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The Dual-task Augmented Reality Treatment (DART) trial recently established that dual-task training (DTT) delivered by a physical therapist or the augmented reality DART platform was effective in improving spatiotemporal gait parameters under single- and dual-task conditions in individuals with Parkinson's disease (PD). Data regarding postural stability were not reported in the primary outcome manuscript. The aim of this secondary analysis was to compare the effects of a Traditional DTT intervention delivered by a physical therapist and DTT delivered by the DART platform on postural stability, functional mobility, and turning in individuals with PD. It was hypothesized that both groups would experience similar improvements. Forty-seven individuals with PD were randomized to an 8-week (16 sessions) Traditional DTT or DART intervention. The limits of stability test and the instrumented Timed Up and Go (TUG) under single- and dual-task conditions were gathered at Baseline, End of Treatment (EOT), and 8-weeks after EOT. At EOT, the Traditional DTT and DART groups experienced a 9 % and 14 % improvement in maximal excursion area and a 7 % and 12 % improvement in total TUG time under dual-task conditions, respectively (p<0.05). Turn duration and average and peak turn velocity during the TUG improved for both groups under single- and dual-task conditions at EOT. Improvements in turn duration (dual-task) and average turn velocity (single- and dual-task) persisted 8-weeks after intervention cessation. Improvements in postural stability, functional mobility, and turning under single- and dual-task conditions following traditional and DART DTT in individuals with PD indicate that cognitive-motor training can be used to effectively treat postural instability in this population. Improvements in the DART group were similar to traditional DTT, supporting our previous data demontrating that DART is an effective digital therapeutic to improve gait and postural instability in individuals with PD. • Dual-task training (DTT) improves postural stability in Parkinson's disease (PD). • Improvements were present in the traditional and augmented reality (AR) training groups. • DTT delivered via AR technology addresses several key barriers to clinical adoption. • The AR platform is a tool for therapist to treat PD and increase accessibility to care. [ABSTRACT FROM AUTHOR]

Aims: The study aimed at examining the effectiveness of cognitive-motor dual-task and single-task cognitive training on executive and attention functions in participants over 65 years of age. Methods: The study comprised 68 participants. They were randomly assigned to dual-task cognitive-motor training (DTT), single-task cognitive training (STT) or a control group (C). The training program in all groups encompassed 4 weeks and consisted of three, 30-min meetings a week. Specialized software was designed for the purposes of the study. Both before and after the training, the cognitive functioning was assessed using: Color Trials Test, Ruff Figural Fluency Test, Wisconsin Sorting Card Test, Digit Span, Verbal Fluency Test, Stroop Color-Word Test. Results: After the cognitive-motor training, improvement was achieved in the control and inhibition of reactions. Moreover, after the cognitive training, improvements in abstract thinking and categorization were reported. Conclusion: Despite the small sample limitation, the preliminary result shows each form of the training supports a different aspect of executive functions but does not contribute to the improvement in attention. [ABSTRACT FROM AUTHOR]

Abstract Physical exercise is recognized for its beneficial effects on brain health and executive function, particularly through the careful manipulation of key exercise parameters, including type, intensity, and duration. The aim of this systematic review and meta-analysis was to delineate the optimal types, intensities, and durations of exercise that improve cognitive functions in older adults with mild cognitive impairment (MCI) or dementia. A comprehensive search was conducted in Scopus, Web of Science, and PubMed from their inception until December 2023. The methodological quality and publication bias of the included studies were assessed using the PEDro scale and Egger’s regression test, respectively. Separate meta-analyses were performed to assess the overall impact of exercise on cognitive assessments and to explore the effects of different exercise types (i.e., aerobic, resistance, dual-task, mind-body, and multi-component exercises) and intensities (i.e., low, moderate, and high) on executive function. Results were presented as standardized mean differences (SMD) and 95% confidence intervals (95% CI). A meta-regression analysis was conducted to examine the correlation between exercise duration and mean effects. In total, 15,087 articles were retrieved from three databases, of which 35 studies were included in our final analyses. The results indicated high overall methodological quality (PEDro score = 8) but a potential for publication bias (t = 2.08, p = 0.045). Meta-analyses revealed that all types of exercise (SMD = 0.691, CI [0.498 to 0.885], p

Physical exercise is recognized for its beneficial effects on brain health and executive function, particularly through the careful manipulation of key exercise parameters, including type, intensity, and duration. The aim of this systematic review and meta-analysis was to delineate the optimal types, intensities, and durations of exercise that improve cognitive functions in older adults with mild cognitive impairment (MCI) or dementia. A comprehensive search was conducted in Scopus, Web of Science, and PubMed from their inception until December 2023. The methodological quality and publication bias of the included studies were assessed using the PEDro scale and Egger's regression test, respectively. Separate meta-analyses were performed to assess the overall impact of exercise on cognitive assessments and to explore the effects of different exercise types (i.e., aerobic, resistance, dual-task, mind-body, and multi-component exercises) and intensities (i.e., low, moderate, and high) on executive function. Results were presented as standardized mean differences (SMD) and 95% confidence intervals (95% CI). A meta-regression analysis was conducted to examine the correlation between exercise duration and mean effects. In total, 15,087 articles were retrieved from three databases, of which 35 studies were included in our final analyses. The results indicated high overall methodological quality (PEDro score = 8) but a potential for publication bias (t = 2.08, p = 0.045). Meta-analyses revealed that all types of exercise (SMD = 0.691, CI [0.498 to 0.885], p < 0.001) and intensities (SMD = 0.694, CI [0.485 to 0.903], p < 0.001) show significant effects favoring exercise. Notably, dual-task exercises (SMD = 1.136, CI [0.236 to 2.035], p < 0.001) and moderate-intensity exercises (SMD = 0.876, CI [0.533 to 1.219], p < 0.001) exhibited the greatest effect. No significant correlation was observed between exercise duration and SMD (R² = 0.038, p = 0.313). Overall, our meta-analyses support the role of physical exercise in enhancing executive function in older adults with MCI or dementia. It is essential to carefully tailor exercise parameters, particularly type and intensity, to meet the specific needs of older adults with MCI or dementia. Such customization is crucial for optimizing executive function outcomes and improving overall brain health. [ABSTRACT FROM AUTHOR]

Working Memory (WM) considers the ability to process and store information and is commonly translated into the acquisition of new knowledge and skills, e.g., in the form of a memory strategy, such as an information grouping strategy. Therefore, increasing the efficiency of WM, particularly through non-invasive methods, such as training, becomes one of the crucial issues in enhancing one's cognitive functioning. Considering the average mobile device usage time, smartphones can be considered up-to-date training tools. Cognitive training using mobile devices can contribute to improvements in the field of online learning by providing a tool for improving students' cognitive skills. This study investigated the effectiveness of memory training using a mobile device, i.e., a smartphone. The training was assessed in a sample of young adults (N = 59) within a longitudinal design involving a pre-test and double post-test with a training and control group. The Dual N-back training improved WM capacity and boosted important proximal and distal outcomes. Overall, our study indicated an increase in WM as a result of the training using smartphones, thus providing important cues for enhancing WM capacity by use of digital training on mobile devices on a daily basis. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusionTrial registrationClinicalTrials.gov Identifier\nIMPLICATIONS FOR REHABILITATIONIndividuals who have experienced stroke may benefit from dual-task related training to improve gait speed performance. Whether noted improvements reflect true effects on gait or cognitive-motor trade-offs still remains unclear. Therefore, this study aimed to investigate the effects of dual-task training on dual-task effects of both walking and cognitive domains in stroke survivors.Forty-four individuals with stroke were randomized to dual-task or single-task training groups. Both groups exercised three 60-minute sessions per week for 4 weeks. The primary outcomes were dual-task effects on gait speed and cognitive score. Outcomes were assessed before and after the intervention and 1-month follow-up.While both groups exhibited improvement in absolute gait speed under dual-task conditions, the dual-task training group demonstrated superior results by providing an additional gain on dual-task effects of gait speed. Compared to single-task training, dual-task training exhibited a significant improvement in dual-task effects of gait speed at post-treatment and follow-up. Regarding the dual-task effects on cognitive scores, no significant differences within and between groups after training were observed.Dual-task training enhances immediate and retained effects on the dual-task effects of gait speed in individuals with stroke, not by cognitive-motor trade-offs.URL: https://www.clinicaltrials.gov.NCT02686515Dual-task interference during walking has important consequences for stroke survivors to walk safely.Multimodal training with dual-task enhances immediate and retained effects on the dual-task effects of gait speed in individuals with stroke, not by cognitive-motor trade-offs.Clinicians are encouraged to incorporate multimodal training with dual-task into the exercise routines to enhance walking under dual-task conditions in stroke survivors.Dual-task interference during walking has important consequences for stroke survivors to walk safely.Multimodal training with dual-task enhances immediate and retained effects on the dual-task effects of gait speed in individuals with stroke, not by cognitive-motor trade-offs.Clinicians are encouraged to incorporate multimodal training with dual-task into the exercise routines to enhance walking under dual-task conditions in stroke survivors. [ABSTRACT FROM AUTHOR]

