individual ( tablet guided , n=13 ) , and brochure ( brochure guided , n=17 ) . All groups joined a 12-week progressive home-based strength-balance training program . Outcome measures were gait performance under single and dual task conditions , dual task costs of walking , falls efficacy , and physical performance as measured by the Short Physical Performance Battery ( SPPB ) . Furthermore , active ( ≥75 % program compliance ) and inactive ( < 75 % program compliance ) individuals were compared based on their characteristics and outcome measures . Results The tablet groups showed significant improvements in single and dual task walking , whereas there were no significant changes observable in the brochure group . Between-groups comparisons revealed significant differences for gait velocity ( U=138.5 ; P=.03 , r=.33 ) and cadence ( U=138.5 , P=.03 r=.34 ) during dual task walking at preferred speed in favor of the tablet groups . The brochure group had more inactive participants , but this did not reach statistical significance ( U=167 , P=.06 , r=.29 ) . The active participants outperformed the inactive participants in single and dual task walking , dual task costs of walking , and SPPB scores . Significant between-groups differences were seen between the tablet groups and the brochure group , in favor of the tablet groups . Conclusions A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program . Social or individual motivation strategies were equally effective . The most prominent differences were observed between active and inactive participants . These findings suggest that in older adults a tablet-based intervention enhances training compliance ; hence , it is an effective way to improve gait Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov This study examined transfer effects of fall training on fear of falling ( Falls Efficacy Scale-International [ FES-I ] ) , balance performance , and spatiotemporal gait characteristics in older adults . Eighteen community-dwelling older adults ( ages 65 - 85 ) were r and omly assigned to an intervention or control group . The intervention group completed 12 training sessions ( 60 min , 6 weeks ) . During pre- and posttesting , we measured FES-I , balance performance ( double limb , closed eyes ; single limb , open eyes ; double limb , open eyes with motor-interfered task ) , and gait parameters ( e.g. , velocity ; cadence ; stride time , stride width , and stride length ; variability of stride time and stride length ) under single- and motor-interfered tasks . Dual tasks were applied to appraise improvements of cognitive processing during balance and gait . FES-I ( p = .33 ) and postural sway did not significantly change ( 0.36 < p < .79 ) . Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task ( p = .05 , ηp 2 = .22 ) . Fall training did not sufficiently improve fear of falling , balance , or gait performance under single- or dual-task conditions in healthy older adults Objective : To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy , fear of falling , gait and balance performance , and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects . Design : R and omized controlled trial , including three groups : two intervention groups ( Training , or Training+Physical activity ) and one Control group , with a 12-week follow-up . Setting : Stockholm County , Sweden . Participants : Ninety-six older adults , aged 66 - 87 , with verified osteoporosis . Interventions : A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks , and physical activity for 30 minutes , three times/week . Main measures : Fall-related self-efficacy ( Falls Efficacy Scale-International ) , fear of falling ( single-item question – ‘ In general , are you afraid of falling ? ’ ) , gait speed with and without a cognitive dual-task at preferred pace and fast walking ( GAITRite ® ) , balance performance tests ( one-leg stance , and modified figure of eight ) , and physical function ( Late-Life Function and Disability Instrument ) . Results : Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls ( p ≤ 0.034 , 4 points ) and improved their balance performance . Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task ( p=0.003 ) , at fast walking speed ( p=0.008 ) , and for advanced lower extremity physical function ( p=0.034 ) . Conclusions : This balance training program , including dual- and multi-task , improves fall-related self-efficacy , gait speed , balance performance , and physical function in older adults with osteoporosis The purpose of this study was to compare the efficiency of three different balance training strategies in an effort to underst and the mechanisms underlying training-related changes in dual-task balance performance of older adults with balance impairment . Elderly individuals with balance impairment , age 65 and older , were r and omly assigned to one of three individualized training programs : single-task ( ST ) balance training ; dual-task training with fixed-priority ( FP ) instruction ; and dual-task training with variable-priority ( VP ) instruction .  