title: Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up.
abstract: BACKGROUND
  About one-third of people older than 65 years fall at least once a year. Physical exercise has been previously demonstrated to improve gait, enhance physical fitness, and prevent falls. Nonetheless, the addition of cognitive training components may potentially increase these effects, since cognitive impairment is related to gait irregularities and fall risk. We hypothesized that simultaneous cognitive-physical training would lead to greater improvements in dual-task (DT) gait compared to exclusive physical training.
  
  
  METHODS
  Elderly persons older than 70 years and without cognitive impairment were randomly assigned to the following groups: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Gait variables, functional fitness (Short Physical Performance Battery, 6-minute walk), and fall frequencies were assessed at baseline, after 3 months and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were carried out.
  
  
  RESULTS
  Eighty-nine participants were randomized to three groups initially; 71 completed the training and 47 were available at 1-year follow-up. DANCE/MEMORY showed a significant advantage compared to PHYS in DT costs of step time variability at fast walking (P=0.044). Training-specific gait adaptations were found on comparing DANCE and MEMORY: DANCE reduced step time at fast walking (P=0.007) and MEMORY reduced gait variability in DT and DT costs at preferred walking speed (both trend P=0.062). Global linear time effects showed improved gait (P<0.05), functional fitness (P<0.05), and reduced fall frequency (-77%, P<0.001). Only single-task fast walking, gait variability at preferred walking speed, and Short Physical Performance Battery were reduced at follow-up (all P<0.05 or trend).
  
  
  CONCLUSIONS
  Long-term multicomponent cognitive-physical and exclusive physical training programs demonstrated similar potential to counteract age-related decline in physical functioning.
authors.affiliation: Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Eggenberger
authors.affiliation: Division of Psychiatry Research, University of Zurich, Zurich, Switzerland ; Center for Gerontology, University of Zurich, Zurich, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Theill
authors.affiliation: Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Holenstein
authors.affiliation: Department of Gerontopsychology and Gerontology, University of Zurich, Zurich, Switzerland ; University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.
authors.forename: Vera
authors.initials: V
authors.lastname: Schumacher
authors.affiliation: Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland ; Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands ; Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, the Netherlands.
authors.forename: Eling D
authors.initials: ED
authors.lastname: de Bruin
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003615:Dancing; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D004856:Postural Balance; D018910:Video Games; D016138:Walking
keywords: dance video game; detraining; elderly; falls; functional fitness; gait; sex