Objective: To summarize the effect of dual-task training on cognitive, physical function, and dual-task performance in people with mild cognitive impairment or dementia. Data sources: Embase, PEDro, PsycINFO, PubMed, CINAHL, The Cochrane Library, and a forward search conducted via Web of Science have been searched from inception to July 2023. Review methods: Good-quality randomized controlled trials compared dual-task training with no/placebo intervention or single-task training among people with a primary diagnosis of mild cognitive impairment or dementia were included. The PEDro scale was used to evaluate the methodological quality of individual studies. The Grading of Recommendations, Assessment, Development and Evaluations system was adopted to appraise the quality of evidence for each outcome. Results: Eighteen trials (1325 participants) were included, and 17 provided data for meta-analysis. Comparing with no intervention, dual-task training led to significant improvements on attention (mean difference (MD) = −20.66, 95%CI [−39.42, −1.90]), functional mobility (MD = −2.73; 95%CI [−3.98, −1.49]). Compared with single-task training, dual-task training had greater effects on overall cognitive function (standardized mean difference (SMD) = 0.29, 95%CI [0.09, 0.49]), balance (SMD = 0.78, 95%CI [0.40, 1.15]) and functional mobility (MD = −1.17; 95%CI [−1.77, −0.58]). Its effect on dual-task performance remains inconclusive due to the inconsistent results reported. Conclusion: Low- to moderate-quality evidence supports that dual-task training has beneficial effects on cognitive function and physical function in individuals with dementia or mild cognitive impairment. The optimal training protocol of dual-task training on cognitive and physical functions, and dual-task performance remains uncertain. Well-designed, randomized studies with large enough sample sizes are warranted. [ABSTRACT FROM AUTHOR]

Background and Objectives: Mild cognitive impairment (MCI) is an early stage of dementia in which everyday tasks can be maintained; however, notable challenges may occur in memory, focus, and problem-solving skills. Therefore, motor-cognitive dual-task training is warranted to prevent cognitive decline and improve cognition in aging populations. This study aimed to determine the influence of such dual-task activities during straight and curved walking on the activities of the prefrontal cortex and associated gait variables in older adults with MCI. Materials and Methods: Twenty-seven older adults aged ≥65 years and identified as having MCI based on their scores (18–23) on the Korean Mini-Mental State Examination were enrolled. The participants performed four task scenarios in random order: walking straight, walking straight with a cognitive task, walking curved, and walking curved with a cognitive task. The activation of the prefrontal cortex, which is manifested by a change in the level of oxyhemoglobin, was measured using functional near-infrared spectroscopy. The gait speed and step count were recorded during the task performance. Results: Significant differences were observed in prefrontal cortex activation and gait variables (p < 0.05). Specifically, a substantial increase was observed in prefrontal cortex activation during a dual task compared with that during a resting-state (p < 0.013). Additionally, significant variations were noted in the gait speed and step count (p < 0.05). Conclusions: This study directly demonstrates the impact of motor-cognitive dual-task training on prefrontal cortex activation in older adults with MCI, suggesting the importance of including such interventions in enhancing cognitive function. [ABSTRACT FROM AUTHOR]

Abstract Background Dual-task training in Parkinson’s disease (PD) improves spatiotemporal gait parameters, cognition, and quality of life. Virtual reality (VR) has been used as a therapeutic tool for patients to participate in activities in a safe environment, engage in multisensory experiences, and improve motivation and interest in rehabilitation. This study aimed to investigate the feasibility of fully immersive VR exergames with dual-task components in patients with PD. Methods We developed VR exergames (go/no-go punch game, go/no-go stepping game, and number punch game) to improve habitual behavior control using motor–cognitive dual-task performance in patients with PD. The participants underwent 10 sessions 2–3 times a week, consisting of 30 min per session. The Unified Parkinson’s Disease Rating Scale, Timed Up and Go test (TUG) under single- and dual-task (cognitive and physical) conditions, Berg balance scale (BBS), Stroop test, trail-making test, and digit span were evaluated before and after intervention. The Simulator Sickness Questionnaire (SSQ) was used to assess VR cybersickness. Usability was assessed using a self-reported questionnaire. Results Twelve patients were enrolled and completed the entire training session. The mean age of participants was 73.83 ± 6.09 years; mean disease duration was 128.83 ± 76.96 months. The Hoehn and Yahr stages were 2.5 in seven patients and 3 in five patients. A significant improvement was observed in BBS and Stroop color–word test (p = 0.047 and p = 0.003, respectively). TUG time and dual-task interferences showed positive changes, but these changes were not statistically significant. The median SSQ total score was 28.05 (IQR: 29.92), 13.09 (IQR: 11.22), and 35.53 (IQR: 52.36) before, after the first session, and after the final session, respectively; the differences were not significant. Overall satisfaction with the intervention was 6.0 (IQR: 1.25) on a 7-point Likert-type scale. Conclusions Fully immersive VR exergames combined with physical and cognitive tasks may be used for rehabilitation of patients with PD without causing serious adverse effects. Furthermore, the exergames using dual-task components improved executive function and balance. Further development of VR training content may be needed to improve motor and dual-task performances. Trial registration NCT04787549 ( https://clinicaltrials.gov/ct2/show/NCT04787549 )

Background and Aims: Stroke is the fifth leading cause of death in the world; which can cause disability. One of the main goals of rehabilitation in these patients is to improve their upper limb function. Dualtask training (DTT) is one of the rehabilitation methods in stroke patients, which include performing motor tasks along with mental exercises. This study aims to investigate the effect of DTT on upper limb function, elbow flexor muscle tone, wrist extension range of motion (ROM), and the ability to perform activities of daily living (ADL) in women with chronic stroke. Methods: In this pilot study, 16 female patients suffering from chronic stroke for more than 6 months were selected and divided into two groups of 8 including training and control. In both groups, the routine treatment included electrical stimulation of quadriceps and dorsiflexors of the affected hand, 10 minutes of bicycling, and performing three movement tasks for the upper limb (sorting colored blocks, opening and closing the bottle cap with the affected hand, and moving the beans with a spoon towards a determined point). In the training group, DTT included performing these three movement tasks simultaneously with performing mental task (counting down from 100). The training was performed for 4 weeks at 12 sessions, three sessions per week. The upper limb function was measured by the box & block test; elbow flexor muscle tone by the modified Ashworth scale; active ROM of wrist extension by a goniometer; and ADL by the Barthel index before and after the treatments. Results: No significant difference was found in any variables between the two groups (P>0.05). In both in groups, there was a significant improvement in the three variables of elbow flexor muscle tone, upper limb function, and the ability to perform ADL after interventions compared to baseline (P<0.05). However, no significant difference was found in the active ROM of wrist extension in any groups (P>0.05). Conclusion: Training with and without DTT can lead to significant improvement in elbow flexor muscle tone, upper limb function, and the ability to perform ADL in women with chronic stroke. The DTT has no superior effect on these variables. [ABSTRACT FROM AUTHOR]