Balance control during gait , under practice d and novel conditions , was assessed by calculating the center of mass and ankle joint center inclination angles in the frontal plane . A smaller angle indicated better balance performance . Other outcomes included gait velocity , stride length , verbal reaction time , and rate of response . All measures were collected at baseline and the end of the 4-week training . Results indicated that all training strategies were equally effective ( P>.05 ) at improving balance performance ( smaller inclination angle ) under single-task context s. However , the VP training strategy was more effective ( P=.04 ) in improving both balance and cognitive performance under dual-task conditions than either the ST or the FP training strategies . Improved dual-task processing skills did not transfer to a novel dual-task condition . Results support Kramer et al. 's proposal that VP training improves both single-task automatization and the development of task-coordination skills Background Previous research has mainly targeted older people with high risk of falling . The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored . Objective This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematic ally screened as having mild balance dysfunction . Design This was a community-based , r and omized controlled trial with assessors blinded to group allocation . Participants Study participants were older people who reported concerns about their balance but remained community ambulant ( n=225 ) . After a comprehensive balance assessment , those classified as having mild balance dysfunction ( n=165 ) were r and omized into the trial . Intervention Participants in the intervention group ( n=83 ) received a 6-month physical therapist – prescribed balance and strength home exercise program , based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit . Participants in the control group ( n=82 ) continued with their usual activities . Outcome Measures Laboratory and clinical measures of balance , mobility , and strength were assessed at baseline and at a 6-month re assessment . Results After 6 months , the intervention group ( n=59 ) significantly improved relative to the control group ( n=62 ) for : the Functional Reach Test ( mean difference=2.95 cm , 95 % confidence interval [CI]=1.75 to 4.15 ) , the Step Test ( 2.10 steps/15 seconds , 95 % CI=1.17 to 3.02 ) , hip abductor strength ( 0.02 , 95 % CI=0.01 to 0.03 ) , and gait step width ( 2.17 cm , 95 % CI=1.23 to 3.11 ) . There were nonsignificant trends for improvement on most other measures . Fourteen participants in the intervention group ( 23.7 % ) achieved balance performance within the normative range following the exercise program , compared with 3 participants ( 4.8 % ) in the control group . Limitations Loss to follow-up ( 26.6 % ) was slightly higher than in some similar studies but was unlikely to have biased the results . Conclusions A physical therapist – prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment Background While many studies confirm the positive effect of cognitive and physical training on cognitive performance of older adults , only little is known about the effects of simultaneously performed cognitive and physical training . In the current study , older adults simultaneously performed a verbal working memory and a cardiovascular training to improve cognitive and motor-cognitive dual task performance . Twenty training sessions of 30 minutes each were conducted over a period of ten weeks , with a test session before , in the middle , and after the training . Training gains were tested in measures of selective attention , paired-associates learning , executive control , reasoning , memory span , information processing speed , and motor-cognitive dual task performance in the form of walking and simultaneously performing a working memory task . Results Sixty-three participants with a mean age of 71.8 ± 4.9 years ( range 65 to 84 ) either performed the simultaneous training ( N = 21 ) , performed a single working memory training ( N = 16 ) , or attended no training at all ( N = 26 ) . The results indicate similar training progress and larger improvements in the executive control task for both training groups when compared to the passive control group . In addition , the simultaneous training result ed in larger improvements compared to the single cognitive training in the paired-associates task and was able to reduce the step-to-step variability during the motor-cognitive dual task when compared to the single cognitive training and the passive control group . Conclusions The simultaneous training of cognitive and physical abilities presents a promising training concept to improve cognitive and motor-cognitive dual task performance , offering greater potential on daily life functioning , which usually involves the recruitment of multiple abilities and re sources rather than a single one Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = .041 , r = .45 ) and for single support time ( U = 24 , P = .029 , r = .48 ) during the fast walking dual task condition in favor of the dance group . No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy . Conclusions There was a significant interaction in favor of the dance video game group for improvements in step time . Significant improved fast walking performance under dual task conditions ( velocity , double support time , step length ) was observed for the dance video game group only . These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program . Trial registration This trial has been registered under IS RCT N05350123 ( http://www.controlled-trials.com OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change BACKGROUND Falls occur mainly while walking or performing concurrent tasks . We determined whether a music-based multitask exercise program improves gait and balance and reduces fall risk  in elderly individuals . METHODS We conducted a 12-month r and omized controlled trial involving 134 community-dwelling individuals older than 65 years , who are at increased risk of falling . They were r and omly assigned to an intervention group ( n = 66 ) or a delayed intervention control group scheduled to start the program 6 months later ( n = 68 ) . The intervention was a 6-month multitask exercise program performed to the rhythm of piano music .  Change in gait variability under dual-task condition from baseline to 6 months was the primary end point . Secondary outcomes included changes in balance , functional performances , and fall risk . RESULTS At 6 months , there was a reduction in stride length variability ( adjusted mean difference , -1.4 % ; P < .002 ) under dual-task condition in the intervention group , compared with the delayed intervention control group . Balance and functional tests improved compared with the control group . There were fewer falls in the intervention group ( incidence rate ratio , 0.46 ; 95 % confidence interval , 0.27 - 0.79 ) and a lower risk of falling ( relative risk , 0.61 ; 95 % confidence interval , 0.39 - 0.96 ) . Similar changes occurred in the delayed intervention control group during the second 6-month period with intervention . The benefit of the intervention on gait variability persisted 6 months later . CONCLUSION In community-dwelling older people at increased risk of falling , a 6-month music-based multitask exercise program improved gait under dual-task condition , improved balance , and reduced both the rate of falls and the risk of falling . Trial Registration clinical trials.gov Identifier : NCT01107288 Objective : The purpose of this pilot trial was to evaluate whether a 24-week program of rhythmic stepping exercise ( RSE ) would be effective in improving physical function and reducing fear of falling  in older adults . Participants : Four units ( n = 52 ) r and omized into an RSE group ( two units , n = 25 ) and a non-rhythmic stepping exercise ( NRSE ) group ( two units , n = 27 ) participated in a pilot cluster r and omized controlled trial . Methods : Each exercise group received 60 min group training sessions once a week for 24 weeks . Measurement was based on the difference in physical functions between the RSE and NRSE groups . Results : Significant differences were observed between the two groups for locomotive function with significant group × time interaction . Relative risk was calculated as 2.778 ( 95 % CI : 1.030–7.492 ) for fear of falling for participants in the NRSE group compared with patients in the RSE group ( p = 0.037 ) . Conclusions : The results of this pilot trial suggest that the RSE program is more effective in improving locomotive function and fear of falling This r and omized controlled trial examined the effects of multicomponent training on muscle power output , muscle mass , and muscle tissue attenuation ; the risk of falls ; and functional outcomes in frail nonagenarians . Twenty-four elderly ( 91.9 ± 4.1 years old ) were r and omized into intervention or control group . The intervention group performed a twice-weekly , 12-week multicomponent exercise program composed of muscle power training ( 8–10 repetitions , 40–60 % of the one-repetition maximum ) combined with balance and gait retraining .  Strength and power tests were performed on the upper and lower limbs . Gait velocity was assessed using the 5-m habitual gait and the time-up- and -go ( TUG ) tests with and without dual-task performance . Balance was assessed using the FICSIT-4 tests . The ability to rise from a chair test was assessed , and data on the incidence and risk of falls were assessed using question naires . Functional status was assessed before measurements with the Barthel Index . Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography . The intervention group showed significantly improved TUG with single and dual tasks , rise from a chair and balance performance ( P < 0.01 ) , and a reduced incidence of falls . In addition , the intervention group showed enhanced muscle power and strength ( P < 0.01 ) . Moreover , there were significant increases in the total and high-density muscle cross-sectional area in the intervention group . The control group significantly reduced strength and functional outcomes . Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population Background This r and omized controlled pilot study aim ed to explore whether a cognitive-motor exercise program that combines traditional physical exercise with dance video gaming can improve the voluntary stepping responses of older adults under attention dem and ing dual task conditions . Methods Elderly subjects received twice weekly cognitive-motor exercise that included progressive strength and balance training supplemented by dance video gaming for 12 weeks ( intervention group ) . The control group received no specific intervention . Voluntary step execution under single and dual task conditions was recorded at baseline and post intervention ( Week 12 ) . Results After intervention between-group comparison revealed significant differences for initiation time of forward steps under dual task conditions ( U = 9 , P = 0.034 , r = 0.55 ) and backward steps under dual task conditions ( U = 10 , P = 0.045 , r = 0.52 ) in favor of the intervention group , showing altered stepping levels in the intervention group compared to the control group . Conclusion A cognitive-motor intervention based on strength and balance exercises with additional dance video gaming is able to improve voluntary step execution under both single and dual task conditions in older adults Objective : To investigate whether a four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance in older adults with knee osteoarthritis . Design : A r and omized controlled trial with two groups : a walking group and a control group . Subjects : Forty older adults with knee osteoarthritis , 20 participants in each group . Intervention : The walking intervention was design ed to increase the number of steps walked daily . The walking group was instructed to increase their number of steps to 3000 steps more than before the intervention . Main outcome measures : Dual-task performance was computed by an automaticity index : the walking velocity under single-task condition/under dual-task conditions × 100 ( % ) , defined as automaticity . The nearer to 100 % automaticity , the better the dual-task performance . Decrease of the Trail Making Test ( TMT ) performance was defined as ΔTMT . ΔTMT was calculated as the difference between times ( part B – part A ) as a measure of executive function . In addition , functional ability was measured by the Japanese Knee Osteoarthritis Measure . Results : The walking group improved significantly in automaticity ( P < 0.001 , from 75.2 ( 7.6 ) to 86.9 ( 10.4 ) , ΔTMT ( P < 0.001 , from 63.4 ( 43.1 ) to 48.3 ( 29.6 ) ) and Japanese Knee Osteoarthritis Measure score ( P < 0.001 , from 54.4 to 51.9 ) compared with before the intervention , while the control group displayed no significant differences . Conclusions : We found that walking exercise improves executive function and dual-task performance BACKGROUND Falls and fall-related injuries are a major public health concern , a financial challenge for health care providers , and critical issues for older adults . Poor balance and limited mobility are major risk factors for falls . OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance , mobility , and balance confidence in older adults . METHODS Participants ( N = 47 , mean age 75.6 ) were r and omly assigned to a Feldenkrais group ( FG , n = 25 ) or to a control group ( CG , n = 22 ) . The FG group attended a 5-week Feldenkrais program , 60 minutes three times per week , while the CG group was a waitlist control . The outcome measures were balance ( t and em stance ) , mobility ( Timed Up and Go ) , gait characteristics ( GAITRite Walkway System ) , balance confidence ( Balance Confidence Scale ; ABC ) , and fear of falling ( Falls Efficacy Scale ) . Pre- and post-tests were conducted . RESULTS After completion of the program , balance ( p = 0.030 ) and mobility ( p = 0.042 ) increased while fear of falling ( p = 0.042 ) decreased significantly for the FG group . No other significant changes were observed . However , participants of the FG group showed improvements in balance confidence ( p = 0.054 ) and mobility while performing concurrently a cognitive task ( p = 0.067 ) . CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility , and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults . A long-term follow-up study of balance and mobility is warranted . Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes OBJECTIVE The purpose of this r and omized control trial study was to evaluate the effectiveness of a digital video disc (DVD)-based seated dual-task ( DT ) stepping exercise to improve the DT walking capability  in elderly people . In the DT exercise , participants were asked to perform a verbal fluency task while stepping as quickly as possible . METHODS Eight clusters ( n=93 ) r and omized into a DVD group ( 4 clusters , n=48 ) and a nonexercise control group ( 4 clusters , n=45 ) participated in this trial . In the DVD group , participants received 20 min of group training twice a week for 24 weeks . The exercise class used an exercise DVD that included a 15-min basic exercise and a 5-min DT exercise . No exercise program was prescribed for the control group . The measurements were based on the difference in physical function , including DT walking , between the DVD and control groups . In the DT walking test , participants walked individually at a comfortable speed while carrying a ball on a tray . The relative DT lag was calculated by using simple walking as the comparison condition . The Timed Up and Go test and the 5-chair st and test were also performed . RESULTS The median relative adherence to the study was 87.5 % ( 25th-75th percentile , 83.3%-95.8 % ) in the DVD group . The outcome measurements , including the DT walking time and DT time lag ( p<0.05 ) , among participants in the DVD group were significantly improved . However , other outcome measurements were not significantly different between the two groups ( p>0.05 ) . CONCLUSION The current study reports the effectiveness of a DVD-based exercise for the improvement of the DT walking capability . A larger study is needed to confirm the present results . Study of a Web-based exercise regime would be valuable to identify the most effective exercise for prevention of falls and fall-related fractures OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment . DESIGN A double-blind , r and omized controlled trial . SETTING University research laboratory . PARTICIPANTS Older adults ( N=23 ) with balance impairment ( mean age , 74.8y ) . They scored 52 or less on the Berg Balance Scale ( BBS )  and /or walked with a self-selected gait speed of 1.1 m/s or less . INTERVENTIONS Participants were r and omly assigned to 1 of 3 interventions : single-task training , dual-task training with fixed-priority instructions , and dual-task training with variable-priority instructions . Participants received 45-minute individualized training sessions , 3 times a week for 4 weeks . MAIN OUTCOME MEASURES Gait speed under single-task and dual-task conditions was obtained at baseline , the second week , the end of training , and the twelfth week after the end of training . Other measures , including the BBS and the Activities-specific Balance Confidence ( ABC ) Scale , were collected at baseline and after training . RESULTS Participants in all groups improved on the BBS ( P<.001 ; effect size [ES]=.72 ) , and walked significantly faster after training ( P=.02 ; ES=.27 ) . When a cognitive task was added , however , only participants who received dual-task training with fixed-priority instructions and dual-task training with variable-priority instructions exhibited significant improvements in gait speed ( P<.001 , ES=.57 ; and P<.001 , ES=.46 , respectively ) . In addition , only the dual-task training with variable-priority instructions group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up . Only the single-task training group showed a significant increase on the ABC after training ( P<.001 ; ES=.61 ) . CONCLUSIONS Dual-task training is effective in improving gait speed under dual-task conditions in elderly participants with balance impairment . Training balance under single-task conditions may not generalize to balance control during dual-task context s. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect OBJECTIVES To evaluate the effects of a trail-walking exercise ( TWE ) program on the rate of falls in community-dwelling older adults . DESIGN Pilot r and omized controlled trial ( RCT ) . SETTING This trial was conducted in Japan and involved community-dwelling older adults as participants . PARTICIPANTS Sixty participants r and omized into a TWE group ( n=30 ) and a walking ( W ) group ( n=30 ) .  INTERVENTION Exercise class combined with multicomponent trail walking program , versus exercise class combined with simple indoor walking program . MEASUREMENT Measurement was based on the difference in fall rates between the TWE and W groups . RESULTS Six months after the intervention , the incidence rate ratio ( IRR ) of falls for the TWE group compared with the W group was 0.20 ( 95 % confidence interval (CI)=0.04 - 0.91 ) ; 12 months after the intervention , the IRR of falls for the TWE group compared with the W group was 0.45 ( 95 % CI=0.16 - 1.77 ) . CONCLUSION The results of this pilot RCT suggest that the TWE program was more effective in improving locomotion and cognitive performance under trail-walking task conditions than walking . In addition , participants who took part in the TWE  demonstrated a decrease in the incidence rate of falls 6 months after trial completion . Further confirmation is needed , but this preliminary result may promote a new underst and ing of accidental falls in older adults OBJECTIVES Few studies have examined the effects of physical training