A Comparative Study On The Effect Of Three Motor-cognitive Dual Task Training Programs On Gait And Cognition In Older Women

Objective:Older women are a vulnerable group for falls,with approximately twice the rate and number of falls than men.Gait and cognition are two important predictors of falls,and brain aging may cause cognitive impairments that lead to gait impairments and ultimately to falls.There is evidence that older adults who perform poorly on dual-task tests are more likely to fall,so it has been suggested that improved dual-task performance may slow functional decline in older adults and reduce the risk of falls.It has been suggested that multimodal exercise involving strength,balance,and aerobics in older adults may lead to more comprehensive improvements in physical function and health,and that the effects of such multimodal training on gait and cognition in older adults are unclear,that existing dual-task training programs require specific equipment and technology,and that comparisons of optimal dual-task design programs are lacking.Therefore,the purpose of this study was to compare the effects of community-based multimodal motor-cognitive dual-task training with two traditional dual-task training programs on gait and cognition in older women.Methods:A total of 78 elderly women were recruited and screened from Luozhuang,Jimenli and North Taipingzhuang communities in Haidian District of Beijing as the participants of this study and randomly divided into Strength&Balance&Aerobic-Cognitive training group（SBAC group）（n=26）,Aerobic-Cognitive training group（AC group）（n=26）,and Strength&Balance-Cognitive training group（SBC group）（n=26）.Each of the three training groups performed dual-task training（i.e.,strength,balance,and aerobic training along with cognitive training）for 40-60 minutes three times per week for 6 weeks.The main test indicators included gait,cognition,and dual-task performance（DTC）（obtained by formula）.The IDEEA 3-NORM was used to collect the step duration,cycle duration,velocity,cadence,step length,and stride length during the single and dual task1-minute walk of the participants,the dual-task cognition index was the number of correct answers to cognitive questions within 15 s during the dual task 1-minute walk,and the single task cognition index was each score and total score of the Montreal cognitive assessment（Mo CA）.SPSS 22.0 was used for statistical analysis.One-way Analysis of variance（ANOVA）was used to compare the differences in baseline characteristics of the study subjects in each group,and two-way repeated measures ANOVA was used to test the differences in test indicators before and after 6 weeks of training in each group.Results:A total of 50 individuals（66.54±4.63 years）completed the 6-week training and testing,including 18 in the SBAC group,17 in the AC group,and 15 in the SBC group.One-way ANOVA results showed no significant differences between the groups for all the pre-test indicators.Repeated measures ANOVA results showed that the Group main effect,the Time main effect,and the Group×Time interaction effect for the dual-task gait indicators of participants were no significant（P>0.05）.The main effect of Group×Time interaction for single-task gait indicators were not significant（P>0.05）,and only the main effect of Time for velocity was significant(F_（1,47）=4.212,P=0.046,partialη²=0.082),and the further analysis showed that only the SBAC group’s post-test velocity higher than pre-test（P=0.039）,and no significant differences were found between the AC and SBC groups for all gait indicators between pre-and post-test（P>0.05）.Repeated measures ANOVA results showed no significant main effect of Group（P>0.05）,a significant between-group×time interaction effect(F_（1,47）=20.956,P<0.001,partialη²=0.308),and a significant interaction effect of Group×Time(F_（2,47）=4.063,P=0.024,partialη²=0.147)for dual-task cognition.Further analysis showed that no significant differences were found between the pre-and post-test dual-task cognition in SBAC and SBC groups（P>0.05）,and only the post-test dual-task cognition were significantly higher than pre-test in the AC group（P<0.001）.A main effect of Group for participants’language(F_（2,47）=3.836,P=0.029,partialη²=0.140),main effects of Time for participants’Mo CA total score(F_（1,47）=61.030,P<0.001,partialη²=0.565),executive function(F_（1,47）=38.011,P<0.001,partialη²=0.447),appointment(F_（1,47）=10.089,P=0.003,partialη²=0.177),attention(F_（1,47）=8.896,P=0.005,partialη²=0.159),abstraction(F_（1,47）=12.896,P=0.001,partialη²=0.215),memory(F_（1,47）=30.208,P<0.001,partialη²=0.391),and no interaction effects of Group×time were found for all cognition indicators（P>0.05）.Further analysis showed that the SBAC group’s post-test Mo CA total scores（P<0.001）,executive function（P<0.001）,appointment（P=0.004）,attention（P=0.021）,and memory（P=0.001）were significantly higher than pre-test;the post-test Mo CA total scores（P<0.001）,executive function（P<0.001）,appointment（P=0.011）,language（P=0.027）,abstraction（P=0.015）,and memory（P=0.008）were significantly higher than pre-test in the AC group;post-test total Mo CA scores（P=0.001）,executive function（P=0.042）,and memory（P=0.003）were significantly higher than pre-test in the SBC group.Repeated-measures ANOVA results showed no significant main effects of Group and Group×Time for all DTC indicators in participants（P>0.05）,and only the significant main effect of Time for step length DTC was found(F_（1,47）=5.874,P=0.019,partialη²=0.111).Further analysis showed no significant difference in pre-and post-test DTC in three groups（P>0.05）.Conclusions:Among the three motor-cognitive dual-task training programs,the strength&balance&aerobic-cognitive program had a significant improvement on the single-task velocity of older women;all three programs positively contributed to the improvement of some single-task cognition indicators,among which the aerobic-cognitive program had the best effect,but only the aerobic-cognitive program improved the number of correct answers to dual-task cognitive questions of older women;none of the three programs significantly improved the dual-task performance.