Background: Dual‐task training (DTT) involves simultaneously motor and cognitive exercises. Objectives: To determine the effectiveness of DTT, in comparison to other interventions [single‐task training (STT) and usual care (UC)], on gait and balance parameters, motor impairments, activities of daily living (ADLs) and quality of life (QoL) in patients with Parkinson's disease (PD) immediately post‐intervention and at 3, 6, and 12 months after therapy. Methods: A meta‐analysis was performed following PRISMA Guidelines through searching in PubMed, SCOPUS, WOS, CINAHL, SciELO and PEDro up to September 2022. We included randomized controlled trials (RCTs) that compare the effect of DTT versus STT and UC on gait (speed, step and stride length, cadence and steps per day), balance (functional and dynamic balance), motor impairments, ADLs and QoL. Methodological quality was assessed using the PEDro scale. The pooled effect was calculated through Cohen's Standardized Mean Difference (SMD) and its 95% confidence interval (95%CI). Results: Seventeen RCTs with 826 participants and a mean PEDro score of 6.59 ± 1 points were included. In comparison to STT and UC, DTT is effective in improving walking speed (SMD 0.42, 95%CI 0.23–0.6), stride length (SMD 0.69, 95%CI 0.23–1.15), cadence (SMD 0.41, 95%CI 0.19–0.63), functional balance (SMD 1.15, 95%CI 0.92–1.4), dynamic balance (SMD −0.5, 95%CI −0.81 to −0.18) and motor impairments (SMD −0.86, 95%CI −1.25 to −0.47). No adverse effects related to DTT were reported. Conclusions: DTT is an effective and safe therapy for improving gait, balance and motor impairments in patients with PD. [ABSTRACT FROM AUTHOR]

Background: Dual-task training in Parkinson's disease (PD) improves spatiotemporal gait parameters, cognition, and quality of life. Virtual reality (VR) has been used as a therapeutic tool for patients to participate in activities in a safe environment, engage in multisensory experiences, and improve motivation and interest in rehabilitation. This study aimed to investigate the feasibility of fully immersive VR exergames with dual-task components in patients with PD. Methods: We developed VR exergames (go/no-go punch game, go/no-go stepping game, and number punch game) to improve habitual behavior control using motor–cognitive dual-task performance in patients with PD. The participants underwent 10 sessions 2–3 times a week, consisting of 30 min per session. The Unified Parkinson's Disease Rating Scale, Timed Up and Go test (TUG) under single- and dual-task (cognitive and physical) conditions, Berg balance scale (BBS), Stroop test, trail-making test, and digit span were evaluated before and after intervention. The Simulator Sickness Questionnaire (SSQ) was used to assess VR cybersickness. Usability was assessed using a self-reported questionnaire. Results: Twelve patients were enrolled and completed the entire training session. The mean age of participants was 73.83 ± 6.09 years; mean disease duration was 128.83 ± 76.96 months. The Hoehn and Yahr stages were 2.5 in seven patients and 3 in five patients. A significant improvement was observed in BBS and Stroop color–word test (p = 0.047 and p = 0.003, respectively). TUG time and dual-task interferences showed positive changes, but these changes were not statistically significant. The median SSQ total score was 28.05 (IQR: 29.92), 13.09 (IQR: 11.22), and 35.53 (IQR: 52.36) before, after the first session, and after the final session, respectively; the differences were not significant. Overall satisfaction with the intervention was 6.0 (IQR: 1.25) on a 7-point Likert-type scale. Conclusions: Fully immersive VR exergames combined with physical and cognitive tasks may be used for rehabilitation of patients with PD without causing serious adverse effects. Furthermore, the exergames using dual-task components improved executive function and balance. Further development of VR training content may be needed to improve motor and dual-task performances. Trial registration NCT04787549 (https://clinicaltrials.gov/ct2/show/NCT04787549) [ABSTRACT FROM AUTHOR]

Objective: Parkinson's disease is one of the most common neurodegenerative diseases in the world, which seriously damages motor and balance ability. Dual-task training is discussed as an appropriate intervention. The aim of this review was to synthesize the existing research findings on the efficacy of dual-task training for people with Parkinson's disease. Data resources: A systematic search on PubMed, CENTRAL, Embase, Web of Science, and PEDro, randomized-controlled trials (RCTs) of dual-task training for individuals with Parkinson's disease. Methods: Articles published until 1 November 2022 were included. Our search identified 7 RCTs with a total of 406 subjects. Review Manager 5.4 software was used for bias evaluation and to process the results of the outcome measures collected from the investigations. Results: Dual-task training was associated with significant improvement in most motor and balance outcomes including gait velocity (standard mean difference (SMD) = 0.62; 95% CI, 0.37–0.87; I 2 = 31%; P = 0.21), cadence (SMD = 0.29; 95% CI, 0.05–0.53; I 2 = 0%; P = 0.71), timed-up-and-go test (mean difference (MD) = -2.38; 95% CI, −3.93 to −0.84; I 2 = 32%; P = 0.22) and mini-balance evaluation systems test (MD = 2.04; 95% CI, 1.05–3.03; I 2 = 0%; P = 0.92). Conclusion: Evidence from meta-analyses suggests that dual-task training may improve motor and balance abilities in Parkinson's disease patients. Future research should focus on finding the most appropriate dual-task treatment model for patients with different degrees, in order to further improve the rehabilitation treatment of Parkinson's disease. [ABSTRACT FROM AUTHOR]

Purpose: At present, there is a controversy regarding the effect of dual-task training on improving the cognitive function of people with mild cognitive impairment (MCI). This study was to develop and verify the effects of the cognitive–physical dual-task training program on the executive function of older adults with MCI. Method: Participants were randomly allocated to the experimental group (EG) receiving cognitive–physical dual-task training (n = 21) or the control group (CG) receiving cognitive single-task training (n = 21). Results: After 16 sessions for 8 weeks, the Korean version of the Executive Function Performance Task (EFPT-K), the Frontal Assessment Battery (FAB), and Korean version of the Instrumental Activities of Daily Living (K-IADL) tests were implemented to assess people's executive function and instrumental activities during daily living. As the result, there were no significant differences in general characteristics between both groups (p > 0.05). After 16 sessions, the EG showed greater improvements in the EFPT-K (p < 0.05; η2 = 0.133), the FAB (p < 0.001; η2 = 0.305), and the K-IADL (p < 0.01; η2 = 0.221) compared to those of the CG. Conclusion: These results indicate that cognitive–physical dual-task training is clinically beneficial to improve the executive function and daily instrumental activities of older adults with MCI. Cognitive–physical dual-task training is a promising intervention for older adults with MCI. [ABSTRACT FROM AUTHOR]