programs on gait variability while single and dual tasking , and they reported mixed results . The aim of this study was to compare the stride time variability while single and dual tasking before and after a physical training program developed to improve gait stability in French community-dwelling older adults . DESIGN A prospect i ve pre-post interventional cohort study . SETTING The community-dwelling area of " Pays de la Loire " , France . POPULATION Forty-eight older adults ( mean age ± st and ard deviation 72.2±8 years ; 75 % female ) . METHODS Physical training program consisted in 12 sessions scheduled to attend physical exercises 1 time a week with total time duration of 3 months . Coefficient of variation ( CoV ) of stride time under three walking conditions ( i.e. , walking alone , walking while backward counting , and while performing a verbal fluency task ) was determined while steady-state walking using the SMTEC ® footswitches system before and after the physical training program . Participants were separated into two groups based on being or not in the highest tertile ( i.e. , worst performance with cutpoint > 4.4 % ) of the CoV of stride time while walking alone . RESULTS After physical training compared to before period , a significant decrease in CoV of stride time ( i.e. , better gait performance ) while walking alone ( 2.8±2.8 % versus 7±7.1 % , P=0.001 ) but not while dual tasking ( P=0.600 for counting backward and P=0.105 for verbal fluency task ) was shown in participants who had highest ( i.e. , worst ) gait variability at baseline . In addition , physical training modified the strategy of dual tasking in participants with highest gait variability at baseline compared to the other participants . Before training , a significant decrease in CoV of stride time ( 7±7.1 % versus 4.9±4.6 % , P=0.017 ) while counting backward was shown , but there was a significant increase after training ( 2.8±2.8 % versus 5.4±5.8 % , P=0.007 ) . CONCLUSIONS Physical training  reduced gait variability while walking alone in participants with gait instability , and influenced their strategy for dual tasking . CLINICAL REHABILITATION IMPACT Physical program training developed in the community to improve gait stability should included participants with high gait variability The present study highlights the effects of the dual-task cognitive-gait intervention ( CGI ) on working memory and gait functions in older adults with a history of falls . Thirteen older adults with a history of falls were recruited from local community centers and r and omly stratified into either the control ( n = 5 ) or experimental ( n = 8) group . The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor ( walking ) and cognitive ( memory recall ) task whereas the control group received a placebo treatment ( walking with simple music ) . The intervention was provided 30 minutes per session , over a 6-week period . Memory measures included a combination of word recall and arithmetic task . Gait function measures included velocity and center of pressure ( COP ) stability . Non-parametric tests were used at p < 0.05 . The experimental group showed a greater memory performance than the control ( p < 0.05 ) . However , no significant intervention-related changes in gait velocity and stability were observed . Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition Objective : To evaluate the effects of a new , individually adjusted , progressive and specific balance group training programme on fear of falling , step execution , and gait in healthy elderly people with fear of falling and tend to fall . Design : R and omized controlled trial . Setting : The study was conducted in Stockholm County , Sweden . Subjects : Fifty-nine community dwelling elderly people were recruited by advertisement , and allocated at r and om to an intervention group ( n = 38 ) or a control group ( n = 21 ) . Intervention : Individually adjusted , progressive and specific balance group training was given three times a week for three months . The training incorporated elements included in , and required for , independent activities of daily living , and for reactions to loss of balance during dual or multiple tasks . Main measures : Fear of falling was assessed with Falls Efficacy Scale International ( FES-I ) . The reaction time of step execution was measured with the step-execution test , and gait was measured with GAITRite ® . Results : After three months the intervention group showed significant positive changes in the FES-I ( P = 0.008 ) , in the step-execution phase of dual-task performance ( P = 0.012 ) , and in gait at preferred speed during single-task performance ; in cadence ( P = 0.030 ) and , at fast speed , in velocity ( P = 0.004 ) and cadence ( P = 0.001 ) . Significant decreases were also found for the likelihood of depression after participating in the training programme . Conclusion : This new balance training programme is feasible and leads to decreased fear of falling , decreased time for step