Original article
Effects of Single-Task Versus Dual-Task Training on Balance Performance in Older Adults: A Double-Blind, Randomized Controlled Trial

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Abstract

Silsupadol P, Shumway-Cook A, Lugade V, van Donkelaar P, Chou LS, Mayr U, Woollacott MH. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial.

Objective

To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment.

Design

A double-blind, randomized controlled trial.

Setting

University research laboratory.

Participants

Older adults (N=23) with balance impairment (mean age, 74.8y). They scored 52 or less on the Berg Balance Scale (BBS) and/or walked with a self-selected gait speed of 1.1m/s or less.

Interventions

Participants were randomly assigned to 1 of 3 interventions: single-task training, dual-task training with fixed-priority instructions, and dual-task training with variable-priority instructions. Participants received 45-minute individualized training sessions, 3 times a week for 4 weeks.

Main Outcome Measures

Gait speed under single-task and dual-task conditions was obtained at baseline, the second week, the end of training, and the twelfth week after the end of training. Other measures, including the BBS and the Activities-specific Balance Confidence (ABC) Scale, were collected at baseline and after training.

Results

Participants in all groups improved on the BBS (P<.001; effect size [ES]=.72), and walked significantly faster after training (P=.02; ES=.27). When a cognitive task was added, however, only participants who received dual-task training with fixed-priority instructions and dual-task training with variable-priority instructions exhibited significant improvements in gait speed (P<.001, ES=.57; and P<.001, ES=.46, respectively). In addition, only the dual-task training with variable-priority instructions group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up. Only the single-task training group showed a significant increase on the ABC after training (P<.001; ES=.61).

Conclusions

Dual-task training is effective in improving gait speed under dual-task conditions in elderly participants with balance impairment. Training balance under single-task conditions may not generalize to balance control during dual-task contexts. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect.

Section snippets

Participants

Fifty older adults with balance impairment were recruited through flyers in the local community. The 2-step eligibility process included an initial telephone interview screen for the following inclusion criteria: (1) age 65 years or older; (2) ability to walk 10m without the assistance of another person; (3) no neurologic or musculoskeletal diagnosis such as cerebral vascular accident, significant orthopedic involvement, or significant visual and auditory impairments; and (4) approval of their

Results

Fifty older adults were evaluated for potential enrollment (fig 1); 17 people did not meet the inclusion criteria. Of 33 people who may have been eligible, 10 declined to participate in the study. Twenty-three older adults who met the eligibility criteria and agreed to participate were randomly assigned to 1 of 3 training groups; 22 completed the training program (1 single-task balance training participant died; 1 variable-priority participant was excluded because of surgery just prior to

Discussion

This randomized controlled trial provides evidence that an individualized training program was effective in improving balance under single-task contexts in older adults with balance impairment. After the 4-week intervention program, participants in all training groups significantly improved performance on single-task gait speed and the BBS. In fact, 15 and 18, respectively, out of 21 older adults exceeded the boundaries of the MDC for the single-task gait speed (0.1m/s) and the BBS (3 points).

Conclusions

Dual-task training is effective in improving gait speed under dual-task contexts in elderly persons with impaired balance, and single-task training may not generalize to balance performance under dual-task conditions. The instructional set was an important contributing factor for improvement in dual-task performance. The variable-priority instructional set offered advantages over the fixed-priority instructional set in terms of the rate of learning and the ability to maintain the skill level

Acknowledgments

We thank Cooper Boydston, BS, for assistance with data collection. We acknowledge Charlene Halterman, MS, Teresa Hawkes, BFA, Chu-jui Chen, PT, MS, and Sujitra Boonyong, PT, MS, for their assistance with training sessions.

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  • Cited by (0)

    Supported by the National Institutes of Health (grant no. AG 021598).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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