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Effects of single-task, dual-task and successive physical-cognitive training on fall risk and balance performance in older adults: a randomized trial

Yıl 2022, Cilt: 9 Sayı: 1, 1 - 11, 29.04.2022
https://doi.org/10.15437/jetr.675975

Öz

Purpose: This study aimed to examine the effects of single-task, dual-task and successive physical-cognitive training on fall risk, balance, and gait performances in elderly.
Methods: A total of 45 healthy older adults (73.0±4.6 years; 6 male and 39 female) underwent one of three interventions 3 times a week for 4 weeks. Group-1 performed single-task balance and gait exercises. Group-2 performed cognitive activity, balance, and gait exercises simultaneously. Group-3 performed successive cognitive activities and balance and gait exercises. Gait speed under single-task and dual-task conditions, Berg Balance Scale, Timed up and Go test, and Tinetti's Falls Efficacy Scale scores were evaluated before and after 4 weeks of interventions.
Results: Gait speed under single-task condition, Timed up and Go Test, and Berg Balance Scale scores were improved in all groups (p<0.05). Gait speed under dual-task condition was improved in Groups-2 and 3 (p<0.05). Group-3 had greater improvement in Berg Balance Scale and Timed up and Go test scores than Group-2. Tinetti's Falls Efficacy Scale was improved in Group-1 and 3 after training while the improvement was greater in Group-3 (p=0.001).
Conclusion: The present study suggests that an intervention involving cognitive and physical activities results in greater improvement in gait speed than interventions involving physical activities alone. However, successive physical-cognitive training may be more effective in reducing fear of fall and improving balance skills in elderly.

Teşekkür

ACKNOWLEDGMENTS The authors wish to thank Assoc. Prof. Hanefi Ozbek for for his help relating to the statistical analyses.

