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

Background This randomized controlled pilot study aimed 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 demanding 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.

[1]  Peter Wolf,et al.  Cognitive and cognitive-motor interventions affecting physical functioning: A systematic review , 2011, BMC geriatrics.

[2]  B. E. Maki,et al.  The role of limb movements in maintaining upright stance: the "change-in-support" strategy. , 1997, Physical therapy.

[3]  Mark W Rogers,et al.  Step training improves the speed of voluntary step initiation in aging. , 2003, The journals of gerontology. Series A, Biological sciences and medical sciences.

[4]  Maureen K. Holden,et al.  Virtual Environments for Motor Rehabilitation: Review , 2005, Cyberpsychology Behav. Soc. Netw..

[5]  Position Stand American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. , 2009, Medicine and science in sports and exercise.

[6]  M. Hartmann,et al.  Bewegungsempfehlungen und Bewegungsangebote in Schweizer Altersheimen , 2008 .

[7]  Jelle Jolles,et al.  The Stroop Color-Word Test , 2006, Assessment.

[8]  Stephanie Studenski,et al.  Interactive video dance games for healthy older adults , 2010, The journal of nutrition, health & aging.

[9]  M. Woollacott,et al.  Age-related changes in anticipatory postural adjustments associated with arm movements. , 1988, Journal of gerontology.

[10]  T. Kennedy The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. , 1987, Danish medical bulletin.

[11]  G. Salem,et al.  American College of Sports Medicine position stand. Exercise and physical activity for older adults. , 2009, Medicine and science in sports and exercise.

[12]  Yea-Ru Yang,et al.  Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. , 2008, Gait & posture.

[13]  F. B. Horak,et al.  The supplementary motor area contributes to the timing of the anticipatory postural adjustment during step initiation in participants with and without Parkinson's disease , 2009, Neuroscience.

[14]  K. Sunnerhagen,et al.  Virtual Rehabilitation in an Activity Centre for Community-Dwelling Persons with Stroke , 2008, Cerebrovascular Diseases.

[15]  Clemens Becker,et al.  Epidemiology of falls in residential aged care: analysis of more than 70,000 falls from residents of bavarian nursing homes. , 2012, Journal of the American Medical Directors Association.

[16]  Karl O’Keeffe Dancing Monkeys ( Automated creation of step files for Dance Dance Revolution , 2003 .

[17]  A. Ismaila,et al.  A tutorial on pilot studies: the what, why and how , 2010, BMC Medical Research Methodology.

[18]  C. Bard,et al.  Attentional demands for static and dynamic equilibrium , 2004, Experimental Brain Research.

[19]  M. Petticrew,et al.  Developing and evaluating complex interventions: the new Medical Research Council guidance , 2008, BMJ : British Medical Journal.

[20]  Eling D de Bruin,et al.  Effect of additional functional exercises on balance in elderly people , 2007, Clinical rehabilitation.

[21]  The effect of a foot gymnastic exercise programme on gait performance in older adults: A randomised controlled trial , 2009, Disability and rehabilitation.

[22]  Itshak Melzer,et al.  The Effect of a Cognitive Task on Voluntary Step Execution in Healthy Elderly and Young Individuals , 2004, Journal of the American Geriatrics Society.

[23]  Noriaki Ichihashi,et al.  Fear of falling is associated with prolonged anticipatory postural adjustment during gait initiation under dual-task conditions in older adults. , 2012, Gait & posture.

[24]  S T Smith,et al.  A novel Dance Dance Revolution (DDR) system for in-home training of stepping ability: basic parameters of system use by older adults , 2009, British Journal of Sports Medicine.

[25]  Neil B Alexander,et al.  Dynamic Balance and Stepping Versus Tai Chi Training to Improve Balance and Stepping in At‐Risk Older Adults , 2006, Journal of the American Geriatrics Society.

[26]  Henry L. Lew,et al.  Stepping over obstacles to improve walking in individuals with poststroke hemiplegia. , 2004, Journal of rehabilitation research and development.

[27]  M. Woollacott,et al.  The influence of a concurrent cognitive task on the compensatory stepping response to a perturbation in balance-impaired and healthy elders. , 2002, Gait & posture.

[28]  B. E. Maki,et al.  Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention. , 2006, Age and ageing.

[29]  E. D. de Bruin,et al.  The effect of a training program combined with augmented afferent feedback from the feet using shoe insoles on gait performance and muscle power in older adults: a randomised controlled trial , 2010, Disability and rehabilitation.

[30]  I. Melzer,et al.  Regular Exercise in the Elderly Is Effective to Preserve the Speed of Voluntary Stepping under Single-Task Condition but Not under Dual-Task Condition , 2008, Gerontology.

[31]  E. Heath Borg's Perceived Exertion and Pain Scales , 1998 .

[32]  Eling D. de Bruin,et al.  Feasibility of Strength-Balance Training Extended with Computer Game Dancing in Older People; Does it Affect Dual Task Costs of Walking? , 2011 .

[33]  Heidi Sveistrup,et al.  Functional Balance and Dual-Task Reaction Times in Older Adults Are Improved by Virtual Reality and Biofeedback Training , 2007, Cyberpsychology Behav. Soc. Netw..

[34]  I. Melzer,et al.  Application of the voluntary step execution test to identify elderly fallers. , 2007, Age and ageing.

[35]  M. Woollacott,et al.  Attentional demands and postural control: the effect of sensory context. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[36]  S. Brauer,et al.  Changes in stepping response to lateral perturbations immediately following a single bout of physical activity. , 2010, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[37]  The influence of stimulus cue on the initiation of stepping in young and older adults. , 2001, Archives of physical medicine and rehabilitation.

[38]  Janice J Eng,et al.  Exercise Leads to Faster Postural Reflexes, Improved Balance and Mobility, and Fewer Falls in Older Persons with Chronic Stroke , 2005, Journal of the American Geriatrics Society.

[39]  Mark Hallett,et al.  Cortical reorganization and associated functional motor recovery after virtual reality in patients with chronic stroke: an experimenter-blind preliminary study. , 2005, Archives of physical medicine and rehabilitation.

[40]  G. Pichierri,et al.  Use of virtual reality technique for the training of motor control in the elderly , 2010, Zeitschrift für Gerontologie und Geriatrie.

[41]  C. Rice,et al.  Ageing and physical activity: evidence to develop exercise recommendations for older adults. , 2007, Canadian journal of public health = Revue canadienne de sante publique.

[42]  Nicole Wenderoth,et al.  Brain Activity during Ankle Proprioceptive Stimulation Predicts Balance Performance in Young and Older Adults , 2011, The Journal of Neuroscience.

[43]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[44]  J. Ridley Studies of Interference in Serial Verbal Reactions , 2001 .

[45]  Itshak Melzer,et al.  Reliability of voluntary step execution behavior under single and dual task conditions , 2007, Journal of NeuroEngineering and Rehabilitation.

[46]  R. Cumming,et al.  Effective Exercise for the Prevention of Falls: A Systematic Review and Meta‐Analysis , 2008, Journal of the American Geriatrics Society.

[47]  Stuart,et al.  Older people's recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: a supplement to the Cochrane systematic review , 2011 .

[48]  Alice M. K. Wong,et al.  Is Tai Chi Chuan effective in improving lower limb response time to prevent backward falls in the elderly? , 2009, AGE.

[49]  Albert V. Carron,et al.  Group Cohesion in Older Adult Exercisers: Prediction and Intervention Effects , 1999, Journal of Behavioral Medicine.