Abstract Background The performing of jump and landing in futsal simultaneous with divided attention is one of the most common mechanisms of non-contact anterior cruciate ligament (ACL) injury. Neuromuscular training has effectively reduced the risk of ACL injury, but the effect of neurocognitive training has received less attention. This study investigated the effect of combining 8 weeks of neuromuscular training with dual cognitive tasks on the landing mechanics of futsal players with knee ligament dominance defects. Methods Thirty male futsal players (mean ± SD: age: 21.86 ± 3.27 years) with knee ligament dominance defects were purposefully identified by the tuck jump test and were randomly divided into the intervention and the control group. The intervention group performed dual task (DT) training for three weekly sessions for 8 weeks and 60 min each, while the control group only did activities of daily living. During the drop vertical jump test, 2D landing kinematics in two moments of initial contact (IC) and full flexion (FF) were assessed. Data were analyzed by means of 2 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of (α ≤ 0.05). Results A significant improvement was observed in the intervention group compared to the control group for the dynamic knee valgus at IC (F1,28 = 6.33; P = 0.02, ES = 0.31) and FF (F1,28 = 13.47; P = 0.003, ES = 0.49), knee flexion at IC (F1,28 = 20.08; P = 0.001, ES = 0.41) and FF (F1,28 = 13.67; P = 0.001, ES = 0.32), ankle dorsiflexion at IC (F1,28 = 37.17; P = 0.001, ES = 0.72) and FF (F1,28 = 14.52; P = 0.002, ES = 0.50), and trunk flexion at FF (F1,28 = 20.48; P = 0.001, ES = 0.59) angles. Changes in the trunk flexion at IC (F1,28 = 0.54; P = 0.47, ES = 0.03) and trunk lateral flexion at IC (F1,28 = 0.006; P = 0.93, ES = 0.00) and FF (F1,28 = 2.44; P = 0.141, ES = 0.148) angles were not statistically significant. Conclusions DT training compared to the control group improved landing mechanics in futsal players with knee ligament dominance defects. Trial registration: Current Controlled Trials using the IRCT website with ID number IRCT20210602051477N1 prospectively registered on 20/06/2021.

Rehabilitation is a high-potential approach to improving physical and cognitive functions in Parkinson's disease (PD). Dual-task training innovatively combines motor and cognitive rehabilitation in a comprehensive module. Patients perform motor and cognitive tasks at the same time in dual-task training. The previous studies of dual-task training in PD had high heterogeneity and achieved controversial results. In the current review, we aim to summarize the current evidence of the effect of dual-task training on motor and cognitive functions in PD patients to support the clinical practice of dual-task training. In addition, we also discuss the current opinions regarding the mechanism underlying the interaction between motor and cognitive training. In conclusion, dual-task training is suitable for PD patients with varied disease duration to improve their motor function. Dual-task training can improve motor symptoms, single-task gait speed, single-task steep length, balance, and objective experience of freezing of gait in PD. The improvement in cognitive function after dual-task training is mild. [ABSTRACT FROM AUTHOR]

Background and Objectives: Mild cognitive impairment (MCI) is an early stage of dementia in which everyday tasks can be maintained; however, notable challenges may occur in memory, focus, and problem-solving skills. Therefore, motor-cognitive dual-task training is warranted to prevent cognitive decline and improve cognition in aging populations. This study aimed to determine the influence of such dual-task activities during straight and curved walking on the activities of the prefrontal cortex and associated gait variables in older adults with MCI. Materials and Methods: Twenty-seven older adults aged ≥65 years and identified as having MCI based on their scores (18–23) on the Korean Mini-Mental State Examination were enrolled. The participants performed four task scenarios in random order: walking straight, walking straight with a cognitive task, walking curved, and walking curved with a cognitive task. The activation of the prefrontal cortex, which is manifested by a change in the level of oxyhemoglobin, was measured using functional near-infrared spectroscopy. The gait speed and step count were recorded during the task performance. Results: Significant differences were observed in prefrontal cortex activation and gait variables (p < 0.05). Specifically, a substantial increase was observed in prefrontal cortex activation during a dual task compared with that during a resting-state (p < 0.013). Additionally, significant variations were noted in the gait speed and step count (p < 0.05). Conclusions: This study directly demonstrates the impact of motor-cognitive dual-task training on prefrontal cortex activation in older adults with MCI, suggesting the importance of including such interventions in enhancing cognitive function.

Objective: The main purpose of this meta-analysis was to evaluate the effect of dual-task training on gait and balance improvement in stroke patients. Design: The PubMed, Embase, Cochrane Library, MEDLINE, CINAHL, CNKI, Wan Fang, and VIP databases were searched from inception to January 28, 2021, for randomized controlled trials investigating the effect of dual-task training on gait and balance intervention in stroke patients. Results: A total of 17 studies with 575 stroke patients that compared the efficacy and safety of dual-task training with those of conventional physical therapy or single-task training were included in this meta-analysis. The meta-analysis showed that the data were as follows under the dual-task training: step length (mean difference = 2.7, 95% confidence interval = 1.33 to 4.08, P = 0.0001); cadence (mean difference = 5.06, 95% confidence interval = 3.37 to 6.75, P < 0.00001); stride length (mean difference = 7.34, 95% confidence interval = 5.47 to 9.22, P < 0.00001); 10-meter walk test times (mean difference = −2.36, 95% confidence interval = −3.70 to −1.02), P = 0.0006); Berg Balance Scale (mean difference = 3.8, 95% confidence interval = 0.04 to 7.55, P = 0.05); Fugl-Meyer motor assessment of lower extremities (mean difference = 2.27, 95% confidence interval = −1.04 to 5.59, P = 0.18). Conclusions: This meta-analysis showed that dual-task training can improve stroke patients' step length, cadence, stride length, and 10-meter walk test. However, possible advantages in improving balance function need further exploration. [ABSTRACT FROM AUTHOR]

In daily functional activities, the body needs the ability to perform two or more tasks at the same time (such as talking while walking). However, the gait disorder of patients with Parkinson's disease is aggravated when performing dual tasks, which seriously affects their quality of life. Therefore, the medical management plan should offer effective exercise training programming to improve Parkinson's disease patients' ability to perform dual tasks. Most traditional exercise intervention methods only focus on the perspective of exercise or cognition, ignoring their interaction, and fail to adequately resolve the dual task obstacles associated with Parkinson's disease. Some scholars put forward the concept of dual-task training and have applied dual-task training to patients with neurological disorders and have achieved good therapeutic effects. Therefore, this article summarizes the research literature concerning dual-task training to improve cognitive impairment and walking function of Parkinson's disease patients, to evaluate and discuss possible mechanisms of action, and provide a basis for adjuvant treatment and rehabilitation of Parkinson's disease patients.

Background: The performing of jump and landing in futsal simultaneous with divided attention is one of the most common mechanisms of non-contact anterior cruciate ligament (ACL) injury. Neuromuscular training has effectively reduced the risk of ACL injury, but the effect of neurocognitive training has received less attention. This study investigated the effect of combining 8 weeks of neuromuscular training with dual cognitive tasks on the landing mechanics of futsal players with knee ligament dominance defects. Methods: Thirty male futsal players (mean ± SD: age: 21.86 ± 3.27 years) with knee ligament dominance defects were purposefully identified by the tuck jump test and were randomly divided into the intervention and the control group. The intervention group performed dual task (DT) training for three weekly sessions for 8 weeks and 60 min each, while the control group only did activities of daily living. During the drop vertical jump test, 2D landing kinematics in two moments of initial contact (IC) and full flexion (FF) were assessed. Data were analyzed by means of 2 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of (α ≤ 0.05). Results: A significant improvement was observed in the intervention group compared to the control group for the dynamic knee valgus at IC (F1,28 = 6.33; P = 0.02, ES = 0.31) and FF (F1,28 = 13.47; P = 0.003, ES = 0.49), knee flexion at IC (F1,28 = 20.08; P = 0.001, ES = 0.41) and FF (F1,28 = 13.67; P = 0.001, ES = 0.32), ankle dorsiflexion at IC (F1,28 = 37.17; P = 0.001, ES = 0.72) and FF (F1,28 = 14.52; P = 0.002, ES = 0.50), and trunk flexion at FF (F1,28 = 20.48; P = 0.001, ES = 0.59) angles. Changes in the trunk flexion at IC (F1,28 = 0.54; P = 0.47, ES = 0.03) and trunk lateral flexion at IC (F1,28 = 0.006; P = 0.93, ES = 0.00) and FF (F1,28 = 2.44; P = 0.141, ES = 0.148) angles were not statistically significant. Conclusions: DT training compared to the control group improved landing mechanics in futsal players with knee ligament dominance defects. Trial registration: Current Controlled Trials using the IRCT website with ID number IRCT20210602051477N1 prospectively registered on 20/06/2021. [ABSTRACT FROM AUTHOR]