execution during dual-task performance and increased velocity during fast walking Objective : ( 1 ) To develop a motor – cognition training programme ; ( 2 ) to evaluate the ability to recruit and retain elderly people ; ( 3 ) to assess the effects of the interventions . Design : Pilot r and omized controlled trial . Setting : Assisted living facility . Participants : Sixteen subjects ( 11 female ) living in an assisted living facility were r and omized to a motor or motor – cognition group . Interventions : Both groups received machine-driven strength training and balance exercises for 45 minutes , twice weekly , for 12 weeks . In addition , the motor – cognition group received computerized training for attention 3–5 times per week for 10 weeks . Main outcome measures : Baseline and post-intervention ( 12 weeks ) assessment s focused on recruitment , attrition and adherence . Secondary outcome measures assessed dual-task costs of gait ( velocity , cadence , step time , step length ) , exp and ed timed get-up- and -go , falls efficacy and reaction time . Results : Of 35 subjects initially approached , 16 started and 14 completed the study , result ing in 46 % recruitment , 19 % attrition and > 80 % adherence rates . There is more evidence of altered levels in the motor – cognitive treatment group with significant differences in average change for fear of falling ( P = 0.017 ) and foot reaction time ( P = 0.046 ) . No statistical significance was reached for gait parameters . Conclusions : Motor – cognition training is feasible and shows trends to stronger improvement in walking and reaction time . The application in a main study is deemed feasible . A minimum of ±55 subjects per group are required to achieve a power of 80 % at the 5 % level of significance based on step length and considering the expectable attrition rate in a required larger scale study Background Due to the many problems associated with reduced balance and mobility , providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills . Objectives The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging , interactive video game paradigm . The intervention focused on performing targeted dynamic tasks , which included reactive balance controls and environmental interaction . Design This study was a r and omized controlled trial . Setting The study was conducted in a geriatric day hospital . Participants Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study . Interventions Participants were r and omly assigned to either a control group or an experimental group . The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital . The experimental group received a program of dynamic balance exercises coupled with video game play , using a center-of-pressure position signal as the computer mouse . The tasks were performed while st and ing on a fixed floor surface , with progression to a compliant sponge pad . Each group received 16 sessions , scheduled 2 per week , with each session lasting 45 minutes . Measurements Data for the following measures were obtained before and after treatment : Berg Balance Scale , Timed “ Up & Go ” Test , Activities-specific Balance Confidence Scale , modified Clinical Test of Sensory Interaction and Balance , and spatiotemporal gait variables assessed in an instrumented carpet system test . Results Findings demonstrated significant improvements in posttreatment balance performance scores for both groups , and change scores were significantly greater in the experimental group compared with the control group . No significant treatment effect was observed in either group for the Timed “ Up & Go ” Test or spatiotemporal gait variables . Limitations The sample size was small , and there were group differences at baseline in some performance measures . Conclusion Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise . This coupling , in turn , result ed in a greater improvement in dynamic st and ing balance control compared with the typical exercise program . However , there was no transfer of effect to gait function Few studies have reported the effect of exercise intervention for improving postural control deficit in older adults at high risk of falling . We have developed a " Dual-task Switch Exercise ( DSE ) " program that focuses on gait initiation performance under the dual-task condition . The purpose of this study was to evaluate whether gait initiation performance could be improved by a specific exercise intervention .  