Kaynakça

  • 1. World Health Organization. WHO Global Report on Falls Prevention in Older Age. Geneva, Switzerland, 2007. Available from:https://www.who.int/ageing/publications/Falls_prevention7March.pdf. Accessed: 26.06.2019.
  • 2. World Health Organization. Falls, Fact sheet N°344. Geneva, Switzerland, 2012. Available from: http://www.who.int/mediacentre/factsheets/fs344/en/. Accessed: 26.06.2019.
  • 3. World Health Organization. What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls. Geneva, Switzerland, 2004. Available from: http://www.euro.who.int/__data/assets/pdf_file/0018/74700/E82552.pdf. Accessed: 26.06.2019.
  • 4. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35:S37-41.
  • 5. Austin N, Devine A, Dick I, et al. Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors. J Am Geriatr Soc. 2007;55:1598-1603.
  • 6. Hardy SE, Perera S, Roumani YF, et al. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc. 2007;55:1727-1734.
  • 7. Guedes RC, Dias RC, Pereira LS, et al. Influence of dual task and frailty on gait parameters of older community-dwelling individuals. Braz J Phys Ther. 2014;18:445-452.
  • 8. Chang JT, Morton SC, Rubenstein LZ, et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004;328:680.
  • 9. Rosano C, Brach J, Studenski S, et al. Gait variability is associated with subclinical brain vascular abnormalities in high-functioning older adults. Neuroepidemiology. 2007;29:193-200.
  • 10. Mirelman A, Herman T, Brozgol M, et al. Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition. PLoS One. 2012;7:40297.
  • 11. Rosano C, Studenski SA, Aizenstein HJ, et al. Slower gait, slower information processing and smaller prefrontal area in older adults. Age Ageing. 2012;41:58-64.
  • 12. Walshe EA, Patterson MR, Commins S, et al. Dual-task and electrophysiological markers of executive cognitive processing in older adult gait and fall-risk. Front Hum Neurosci. 2015;9:200.
  • 13. Tombu M, Jolicoeur P. A central capacity sharing model of dual-task performance. J Exp Psychol Hum Percept Perform. 2003;29:3-18.
  • 14. Mirelman A, Maidan I, Bernad-Elazari H, et al. Increased frontal brain activation during walking while dual tasking: an fNIRS study in healthy young adults. J Neuroeng Rehabil. 2014;11:85.
  • 15. Plummer P, Zukowski LA, Giuliani C, et al. Effects of physical exercise interventions on gait-related dual-task interference in older adults: a systematic review and meta-analysis. Gerontology. 2015;62:94-117.
  • 16. Wang X, Pi Y, Chen P, et al. Cognitive motor interference for preventing falls in older adults: a systematic review and meta-analysis of randomised controlled trials. Age Ageing. 2015;44:205-212.
  • 17. van het Reve E, de Bruin ED. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial. BMC Geriatr. 2014;14:134.
  • 18. Tait JL, Duckham RL, Milte CM, et al. Influence of sequential vs. simultaneous dual-task exercise training on cognitive function in older adults. Front Aging Neurosci. 2017;9:368.
  • 19. Ruthruff E, Van Selst M, Johnston JC, et al. How does practice reduce dual-task interference: integration, automatization, or just stage-shortening? Psychol Res. 2006;70:125-142.
  • 20. Van Praag H, Shubert T, Zhao C, et al. Exercise enhances learning and hippocampal neurogenesis in aged mice. J. Neurosci. 2005;25:8680-8685.
  • 21. Trachtenberg JT, Chen BE, Knott GW, et al. Long-term in vivo imaging of experience-dependent synaptic plasticity in adult cortex. Nature. 2002;420:788-794.
  • 22. Thrane G, Joakimsen RM, Thornquist E. The association between timed up and go test and history of falls: the Tromsø study. BMC Geriatr. 2007;7:1.
  • 23. Keskinoğlu P, Uçku R, Yener G. Pretest results of the revised standardized mini mental examination test in community dwelling elderly. J Neurol Sci. 2008;25:18-24.
  • 24. Shubert TE, Schrodual-task LA, Mercer VS, et al. Are scores on balance screening tests associated with mobility in older adults? J Geriatr Phys Ther. 2006;29:35-39.
  • 25. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol. 1990;45:239-243.
  • 26. Sahin F, Yilmaz F, Ozmaden A, et al. Reliability and validity of the Turkish version of the Berg Balance Scale. J Geriatr Phys Ther. 2008;31:32-37.
  • 27. Silsupadol P, Shumway-Cook A, Lugade V, et al. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Arch Phys Med Rehabil. 2009;90:381-387.
  • 28. Silsupadol P, Siu KC, Shumway-Cook A, et al. Training of balance under single- and dual-task conditions in older adults with balance impairment. Phys Ther. 2006;86:269-281.
  • 29. Kang L, Han P, Wang J, et al. Timed Up and Go Test can predict recurrent falls: a longitudinal study of the community-dwelling elderly in China. Clin Interv Aging. 2017;12:2009-2016.
  • 30. Kristensen, MT. Factors influencing performances and indicating risk of falls using the true Timed Up and Go test time of patients with hip fracture upon acute hospital discharge. Physiother Res Int. 2020;25:1841.
  • 31. Shumway-Cook A, Baldwin M, Polissar NL, et al. Predicting the probability for falls in community-dwelling older adults. Phys Ther. 1997;77:812-819.
  • 32. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80:896-903.
  • 33. Sibley KM, Beauchamp MK, Van Ooteghem K, et al. Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: a scoping review. Arch Phys Med Rehabil. 2015;96:122-132.
  • 34. Ban B, Sevsek F, Rugelj D. A comparison of the ceiling effect between Berg Balance Scale and Mini-BESTest in a group of balance trained community-dwelling older adults. Physiother Q. 2017;25:3-9.
  • 35. Balasubramanian CK. The community balance and mobility scale alleviates the ceiling effects observed in the currently used gait and balance assessments for the community-dwelling older adults. J Geriatr Phys Ther. 2015; 38:78-89.
  • 36. Patil R, Uusi-Rasi K, Kannus P, et al. Concern about falling in older women with a history of falls: associations with health, functional ability, physical activity and quality of life. Gerontology. 2014;60:22-30.
  • 37. Halvarsson A, Oddsson L, Olsson E, et al. Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial. Clin Rehabil. 2011;25:1021-1031.
  • 38. Halvarsson A, Franzén E, Ståhle A. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial. Clin Rehabil. 2015;29:365-375.
  • 39. Arai T, Obuchi S, Inaba Y, et. al. The Effects of short-term exercise intervention on falls self-efficacy and the relationship between changes in physical function and falls self-efficacy in japanese older people. Am J Phys Med Rehabil. 2007;86:133-141.
  • 40. Best JR, Liu-Ambrose T, Boudreau RM, et al. An evaluation of the longitudinal, bidirectional associations between gait speed and cognition in older women and men. J Gerontol Ser A Biol Sci Med Sci. 2016;71:1616-1623.
  • 41. Demnitz N, Esser P, Dawes H, et al. A systematic review and meta-analysis of cross-sectional studies examining the relationship between mobility and cognition in healthy older adults. Gait Posture. 2016;50:164-174.
  • 42. Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture. 2002;16:1-14.
  • 43. Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord. 2008;23:329-342.
  • 44. Cesari M, Kritchevsky SB, Penninx BW, et al. Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2005;53:1675-1680.
  • 45. Shumway-Cook A, Woollacott MH. Motor Control: Translating Research into Clinical Practice. Philadelphia, PA. Lippincott Williams and Wilkins, 2007.