Background: Dual-task training is an emerging field used for people with Parkinson disease (PD) to improve their physical and cognitive well-being, but the patients’ acceptability, safety, and adherence to such training in online settings are unknown. Objective: This study aims to evaluate the acceptability of a dual-task cognitive and motor online training program for people with PD as a group online community program. Methods: People with PD were invited to participate in an online program (PD3 Move) consisting of physical and vocal exercises in response to different cognitive challenges displayed as dynamic backgrounds on Zoom. The program ran twice per week for 16 weeks. Patient acceptability was assessed at 4 months by monitoring attendance rates and feedback from an exit questionnaire emailed to all participants assessing satisfaction, perceived benefit, safety, and willingness to continue and recommend to others. Results: The online program was delivered to 15 participants (n=9, 60%, females) with a diagnosis of PD, a mean age of 69.4 (SD 9.3) years, and Hoehn and Yahr (H&Y) stages I-IV. The attendance rate was high, with participants coming to more than 13 (81%) of the sessions. Participants were very satisfied (n=8, 53%) or satisfied (n=7, 47%) with the program. Participants reported that what they most liked were the new cognitive physical challenges. The 3 main facilitators to participating were perceiving the benefits, instructor’s flexibility and engagement, and the social interaction moments with others. The 3 main difficulties were dealing with motor fluctuations (n=3, 20%), difficulties in using technology (n=2, 13%), and difficulty hearing instructions due to hearing loss (n=2, 13%). Patients had favorable perceived benefits of the program, with 14 (93%) considering it very useful for the current management of health and 1 (7%) moderately useful. No adverse events were reported, and all participants said that they were willing to continue the program and recommend it to others. Conclusions: Our findings suggest that the online cognitive and motor program was well received, safe, and perceived to be of benefit to this group of medically stable people with PD in H&Y stages I-IV. Access to specialized care and enhancement of long-term adherence to regular exercise can be achieved with online community group programs. [ABSTRACT FROM AUTHOR]

The dual task training (DTT) has been shown to improve postural and cognitive performances in many populations. Therefore, it seems of interest to explore the effect of such training modality in individuals with Down syndrome (DS) presenting both cognitive and postural deficits. This study explored the effect of a DTT compared to a single task training (STT) on postural and cognitive performances in adolescents with DS. The center of pressure velocity (CoP Vm) and the cognitive performance in the selective word recall test were recorded under single task (ST) and DT conditions before and after 8 weeks in the STT group (STTG), the DTTG and the control group (CG). Before training, CoP Vm values increased and cognitive performances decreased (p < 0.001) during the DT compared to ST conditions in all groups. After training, CoP Vm decreased (p < 0.001) in the DTTG and the STTG under the ST conditions. However, under DT conditions, these values decreased (p < 0.001) only in the DTTG. The cognitive performance increased (p < 0.001) only in the DTTG in both ST and DT conditions. The DTT is strongly recommended to improve both postural and cognitive performances in individuals with DS notably in DT conditions. • Single task training improved postural balance in adolescents with Down syndrome. • Dual task-training improved postural balance in adolescents with Down syndrome. • Only dual-task training enhanced dual-task ability in adolescents with Down syndrome. • Only dual-task training improved cognitive ability in adolescents with Down syndrome. [ABSTRACT FROM AUTHOR]

Background: Children with cerebral palsy (CP) may have difficulties under dual-task conditions. Spatiotemporal gait parameters have deteriorated with concurrent tasks in children with CP. However, how dual-task training affects gait parameters in children with spastic diplegic CP has not been clarified.Research Question: How does dual-task training program effect gait, functional skills, and health-related quality of life in children with spastic diplegic CP?Methods: Eleven children with spastic diplegic CP (median age 11 y, range 7-16 y; 4 female; 7 male) Gross Motor Function Classification System level 1-2 and obtained 27 and higher scores from Modified Mini Mental Test included in the study. The study was planned as a self-controlled clinical research design. Children were recruited to conventional physiotherapy program for 8 weeks and dual-task training program added to conventional physiotherapy program for following 8 weeks. Children were evaluated at baseline, after conventional physiotherapy program, and after dual-task training program. Children's gait was evaluated with Zebris™ FDM-2 device and Edinburgh Visual Gait Score, functional mobility skills with 1 min Walk Test (1MWT), and health-related quality of life with the Pediatric Quality of Life Inventory (PedsQL) - CP module.Results: The difference in step length, step time, stride time, cadence and gait speed of spatiotemporal parameters of gait during dual-task performance were found statistically significant in children with spastic diplegic CP, after dual-task training program (p < 0,05). After dual-task training, statistically significant gains were found in 1MWT, movement and balance subtitle of PedsQL-CP module Parent Form (p < 0,05).Significance: Dual-task training program added to a conventional physiotherapy program provides more gains in terms of functionality of children with spastic diplegic CP will contribute to the improvement of the motor functional level. [ABSTRACT FROM AUTHOR]

Background: The number of patients with cognitive impairment increases as the population becomes older. This perspective may persist a burden on health care systems unless considered new options of prevention and treatment. The aim of this meta-synthesis is to analyze different systematic reviews on the effectiveness of dual-task training (DTT) on cognition and motor function of different people. Methods: A systematic search of systematic reviews published until October 2019 was conducted in PubMed/Medline, Scopus and Cochrane databases addressing studies which investigated the effect of DTT compared to control or other intervention on cognitive functions of healthy or unhealthy individuals. Three steps were followed to retrieve studies: reading title, abstract and full text. Checklist Assessing the Methodological Quality of Systematic Reviews (AMSTAR) was used to assess the quality of selected articles. Results: In terms of quality of evidence, according to AMSTAR, 62.5 % of the reviews were rated as being “low” and 37.5 % were graded as “moderate” quality. Two main themes were identified among the studies’ outcomes: Improvement on mobility performance or postural stability; and beneficial effect on cognitive function. In terms of effect size, there were reported an important variation, having more significant results for findings involving mobility and modest effect for findings regarding cognitive function. Conclusion: People with different clinical conditions could benefit from dual-task training. The benefits may encompass general cognitive functions, memory, physical performance, gait and balance, to name a few aspects.

Objective : To design a randomized controlled trial combining resistance exercise and cognitive intervention to carry out a dual-task computer-aided product design that combines hardware and software to explore the effects of different intensities of resistance exercise on cognitive function in elderly individuals with cognitive decline. Materials and Methods : Forty-eight participants (aged between 60 and 75 years) who satisfied the specified criteria were randomly assigned to one of four groups as follows: control ( n = 12), low intensity ( n = 12), medium intensity ( n = 12), and high intensity ( n = 12). The control group exclusively underwent cognitive training, whereas the experimental group underwent dual-task training at varying resistance exercise intensities. The main outcomes were short-term effects on cognitive function and lower limb strength using the Montreal Cognitive Assessment (MoCA), One-Rep Max (1RM) data, and training scores. The secondary outcomes were the effects of the participants' subjective fatigue and the system availability of the product. Results : The experimental group subjected to medium-intensity exercise exhibited the most substantial improvement in MoCA score ( P = 0.017). All the groups achieved training scores that were substantially higher than the initial data ( P < 0.05), and significant 1RM values were obtained for the left and right legs in the middle- and high-strength groups ( P < 0.05). In addition, the participants indicated a positive experience with the application. Conclusions : Overall, we found support for the feasibility and acceptability of the product developed by dual-task therapy based on resistance exercise combined with cognitive intervention and showed the initial impact prospect of moderate-intensity resistance exercise. Future applications should be replicated in older individuals with Clinical trial registration: NCT06220565 Ethical approval: H2022013I decline.

