The Dual-task Training Under Different Priority Instructions on Gait Speed in Community-dwelling Older Adults

University of Pernambuco

Status: Completed

Conditions: Postural Balance; Gait

Treatments: Other: Dual-task with variable-priority instructions; Other: Dual task with variable- and fixed-priority instructions

Study type: Interventional

Funder types: Other

Identifiers

NCT03886805

U1111-1229-1346

Details and patient eligibility

About

This study analyzed the effect of different modalities of dual-task training in the improvement of gait biomechanics, postural balance, falls episodes, executive functioning, and quality of life in community-dwelling older adults. Half of the participants have undertaken a dual-task protocol training with progression from variable-priority to fixed-priority instructions, while the other half have undertaken a dual-task protocol training under variable-priority instructions.

Full description

Although dual-task training for improving postural balance is an emerging interest area, the effects of dual tasks and dual-task training on static and dynamic postural stability remain unclear. Even though variable (alternating) instructional priority dual-task training has been shown higher effect than fixed (concurrent) priority dual-task training approach to improving the balance impairments, we must consider in everyday pragmatic situations, motor, and cognitive tasks are often demanded simultaneously and this requires an individual's attention toward an external source of attention while performing a primary task. Then, our rationale for this study is older adults who underwent a training protocol composed of a dual task with variable and fixed instructional priority will achieve better improvements regarding the studied variables in comparison to the group who will be submitted a protocol composed only by dual-task with variable priority training. Therefore, this protocol for a six-month, double-blind, randomized controlled trial with six-month follow-up post-training analyzed whether examine whether a dual-task protocol training with progression from variable priority to fixed priority instructions is effective in improvement of gait biomechanics, postural balance, falls episodes, executive functioning and quality of life in community-dwelling older adults.

Enrollment: 60 patients

Sex: All

Ages: 60 to 80 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Participants of both sexes
• Age between 60 and 80 years old
• Participants with a score greater or equal to 52 (up to a maximum of 56) in the Berg Balance Scale
• Participants with a score greater or equal to 24 (up to a maximum of 30) in the Mini-mental State Exam
• Participants who are able to walk uninterruptedly for a distance of 10-meter at a self-selected velocity of at least 1.0 m/s without the need from another person, cane or walker

Exclusion criteria

• Self-report of two or more falls in the last 12 months
• Any contraindication to balance postural training
• Any contraindication to cognitive exercise training
• With self-report of two or more falls in the last 12 months
• Who is participating or have participated, in the last 6 months, in any regular and structured physical exercise program, for 3 or more times per week
• Any chronic health condition, including cardiovascular disease, respiratory disease, stroke, active cancer, neurological or neuromuscular conditions whose exercise is contraindicated
• Any upper or lower limb fracture in the last 6 months
• Evidence of any surgical procedures in the knees, ankles, and hips or muscle damage in the last 6 months
• Uncontrolled diabetes.
• No able to speak and understand the Portuguese language
• Refusal to give informed consent

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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60 participants in 2 patient groups

Dual task with variable- and fixed-priority instructions

Experimental group

Description:

Sixty-minute training sessions, 2 times a week for 24 weeks. From the 1st to 12th week the participants were trained under variable-priority instructions (half the session was focused on balance motor task and half the session focused on cognitive task performance). From the 13th to 24th week) the participants performed dual tasks under fixed-priority instructions (simultaneous focus attention on balance and cognitive tasks). The motor tasks were performed in a circuit composed of hula hoops, ropes (in a straight line and zigzag), agility ladder, traffic cones, steps, cardboard box, and other obstacles arranged on the floor (stable surface) or on mattresses (unstable surface), depending on the aiming of each training stage. The cognitive tasks will include activities such as saying fruits, animals, cities, and/or person names started with a specific letter, solving mathematical accounts, singing songs, reciting verses, working memory, among other cognitive tasks.

Treatment:

Other: Dual task with variable- and fixed-priority instructions

Dual-task with variable-priority instructions

Active Comparator group

Description:

Sixty-minute training sessions, 2 times a week for 24 weeks (48 sessions). From the 1st to 24th week, the participants were trained under variable-priority instructions, in which they were asked to spend half the session focused on balance (motor task) and half the session focused on cognitive task performance. The motor tasks (gait and postural balance) of this protocol were performed in a circuit composed of hula hoops, ropes (in a straight line and zigzag), agility ladder, traffic cones, steps, cardboard box, and other obstacles arranged on the floor (stable surface) or on mattresses (unstable surface), depending on the aiming of each training stage. The cognitive tasks included activities such as saying fruits, animals, cities, and/or person names started with a specific letter, solving mathematical accounts, singing songs, reciting verses, rescue working memory, among other cognitive tasks.

Treatment:

Other: Dual-task with variable-priority instructions