Yaşlı bireylerde tek-görev, çift-görev ve ardışık fiziksel-bilişsel eğitimin düşme riski ve denge performansı üzerine etkileri: randomize çalışma

Yıl 2022, Cilt: 9 Sayı: 1, 1 - 11, 29.04.2022
https://doi.org/10.15437/jetr.675975

Öz

Amaç: Bu çalışma, tek görev, çift görev ve ardışık fiziksel-bilişsel eğitimin yaşlı erişkinlerde düşme riski, denge ve yürüme performansları üzerindeki etkilerini incelemek amacıyla yapıldı.
Yöntem: Toplam 45 sağlıklı yaşlı yetişkine (73,0±4,6 yıl; 6 erkek ve 39 kadın) haftanın 3 günü 4 hafta üç müdahaleden biri uygulandı. Grup-1’e tekli görev denge ve yürüyüş egzersizleri yaptırıldı. Grup-2 eş zamanlı olarak bilişsel aktivite, denge ve yürüyüş egzersizleri yaptı. Grup-3 birbirini takip eden bilişsel aktiviteler, denge ve yürüyüş egzersizleri gerçekleştirdi. Dört haftalık müdahalelerden önce ve sonra tek ve çift görev koşullarında yürüyüş hızı, Süreli Kalk Yürü Testi, Berg Denge Ölçeği ve Tinetti'nin Düşme Etkinlik Ölçeği puanları değerlendirildi.
Bulgular: Tüm gruplarda tek görev koşulu altında yürüyüş hızı, Berg Denge Ölçeği ve Süreli Kalk Yürü Testi puanları düzeldi (p<0,05). Grup 2 ve 3'te çift görev koşulu altında yürüyüş hızı düzeldi (p<0,05). Grup-3’ün, Süreli Kalk Yürü Testi ve Berg Denge Ölçeği puanlarında Grup-2'den daha fazla düzelme görüldü. Tinetti'nin Düşme Etkinlik Ölçeği puanları, Grup-1 ve 3'te düzelirken, Grup-3'te düzelme daha yüksekti (p=0,001).
Sonuç: Bu çalışma yürüyüş hızında, bilişsel ve fiziksel aktiviteleri içeren bir müdahalenin, sadece fiziksel aktiviteleri içeren müdahalelere göre daha fazla düzelmeye yol açtığını göstermektedir. Birbirini takip eden fiziksel-bilişsel eğitim, denge becerilerini geliştirme ve yaşlılarda düşme korkusunu azaltmada daha etkili olabileceği düşünüldü.