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Objective: To evaluate the effects of dual-task training on static and dynamic balance in patients with multiple sclerosis. Data sources: PubMed/MEDLINE, EMBASE, Scopus, and PEDro databases were searched from inception to March 1, 2021. Methods: This study was conducted in agreement with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers assessed studies for inclusion and extracted data. We used the Physiotherapy Evidence Database scale to evaluate the methodological quality and the risk-of-bias. Randomized clinical trial data were pooled for the meta-analysis. The effect sizes and 95% confidence interval (CI) were calculated by random-effect models. Egger regression and Begg-Mazumdar rank correlation test were used for publication bias. Results: A total of 13 studies involving 584 patients (42.3 ± 9 years mean ± SD; 377 females) met the inclusion criteria for the systematic review, while nine were included in the meta-analysis. People who received dual-task training interventions showed significant improvements in the Timed Up & Go test 0.44 [(95% CI = 0.22; 0.65), P -value<0.001], and in the Berg Balance scale 0.46 [(95% CI = 0.07; 0.85), P -value = 0.02]. Low and moderate heterogeneity between the studies was found for the Timed Up & Go test and the Berg Balance scale, respectively. Conclusion: The findings from the current meta-analysis support dual-task training as a beneficial therapy for improving dynamic balance and functional mobility in patients with multiple sclerosis. The limited number of studies that investigated static balance performance after dual-task training do not currently allow us to draw a conclusion about any possible improvements in this ability. [ABSTRACT FROM AUTHOR]

• A simultaneous cognitive–physical dual-task training program based on familiar cultural backgrounds using fairy tales is beneficial for cognitive and physical functions in older adults with MCI. • Along with improvements in cognitive and physical function, the intervention has shown beneficial effects by increasing memory and physical self-efficacy. • Further studies examining beta band power in larger sample sizes using a randomized controlled design are required to determine the effects of the simultaneous dual-task intervention on neurophysiological function in older adults with MCI. In this study, we aimed to develop a simultaneous cognitive–physical dual-task training program based on familiar cultural backgrounds using fairy tales and to explore its feasibility and preliminary effects, including effects on neurophysiological, cognitive, and physical functions. A single-group pretest–posttest design (n = 9) was employed to evaluate the effects of the cognitive–physical intervention performed for 60–90 min once a week for 12 weeks. The findings showed that perceived memory and physical self-efficacy, muscle strength, and cognitive function were significantly increased after the intervention. Although the relative beta band power measured using electroencephalography showed a tendency to increase in eight brain domains after the 12-week intervention, the changes were not significant. Findings suggested that the intervention was feasible and provided beneficial effects on cognitive and physical functions in older adults with mild cognitive impairment. Future research on larger sample sizes using randomized controlled trials is needed to determine the effectiveness of such interventions on neurophysiological functions. [ABSTRACT FROM AUTHOR]

To determine the effects of simultaneous dual-task training on cognitive function, physical function, and depression in older adults with mild cognitive impairment or dementia. Comprehensive database searches were conducted in PubMed, Embase, the Cochrane Library, CINAHL, Ovid-Medline, Web of Science, and Scopus up to December 2022. Randomized controlled trials were included to assess the efficacy of simultaneous dual-task training for older adults with mild cognitive impairment or dementia. The analysis utilized Comprehensive Meta-Analysis version 3.0, presenting Hedges' g and the corresponding 95 % confidence interval (CI) for the pooled effect size and, applying a random-effects model. The I 2 and Cochran's Q tests were employed to evaluate heterogeneity. The Cochrane Risk of Bias 2.0 tool was employed to assess study quality. The Copenhagen Trial Unit (version 0.9.5.10 Beta) was employed for trial sequential analysis, providing a rigorous methodology for evaluating cumulative evidence from multiple studies. Of the 1676 studies identified, 20 studies involving 1477 older adults with cognitive impairment were included. Dual-task training significantly enhanced global cognition (0.477, 95 % CI: 0.282 to 0.671), executive function (− 0.310, 95 % CI: − 0.586 to − 0.035), working memory (0.714, 95 % CI: 0.072 to 1.355), gait (0.418, 95 % CI: 0.252 to 0.583), physical activity (0.586, 95 % CI: 0.012 to 1.16), and depression (− 0.703, 95 % CI: − 1.253 to − 0.153). Trial sequential analyses revealed the robustness of this meta-analysis, which was based on a sufficient sample size from the included studies. Moreover, dual-task training demonstrated beneficial effects on global cognition, executive function, working memory, and gait. Dual-task training improved cognition, physical function, and depression among older adults with cognitive impairment. Accordingly, dual-task training should be considered a clinical nonpharmacological intervention for older adults with mild cognitive impairment or dementia. Nevertheless, the trial sequential analysis results were consistent with those of the pairwise meta-analysis but only global cognition reached significance by crossing the trial sequential analysis boundary. Future studies with higher-quality designs and larger sample sizes are required to obtain more conclusive results regarding other outcomes. PROSPERO CRD42023418598. [ABSTRACT FROM AUTHOR]

• Dual task training (DTT) improves balance in older adults. • DTT enhances balance in older adults compared to different interventions. • DTT provides notable benefit in older adults compared to no intervention. Our review aims to analyze the effect of dual-task training (DTT) on balance in healthy older adults. PubMed, EbscoHost, Web of Science (WOS), Scopus, Cochrane Library, MEDLINE, EBSCO Open Dissertations, ULAKBIM (TR Index) and YOK (Council of Higher Education Thesis Center) databases and the gray literature were searched. The quality of the studies was assessed with the Cochrane Risk of Bias tool and statistical analysis of the data was performed with Comprehensive Meta-Analysis (CMA) software. A funnel plot and Egger's test were used to detect publication bias. Fourteen studies with 691 participants were included. According to the results of our study, DTT was found to have a significant benefit on balance in older adults than the non-intervention group (standardized mean difference (SMD): -0.691: -1.153, -0.229, 95 % confidence interval (CI)). Furthermore, DTT was superior to different intervention groups in improving balance in older adults (SMD: -0.229: -0.441, -0.016, 95 % CI). The findings of this review suggest that DTT may be an effective intervention to improve balance in healthy older adults. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Parkinson disease (PD) is characterized by motor and non-motor symptoms that affect patients’ functions, especially while performing dual-tasks a critical factor in everyday living. However, many controversies exist about the benefits of dual-task training in patients with PD. Objectives: This study assessed the efficacy of motor and cognitive dual-task training in improving balance and gait parameters in people with idiopathic PD. Materials & Methods: A single-blind controlled trial was conducted on PD patients living in Guilan Province of Iran, in 2018-2019. A total of 30 PD patients (Hoehn and Yahr stage II-III while on medication) were assigned to the cognitive dual-task training group (n=10), motor dual-task training group (n=10), and single-task control group (n=10). All groups received 30 sessions of different exercises for 10 consecutive weeks. The patients’ balance and some spatiotemporal gait parameters were respectively assessed with timed up and go test and HD VideoCam-Kinovea before and after training and then 1 month later. Results: Both dual-task and single-task trainings improved the outcome measures (timed up and go test (F=535.54; P=0.000), stride length (F=87.41; P=0.00), stride time (F=102.11; P=0.00), cadence (F=286.36; P=0.00), swing time (F=48.90; P=0.00), and stance time (F=40.56; P=0.00)). These improvements were maintained at 1-month follow-up, although the effect slightly reduced. No significant differences were found between the study groups (P>0.05). Conclusion: Motor/cognitive dual-task training and single-task training were found to be significantly and equally effective in improving balance and gait parameters in people with PD.