Eighteen participants were r and omly assigned to either DSE or control groups . The DSE group received focused training to improve the ability to initiate movements quickly under the dual-task condition . The control group received steady-state walking training . After 30-min of seated training sessions , participants received 5-min individualized training sessions once a week for 24 weeks . In the pre- and post-training period , performance of the steady-state gait ( 10-m walking time ) and gait initiation ( reaction time , backward center of pressure ( COP ) displacement ) were measured under the single- and dual-task conditions . The results of a r and omized clinical trial showed that both groups showed improvement of steady-state walking time under the dual-task condition ( main effect of time ; p=0.018 ) . However , DSE was more effective in improving both the reaction time and backward COP displacement during gait initiation under the dual-task condition than control ( interaction effect of time × group ; reaction time , p=0.015 ; COP displacement , p=0.011 ) . There were no significant differences in steady-state gait and gait initiation performance under the single-task condition between pre- and post-training in both groups . Only the specific exercise intervention  improved gait initiation performance under the dual-task condition OBJECTIVES To determine the effects of tai chi training on functional performance and walking with and without the addition of the performance of a cognitive task , in older adults living in supportive housing facilities . DESIGN Secondary data analysis comparing a single-blind , r and omized controlled trial of tai chi training with an attention-matched educational control intervention with crossover to tai chi . SETTING Two supportive housing facilities . PARTICIPANTS Sixty-six men and women living in supportive housing facilities entered the study , and 57 aged 87±7 completed all study procedures . INTERVENTION Interventions consisted of two 1-hour-long instructor-led group sessions per week for 12 weeks . Tai chi training consisted of movements based upon the Yang-style short form . Educational sessions consisted of lectures and discussion s of age-related health topics . MEASUREMENTS Subjects were tested for physical function ( Short Physical Performance Battery , SPPB ) , balance ( Berg Balance Scale , BBS ) , mobility ( timed up- and -go , TUG ) , and walking speed under normal and cognitive dual-task conditions . RESULTS The tai chi group exhibited greater improvement in SPPB scores ( baseline 8.1±2.9 , follow-up 9.0±2.6 ) than controls ( baseline 8.2±2.6 , follow-up 8.2±2.6 ) ( P=.005 ) . Tai chi also increased normal and dual-task walking speed ( P<.001 ) yet did not affect BBS ( P=.02 ) or TUG ( P=.02 ) after accounting for multiple comparisons . The dual-task cost ( percentage change ) to walking speed was unaffected . After the crossover tai chi intervention , the control group improved performance in the SPPB , BBS , and TUG , and increased walking speed under normal and dual-task conditions ( P=.008 ) . CONCLUSION Tai chi training may be a safe and effective therapy to help improve physical function and dual-task walking in very old adults living in supportive housing facilities Decline in dual-task walking performance is associated with increased risk of falls among older adults . The objective of this study is to determine whether 18 hr of participation in EnhanceFitness ( EF ) , an evidence -based group exercise program , improves dual-task walking performance among community-dwelling older adults . Twenty-eight healthy , community-dwelling older adults were evaluated before participating in EF and after 18 hr of participation . Gait speed was evaluated under single task and dual tasks using the TUG ( Timed Up and Go ) and 1-min walk tests . Dual-task costs ( DTC ) , the relative cost of dual-task performance compared to single-task performance , were calculated for both cognitive and motor tasks . Postural control and executive functions were evaluated as well . After 18 hr of EF , dual-task walking performance improved . Single-task performance improved as well as postural control and executive function . There was no significant change in DTC across all measurements , except for the cognitive task of the TUG
target: Evidence from subgroup comparisons showed no difference in treatment-related changes between cognitive-motor and motor-motor dual tasks , or when interventions were compared to active or inactive controls .
  In summary , physical exercise interventions can improve dual-task walking in older adults primarily by increasing the speed at which individuals walk in dual-task conditions .
  Currently , evidence concerning whether physical exercise interventions reduce DTC or alter the self-selected dual-task strategy during unobstructed walking is greatly lacking , mainly due to the failure of studies to measure and report reciprocal dual-task effects on the non-gait task
background: Dual-task interference during walking can substantially limit mobility and increase the risk of  falls among community-dwelling older adults .
  Previous systematic review s examining intervention effects on dual-task gait and mobility have not assessed relative dual-task costs ( DTC ) or investigated whether there are differences in treatment-related changes based on the type of dual task or the type of control group .
  The purpose of this systematic review was to examine the effects of physical exercise interventions on dual-task performance during walking in older adults .