Effects of Progressive Dual-task Training on Motor Performance, Cognitive Status and Fall Risk among Older Adults With and Without Mild Cognitive Impairment

Document Type : Original Article


1 PhD Candidate of Motor Behavior, Department of Motor Behavior. Motor Learning and Control Dep, Tehran, Iran.

2 Associate Professor of Motor Behavior. Department of Motor Behavior. Motor Learning and Control Dep, Tehran, Iran.

3 Associate Professor of Motor Behavior.Department of Motor Behavior. Motor Learning and Control Dep, Tehran, Iran.


Background and Objective: Patients with Mild Cognitive Impairment (MCI) demonstrate inadequacy in compensatory techniques and lacking motor control while falling; hence it appears that cognitive and motor deficiencies are inter-related. The aim of this study was to investigate the progressive dual-task effects on motor performance, cognitive status and fall risk between older adults.
Subjects and Methods: This study is semi experimental with pre– and post-test design. The subjects were selected from community dwelling elderly adults with mean age of 75.65 y (range, 65–90). Both groups (20 with MCI and 20 Healthy) participated in 12 weeks of intervention with progressive dual-task training, which entailed sitting, standing and transforming practices.
Results: Examinations after 12 weeks showed that intervention caused improvements in cognitive status, postural control, and fall risk in both older adults with and without MCI. The MCI group experienced more positive changes in cognition, while the normal group had the most evident effects in fall risk and performance in Functional Reach (FR) test.
Conclusion: This finding supports the previous results which implied the positive effects of dual-task training on cognitive variables are associated to biological variations which arise during exercise training. We also suggest that the physical benefits of progressive dual-task training (e.g. flexibility) are overriding the cognitive changes. In future research, the pathophysiology and further clinical implications should be investigated.


1-Olazaran, J., et al., Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology, 2004. 63(12): p. 2348-2353.
2-Tang, P.F. and M.H. Woollacott, Inefficient postural responses to unexpected slips during walking in older adults. J Gerontol A Biol Sci Med Sci, 1998. 53(6): p. M471-80.
3-Ganguli, M., et al., Outcomes of mild cognitive impairment by definition: a population study. Archives of neurology, 2011. 68(6): p. 761-767.
4-Anderson-Hanley, C., et al., Exergaming and older adult cognition: a cluster randomized clinical trial. American journal of preventive medicine, 2012. 42(2): p. 109-119.
5-Zijlstra, A., et al., Do dual tasks have an added value over single tasks for balance assessment in fall prevention programs? A mini-review. Gerontology, 2008. 54(1): p. 40-49.
6-Amboni, M., P. Barone, and J.M. Hausdorff, Cognitive contributions to gait and falls: evidence and implications. Movement Disorders, 2013. 28(11): p. 1520-1533.
7-Hamacher, D., D. Hamacher, and L. Schega, A cognitive dual task affects gait variability in patients suffering from chronic low back pain. Experimental brain research, 2014. 232(11): p. 3509-3513.
8-Wild, L.B., et al., Characterization of cognitive and motor performance during dual-tasking in healthy older adults and patients with Parkinson’s disease. Journal of neurology, 2013. 260(2): p. 580-589.
9-Chang, Y.-K., et al., Tai Ji Quan, the brain, and cognition in older adults. Journal of Sport and Health Science, 2014. 3(1): p. 36-42.
10-Hauer, K., et al., Physical training improves motor performance in people with dementia: a randomized controlled trial. Journal of the American Geriatrics Society, 2012. 60(1): p. 8-15.
11-Mitchell, A.J., A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. Journal of psychiatric research, 2009. 43(4): p. 411-431.
12-Tanaka, K., et al., Benefits of physical exercise on executive functions in older people with Parkinson’s disease. Brain and cognition, 2009. 69(2): p. 435-441.
13-Midtgaard, J., et al., The group matters: an explorative study of group cohesion and quality of life in cancer patients participating in physical exercise intervention during treatment. European Journal of Cancer Care, 2006. 15(1): p. 25-33.
14-Wernick-Robinson, M., D.E. Krebs, and M.M. Giorgetti, Functional reach: does it really measure dynamic balance? Archives of physical medicine and rehabilitation, 1999. 80(3): p. 262-269.
15-Owsley, C., et al., Visual risk factors for crash involvement in older drivers with cataract. Archives of ophthalmology, 2001. 119(6): p. 881-887.
16-Wall, J.C., et al., The Timed Get-up-and-Go test revisited: measurement of the component tasks. Journal of rehabilitation research and development, 2000. 37(1): p. 109.
17-Bunce, D., Age differences in vigilance as a function of health-related physical fitness and task demands. Neuropsychologia, 2001. 39(8): p. 787-797.
18-Qutubuddin, A.A., et al., Validating the Berg Balance Scale for patients with Parkinson’s disease: a key to rehabilitation evaluation. Archives of physical medicine and rehabilitation, 2005. 86(4): p. 789-792.
19-Woollacott, M. and A. Shumway-Cook, Attention and the control of posture and gait: a review of an emerging area of research. Gait & posture, 2002. 16(1): p. 1-14.
20-Deslandes, A., et al., Exercise and mental health: many reasons to move. Neuropsychobiology, 2009. 59(4): p. 191-198.
21-McCormick, S.A., J. Causer, and P.S. Holmes, The influence of early aging on eye movements during motor simulation. Age (Dordr), 2014. 36(4): p. 9671.
22-Scherder, E., et al., Gait in ageing and associated dementias; its relationship with cognition. Neuroscience & Biobehavioral Reviews, 2007. 31(4): p. 485-497.
23-Shigematsu, R., et al., Square-stepping exercise and fall risk factors in older adults: a single-blind, randomized controlled trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008. 63(1): p. 76-82.
24-Shigematsu, R., et al., Square-stepping exercise versus strength and balance training for fall risk factors. Aging clinical and experimental research, 2008. 20(1): p. 19-24.
25-Silsupadol, P., et al., Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial. Gait & posture, 2009. 29(4): p. 634-639.
26-Lamb, S., et al., Prevention of Falls Network Europe and Outcomes Consensus Group (2005) Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc, 2005. 53(9): p. 1618-1622.
27-Hyndman, D. and A. Ashburn, People with stroke living in the community: Attention deficits, balance, ADL ability and falls. Disability & Rehabilitation, 2003. 25(15): p. 817-822.
28-Spirduso, W.W., K.L. Francis, and P.G. MacRae, Physical dimensions of aging. 1995.
29-Sinoff, G. and L. Ore, The Barthel Activities of Daily Living Index: selfreporting versus actual performance in the oldold ( 75 years). Journal of the American Geriatrics Society, 1997. 45(7): p. 832-836.
30-Silsupadol, P., et al., Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Archives of physical medicine and rehabilitation, 2009. 90(3): p. 381-387.