Heart rate variability (HRV) mirrors autonomic nervous system activities and might serve as a parameter to monitor health status in older adults. However, it is currently unknown which functional health measures, including cognitive, physical, and gait performance parameters, are most strongly related to HRV indices. This knowledge would enable implementing HRV assessments into health monitoring routines and training planning for older adults. Simultaneous cognitive–motor and exergame training may be effective to improve HRV indices but has not been investigated yet. Eighty-nine healthy older adults (≥70 years of age) were randomized into three groups: (1) virtual reality video game dancing, i.e., exergaming (DANCE); (2) treadmill walking with simultaneous verbal memory training (MEMORY); or (3) treadmill walking only (PHYS). Strength and balance exercises complemented each program. Over 6 months, two weekly 1-h training sessions were performed. HRV indices (standard deviation of N–N intervals, SDNN; root mean square of successive R–R interval differences, RMSSD; and absolute power of high-frequency band (0.15–0.4 Hz), HF power) and various measures of cognitive, physical, and gait performance were assessed at baseline and after 3 months and 6 months. Multiple linear regression analyses with planned comparisons were calculated. At baseline, 8–12% of HRV variance was significantly explained by cognitive executive functions and leg strength (inversely related). Verbal long-term memory, aerobic and functional fitness, and gait performance did not contribute to the model (SDNN: R2 = 0.082, p = 0.016; RMSSD: R2 = 0.121, p = 0.013; HF power: R2 = 0.119, p = 0.015). After 6 months, DANCE improved HRV indices, while MEMORY and PHYS did not (time × intervention interactions: first-contrast DANCE/MEMORY vs. PHYS: SDNN p = 0.014 one-tailed, ΔR2 = 0.020 and RMSSD p = 0.052 one-tailed (trend), ΔR2 = 0.007; second-contrast DANCE vs. MEMORY: SDNN p = 0.002 one-tailed, ΔR2 = 0.035, RMSSD p = 0.017 one-tailed, ΔR2 = 0.012, and HF power p = 0.011 one-tailed, ΔR2 = 0.013). We conclude that mainly cognitive executive functions are associated with HRV indices and that exergame training improves global and parasympathetic autonomic nervous system activities in older adults. Periodic assessments of HRV in older citizens could be particularly beneficial to monitor cognitive health and provide indications for preventative exercise measures.

Abstract Background Randomized controlled trials (RCTs) provide the highest level of scientific evidence, but successful participant recruitment is critical to ensure the external and internal validity of results. This study describes the strategies associated with recruiting older adults at increased falls risk residing in retirement villages into an 18-month cluster RCT designed to evaluate the effects of a dual-task exercise program on falls and physical and cognitive function. Methods Recruitment of adults aged ≥65 at increased falls risk residing within retirement villages (size 60–350 residents) was initially designed to occur over 12 months using two distinct cohorts (C). Recruitment occurred via a three-stage approach that included liaising with: 1) village operators, 2) independent village managers, and 3) residents. To recruit residents, a variety of different approaches were used, including distribution of information pack, on-site presentations, free muscle and functional testing, and posters displayed in common areas. Results Due to challenges with recruitment, three cohorts were established between February 2014 and April 2015 (14 months). Sixty retirement villages were initially invited, of which 32 declined or did not respond, leaving 28 villages that expressed interest. A total of 3947 individual letters of invitation were subsequently distributed to residents of these villages, from which 517 (13.1%) expressions of interest (EOI) were received. Across three cohorts with different recruitment strategies adopted there were only modest differences in the number of EOI received (10.5 to 15.3%), which suggests that no particular recruitment approach was most effective. Following the initial screening of these residents, 398 (77.0%) participants were deemed eligible to participate, but a final sample of 300 (58.0% of the 517 EOI) consented and was randomized; 7.6% of the 3947 residents invited. Principal reasons for not participating, despite being eligible, were poor health, lack of time and no GP approval. Conclusion This study highlights that there are significant challenges associated with recruiting sufficient numbers of older adults from independent living retirement villages into an exercise intervention designed to improve health and well-being. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613001 161718. Date registered 23rd October 2013.

Ageing is associated with cognitive decline, ranging from normal to mild cognitive impairment or dementia. This leads to physical and cognitive impairments, which are risk factors for loss of autonomy. Therefore, cognitive and physical training are important for cognitively impaired older adults. The combination of both may represent an efficiency advantage. This overview aims to summarize the effectiveness of cognitive-motor dual-task (CMDT) interventions on cognitive, physical and dual-task functions in cognitively impaired older adults, as well as the safety, adherence, and retention of benefits of these interventions. We searched for systematic reviews or meta-analyses assessing the effects of CMDT interventions on cognitive or physical functions in older adults with mild cognitive impairment or dementia through eight databases (CDSR (Cochrane), MEDLINE, Scopus, EMBASE, CINAHL, PsycINFO, ProQuest and SportDiscus). Two reviewers independently performed the selection, data extraction and risk of bias evaluation. Nine reviews were included in this overview. CMDT interventions were found to be more effective than active control groups on cognitive and physical functions in older adults with cognitive impairment, irrespective of intervention dose and modalities; no information on dual-task functions was available. Retention of benefits, adherence, need for supervision and safety are still unclear. These results should be interpreted with caution, considering the low average methodological quality of included reviews. Future intervention research should follow more rigorous methodological standards and focus on other forms of CMDT. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to systematically evaluate and quantify the effectiveness of dual-task training on gait parameters, motor symptoms and balance in individuals diagnosed with Parkinson's disease. Data resources: A systematic review of published literature was conducted until May 2020, using PubMed, EMBASE, Cochrane Library, Web of Science, EBSCO and CNKI databases. Methods: We included randomized controlled trials (RCTs) and non-RCTs to evaluate the effects of dual-task training compared with those of non-intervention or other forms of training. The measurements included gait parameters, motor symptoms and balance parameters. Methodological quality was assessed using the PEDro scale. Outcomes were pooled by calculating between-group mean differences using fixed- or random-effects models based on study heterogeneity. Results: A total of 11 RCTs comprising 322 subjects were included in the present meta-analysis. Results showed that dual-task training significantly improved gait speed (standardized mean difference [SMD], −0.23; 95% confidence interval [CI], −0.38 to −0.08; P = 0.002), cadence (SMD, −0.25; 95% CI, −0.48 to −0.02; P = 0.03), motor symptoms (SMD, 0.56; 95% CI, 0.18 to 0.94; P = 0.004) and balance (SMD, −0.44; 95% CI, −0.84 to −0.05; P = 0.03). However, no significant changes were detected in step length or stride length. Conclusion: Dual-task training was effective in improving gait performance, motor symptoms and balance in patients with Parkinson's disease relative to other forms of training or non-intervention. [ABSTRACT FROM AUTHOR]

Aim: The basis of the paradigm of cognitive-motor interference is the belonging of executive and motor functions. The conditions of a normal day lead to the need to perform several tasks simultaneously. Optimal functional adjustment after stroke should be eff ective in a combination of cognitive and movement training. The basic idea of the neurorehabilitation approach is primarily seen in the potentiation of neuroplasticity. However, so far, no obvious benefi t of cognitive-motor interference has been demonstrated due to the relatively small amount of available data. The aim of the systematic review was to demonstrate the eff ect of cognitive-motor interference on the improvement of gait and postural stability in patients after stroke. Methods: First, we formulated a review question and specifi ed criteria for the inclusion and exclusion of primary studies into a systematic review. We created a systematic search strategy and a three-step systematic search of published and unpublished primary studies in six databases. We searched for experimental and observational studies in the range from January 1, 2003 to December 31, 2019 in the English language only. Results: We found a total of 58 studies and removed 20 duplicates. Based on a two-phase evaluation of the relevance and critical evaluation of the methodological quality of the studies using the standardized evaluation tool Standard Quality Assessment Criteria for Evaluating a Primary Research Paper, 5 meta-analyses and randomized controlled trials were included. Conclusion: Cognitive-motor interference training brings benefi ts in locomotor and postural strategies in patients after stroke. However, current research has also shown a signifi cant variability in the use of cognitive tasks. [ABSTRACT FROM AUTHOR]

