Effects of dual-task prioritization training on dual-task walking in older people: A single-blinded randomized controlled trial

Abstract

Objective

Dual-task walking (DTW) performance is commonly reduced in older adults and is associated with a higher risk of falls. While dual-task deficits have been documented, it remains unclear how different task prioritization strategies during training influence DTW outcomes. This study compared effects of posture-first (PF), supraposture-first (SF), and conventional training on DTW performance in older adults.

Methods

A three-arm randomized, single-blind controlled study was conducted. Thirty-nine community-dwelling older adults were randomly assigned to PF, SF, or control groups to receive 12-session of cognitive-motor dual-task training with distinct task prioritization instructions. Cognitive and motor DTW performance, Trail Making Test Part B, Berg Balance Scale, single-task walking performance, and secondary task performance were assessed pre- and post-intervention.

Results

The PF group showed significant improvements in both cognitive and motor DTW performance, including speed (cognitive: p = 0.001, motor: p = 0.008), cadence (p < 0.001), and dual-task cost (DTC-speed) (p < 0.001). Compared to the SF and control groups, the PF group showed greater improvements in stride length (p = 0.009 vs. SF; p = 0.001 vs. control) and DTC (p = 0.025 vs. SF; p = 0.005 vs. control) during cognitive DTW. During motor DTW, improvements in speed (p = 0.008), cadence (p = 0.016), and DTC (p = 0.049) were also greater than in the SF group.

Conclusions

Posture-first strategy during training enhances cognitive and motor DTW performance more effectively than other approaches. These findings support its implementation to improve functional mobility and dual-task coordination in older adults.