Kaynakça

  • 1. World Health Organization. WHO Global Report on Falls Prevention in Older Age. Geneva, Switzerland, 2007. Available from:https://www.who.int/ageing/publications/Falls_prevention7March.pdf. Accessed: 26.06.2019.
  • 2. World Health Organization. Falls, Fact sheet N°344. Geneva, Switzerland, 2012. Available from: http://www.who.int/mediacentre/factsheets/fs344/en/. Accessed: 26.06.2019.
  • 3. World Health Organization. What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls. Geneva, Switzerland, 2004. Available from: http://www.euro.who.int/__data/assets/pdf_file/0018/74700/E82552.pdf. Accessed: 26.06.2019.
  • 4. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35:S37-41.
  • 5. Austin N, Devine A, Dick I, et al. Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors. J Am Geriatr Soc. 2007;55:1598-1603.
  • 6. Hardy SE, Perera S, Roumani YF, et al. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc. 2007;55:1727-1734.
  • 7. Guedes RC, Dias RC, Pereira LS, et al. Influence of dual task and frailty on gait parameters of older community-dwelling individuals. Braz J Phys Ther. 2014;18:445-452.
  • 8. Chang JT, Morton SC, Rubenstein LZ, et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004;328:680.
  • 9. Rosano C, Brach J, Studenski S, et al. Gait variability is associated with subclinical brain vascular abnormalities in high-functioning older adults. Neuroepidemiology. 2007;29:193-200.
  • 10. Mirelman A, Herman T, Brozgol M, et al. Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition. PLoS One. 2012;7:40297.
  • 11. Rosano C, Studenski SA, Aizenstein HJ, et al. Slower gait, slower information processing and smaller prefrontal area in older adults. Age Ageing. 2012;41:58-64.
  • 12. Walshe EA, Patterson MR, Commins S, et al. Dual-task and electrophysiological markers of executive cognitive processing in older adult gait and fall-risk. Front Hum Neurosci. 2015;9:200.
  • 13. Tombu M, Jolicoeur P. A central capacity sharing model of dual-task performance. J Exp Psychol Hum Percept Perform. 2003;29:3-18.
  • 14. Mirelman A, Maidan I, Bernad-Elazari H, et al. Increased frontal brain activation during walking while dual tasking: an fNIRS study in healthy young adults. J Neuroeng Rehabil. 2014;11:85.
  • 15. Plummer P, Zukowski LA, Giuliani C, et al. Effects of physical exercise interventions on gait-related dual-task interference in older adults: a systematic review and meta-analysis. Gerontology. 2015;62:94-117.
  • 16. Wang X, Pi Y, Chen P, et al. Cognitive motor interference for preventing falls in older adults: a systematic review and meta-analysis of randomised controlled trials. Age Ageing. 2015;44:205-212.
  • 17. van het Reve E, de Bruin ED. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial. BMC Geriatr. 2014;14:134.
  • 18. Tait JL, Duckham RL, Milte CM, et al. Influence of sequential vs. simultaneous dual-task exercise training on cognitive function in older adults. Front Aging Neurosci. 2017;9:368.
  • 19. Ruthruff E, Van Selst M, Johnston JC, et al. How does practice reduce dual-task interference: integration, automatization, or just stage-shortening? Psychol Res. 2006;70:125-142.
  • 20. Van Praag H, Shubert T, Zhao C, et al. Exercise enhances learning and hippocampal neurogenesis in aged mice. J. Neurosci. 2005;25:8680-8685.
  • 21. Trachtenberg JT, Chen BE, Knott GW, et al. Long-term in vivo imaging of experience-dependent synaptic plasticity in adult cortex. Nature. 2002;420:788-794.
  • 22. Thrane G, Joakimsen RM, Thornquist E. The association between timed up and go test and history of falls: the Tromsø study. BMC Geriatr. 2007;7:1.
  • 23. Keskinoğlu P, Uçku R, Yener G. Pretest results of the revised standardized mini mental examination test in community dwelling elderly. J Neurol Sci. 2008;25:18-24.
  • 24. Shubert TE, Schrodual-task LA, Mercer VS, et al. Are scores on balance screening tests associated with mobility in older adults? J Geriatr Phys Ther. 2006;29:35-39.