Heart rate variability (HRV) mirrors autonomic nervous system activities and might serve as a parameter to monitor health status in older adults. However, it is currently unknown which functional health measures, including cognitive, physical, and gait performance parameters, are most strongly related to HRV indices. This knowledge would enable implementing HRV assessments into health monitoring routines and training planning for older adults. Simultaneous cognitive–motor and exergame training may be effective to improve HRV indices but has not been investigated yet. Eighty-nine healthy older adults (≥70 years of age) were randomized into three groups: (1) virtual reality video game dancing, i.e., exergaming (DANCE); (2) treadmill walking with simultaneous verbal memory training (MEMORY); or (3) treadmill walking only (PHYS). Strength and balance exercises complemented each program. Over 6 months, two weekly 1-h training sessions were performed. HRV indices (standard deviation of N–N intervals, SDNN; root mean square of successive R–R interval differences, RMSSD; and absolute power of high-frequency band (0.15–0.4 Hz), HF power) and various measures of cognitive, physical, and gait performance were assessed at baseline and after 3 months and 6 months. Multiple linear regression analyses with planned comparisons were calculated. At baseline, 8–12% of HRV variance was significantly explained by cognitive executive functions and leg strength (inversely related). Verbal long-term memory, aerobic and functional fitness, and gait performance did not contribute to the model (SDNN: R2 = 0.082, p = 0.016; RMSSD: R2 = 0.121, p = 0.013; HF power: R2 = 0.119, p = 0.015). After 6 months, DANCE improved HRV indices, while MEMORY and PHYS did not (time × intervention interactions: first-contrast DANCE/MEMORY vs. PHYS: SDNN p = 0.014 one-tailed, Δ R 2 = 0.020 and RMSSD p = 0.052 one-tailed (trend), Δ R 2 = 0.007; second-contrast DANCE vs. MEMORY: SDNN p = 0.002 one-tailed, Δ R 2 = 0.035, RMSSD p = 0.017 one-tailed, Δ R 2 = 0.012, and HF power p = 0.011 one-tailed, Δ R 2 = 0.013). We conclude that mainly cognitive executive functions are associated with HRV indices and that exergame training improves global and parasympathetic autonomic nervous system activities in older adults. Periodic assessments of HRV in older citizens could be particularly beneficial to monitor cognitive health and provide indications for preventative exercise measures. [ABSTRACT FROM AUTHOR]

The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children’s experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant’s experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.

The ability to effectively execute compensatory steps is critical for preventing accidental falls, and consequently stepping training is an essential ingredient of fall prevention programs. In this paper, we propose a concept for stepping training that aims to maximize training effects by taking into account recent research evidence and a precise dosing of training ingredients. The concept addresses motor as well as cognitive falls-related aspects, it is suitable for individual as well as group based training, and it does not require costly equipment. Theory and evidence behind all of the training principles is reviewed, and an example of an exercise protocol is described in detail. Participants are presented with stepping patterns which they have to memorize and implement on a mat. In order to enable investigation of dose-response effects, the difficulty level systematically and gradually increases session by session based on four principles: execution speed, pattern complexity, pattern length and execution in dual-/multi-tasking conditions. The presented concept can be used as a framework for the development of further prevention and/or rehabilitation stepping exercise programs. Further studies using this exercise regimen or modified versions of it are encouraged.

Background: People with dementia progressively lose cognitive and functional abilities. Interventions promoting exercise and activity may slow decline. We developed a novel intervention to promote activity and independence and prevent falls in people with mild cognitive impairment (MCI) or early dementia. We successfully undertook a feasibility randomised controlled trial (RCT) to refine the intervention and research delivery. We are now delivering a multi-centred RCT to evaluate its clinical and cost-effectiveness.Methods: We will recruit 368 people with MCI or early dementia (Montreal Cognitive Assessment score 13-25) and a family member or carer from memory assessment clinics, other community health or social care venues or an online register (the National Institute for Health Research Join Dementia Research). Participants will be randomised to an individually tailored activity and exercise programme delivered using motivational theory to promote adherence and continued engagement, with up to 50 supervised sessions over one year, or a brief falls prevention assessment (control). The intervention will be delivered in participants' homes by trained physiotherapists, occupational therapists and therapy assistants. We will measure disabilities in activities of daily living, physical activity, balance, cognition, mood, quality of life, falls, carer strain and healthcare and social care use. We will use a mixed methods approach to conduct a process evaluation to assess staff training and delivery of the intervention, and to identify individual- and context-level mechanisms affecting intervention engagement and activity maintenance. We will undertake a health economic evaluation to determine if the intervention is cost-effective.Discussion: We describe the protocol for a multi-centre RCT that will evaluate the clinical and cost-effectiveness of a therapy programme designed to promote activity and independence amongst people living with dementia.Trial Registration: ISRCTN, ISRCTN15320670. Registered on 4 September 2018. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dual-task (simultaneous motor and cognitive task) (DT) training via virtual-reality exergaming is known to benefit balance control post-stroke. However, the efficacy of such training on DT balance control (volitional and reactive) and cognitive (executive function and attention) domains associated with fall risk remains unclear. OBJECTIVE: We evaluated the efficacy of cognitive-motor exergame training (CMT) (Wii-fit games in conjunction with cognitive tasks) for improving balance control (volitional and reactive) and cognition (executive function and attention) among people with chronic stroke (PwCS). METHODS: Hemiparetic, ambulatory PwCS were randomly assigned to either CMT (n = 12) or conventional training (CT) (n = 12) and underwent six weeks of high-intensity, tapered balance training. The CMT group performed Wii-fit games in conjunction with cognitive tasks, while CT group underwent customized, progressive balance training. Performance under DT conditions on Limits of Stability (volitional) and Slip-Perturbation (reactive) tests, and letter-number sequencing (cognition) determined the efficacy of CMT. RESULTS: Post-intervention, under DT reactive conditions, CMT group improved both motor and cognition, while the CT group improved motor alone. Under DT volitional conditions, motor performance improved only in CMT group. CONCLUSION: Cognitive-motor exergaming appears to be effective for improving balance control and cognition and could be implemented in clinical stroke rehabilitation settings. [ABSTRACT FROM AUTHOR]

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Objective: This systematic review aimed to examine the effects of dual-task balance and mobility training in people with stroke. Methods: An extensive electronic databases literature search was conducted using MEDLINE, PubMed, EBSCO, The Cochrane Library, Web of Science, SCOPUS, and Wiley Online Library. Randomized controlled studies that assessed the effects of dual-task training in stroke patients were included for the review (last search in December 2017). The methodological quality was evaluated using the Cochrane Collaboration recommendation, and level of evidence was determined according to the criteria described by the Oxford Center for Evidence-Based Medicine. Results: About 13 articles involving 457 participants were included in this systematic review. All had substantial risk of bias and thus provided level IIb evidence only. Dual-task mobility training was found to induce more improvement in single-task walking function (standardized effect size = 0.14–2.24), when compared with single-task mobility training. Its effect on dual-task walking function was not consistent. Cognitive-motor balance training was effective in improving single-task balance function (standardized effect size = 0.27–1.82), but its effect on dual-task balance ability was not studied. The beneficial effect of dual-task training on cognitive function was provided by one study only and thus inconclusive. Conclusion: There is some evidence that dual-task training can improve single-task walking and balance function in individuals with stroke. However, any firm recommendation cannot be made due to the weak methodology of the studies reviewed. [ABSTRACT FROM AUTHOR]