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

The Effectiveness of Dual-task Training With Variable- and Fixed-priority Instructions on Gait Speed in Community-dwelling Older Adults

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.

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.

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