The Influence of Attentional Focus on Gait Stability and Conscious Movement Processing During Challenging Walking Conditions in Older Adults.

Objectives: It has been proposed that the effect of an external focus in gait might be more beneficial in more challenging tasks compared to a natural walking condition. This study sought to (a) address any causal link between an external focus and improved gait stability during walking on an unstable surface and (b) explore any possible psycho-cognitive mechanism underpinning these changes in older adults.

Methods: 98 older adults (mean age: 70.6 ± 4.6) were invited to walk along an 8-meter elevated, foam walkway at a self-selected pace under 3 blocks of attentional focus conditions (i.e., internal focus, external focus, and control) for a total of 9 trials (3 trials for each condition). Gait stability was represented by the variability of spatial and temporal gait parameters. Electroencephalography (EEG) T3-Fz coherence was used to indicate real-time conscious movement processing during walking.

Results: Older adults displayed significantly lower variability of stride length and step width under an external focus condition compared to control. No gait changes were observed between an internal focus condition and control. There were no significant differences in EEG T3-Fz coherence among the 3 conditions.

Discussion: We demonstrate evidence of a causal link between an external focus and improved gait stability in older adults under a challenging walking environment. However, we postulate that this improvement might be independent of real-time conscious movement processing. Our findings nonetheless suggest that external focus strategies might be an effective rehabilitative approach for falls prevention by reducing gait variability during adaptive locomotion in older adults.

Clinical trials registration number: NCT05411536.