  • 25. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol. 1990;45:239-243.
  • 26. Sahin F, Yilmaz F, Ozmaden A, et al. Reliability and validity of the Turkish version of the Berg Balance Scale. J Geriatr Phys Ther. 2008;31:32-37.
  • 27. Silsupadol P, Shumway-Cook A, Lugade V, et al. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Arch Phys Med Rehabil. 2009;90:381-387.
  • 28. Silsupadol P, Siu KC, Shumway-Cook A, et al. Training of balance under single- and dual-task conditions in older adults with balance impairment. Phys Ther. 2006;86:269-281.
  • 29. Kang L, Han P, Wang J, et al. Timed Up and Go Test can predict recurrent falls: a longitudinal study of the community-dwelling elderly in China. Clin Interv Aging. 2017;12:2009-2016.
  • 30. Kristensen, MT. Factors influencing performances and indicating risk of falls using the true Timed Up and Go test time of patients with hip fracture upon acute hospital discharge. Physiother Res Int. 2020;25:1841.
  • 31. Shumway-Cook A, Baldwin M, Polissar NL, et al. Predicting the probability for falls in community-dwelling older adults. Phys Ther. 1997;77:812-819.
  • 32. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80:896-903.
  • 33. Sibley KM, Beauchamp MK, Van Ooteghem K, et al. Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: a scoping review. Arch Phys Med Rehabil. 2015;96:122-132.
  • 34. Ban B, Sevsek F, Rugelj D. A comparison of the ceiling effect between Berg Balance Scale and Mini-BESTest in a group of balance trained community-dwelling older adults. Physiother Q. 2017;25:3-9.
  • 35. Balasubramanian CK. The community balance and mobility scale alleviates the ceiling effects observed in the currently used gait and balance assessments for the community-dwelling older adults. J Geriatr Phys Ther. 2015; 38:78-89.
  • 36. Patil R, Uusi-Rasi K, Kannus P, et al. Concern about falling in older women with a history of falls: associations with health, functional ability, physical activity and quality of life. Gerontology. 2014;60:22-30.
  • 37. Halvarsson A, Oddsson L, Olsson E, et al. Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial. Clin Rehabil. 2011;25:1021-1031.
  • 38. Halvarsson A, Franzén E, Ståhle A. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial. Clin Rehabil. 2015;29:365-375.
  • 39. Arai T, Obuchi S, Inaba Y, et. al. The Effects of short-term exercise intervention on falls self-efficacy and the relationship between changes in physical function and falls self-efficacy in japanese older people. Am J Phys Med Rehabil. 2007;86:133-141.
  • 40. Best JR, Liu-Ambrose T, Boudreau RM, et al. An evaluation of the longitudinal, bidirectional associations between gait speed and cognition in older women and men. J Gerontol Ser A Biol Sci Med Sci. 2016;71:1616-1623.
  • 41. Demnitz N, Esser P, Dawes H, et al. A systematic review and meta-analysis of cross-sectional studies examining the relationship between mobility and cognition in healthy older adults. Gait Posture. 2016;50:164-174.
  • 42. Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture. 2002;16:1-14.
  • 43. Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord. 2008;23:329-342.
  • 44. Cesari M, Kritchevsky SB, Penninx BW, et al. Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2005;53:1675-1680.
  • 45. Shumway-Cook A, Woollacott MH. Motor Control: Translating Research into Clinical Practice. Philadelphia, PA. Lippincott Williams and Wilkins, 2007.
Toplam 45 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Leyla Ataş Balcı 0000-0002-3302-3722

Kübra Soğukkanlı 0000-0002-9855-8859

Sinem Burcu 0000-0001-6028-3477

Lütfü Hanoğlu 0000-0003-4292-5717

Yayımlanma Tarihi 29 Nisan 2022
Gönderilme Tarihi 16 Ocak 2020
Yayımlandığı Sayı Yıl 2022 Cilt: 9 Sayı: 1

Kaynak Göster

Vancouver Ataş Balcı L, Soğukkanlı K, Burcu S, Hanoğlu L. Effects of single-task, dual-task and successive physical-cognitive training on fall risk and balance performance in older adults: a randomized trial. JETR. 2022;9(1):1-11.