The Effects of a Divided-Attention Timed Stepping Accuracy Task on Balance, Strength, Endurance, and Functional Performance in Healthy Older Adults: A Pilot Study

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The aim of this study was to investigate whether a 6-week Divided-Attention Stepping Accuracy Task (DATSAT) intervention improved the primary outcome measure, maximal step length; other balance measures (Berg Balance scale and Timed Up and Go test); leg strength; endurance (6-min walk test); and functional tasks in 15 community-dwelling healthy older adults (x¯ age: 71.5 years, female: 46.7%) compared with 15 community-dwelling healthy older adults in a Bike and Strength (B&S) program (x¯ age: 73.8 years, female: 33.3%). Participants trained 3× per week, 30–60 min per session. Stepping-group differences were significant for all measures. B&S group improved in maximal step length (anterior and lateral), strength, and one functional task. Stepping group outperformed B&S group in Timed Up and Go and maximal step length posterior. B&S group outperformed stepping group in two strength measures. Exertion scores were lower for the stepping group. Overall, Divided-Attention Timed Stepping Accuracy Task training resulted in more within-group improvements and two between-group measures with less perceived effort and shorter intervention times.

Leach is with the Division of Physical Therapy, School of Medicine, University of New Mexico, Albuquerque, NM. Maring and Costello are with the Physical Therapy Program, Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine & Health Sciences, The George Washington University, Washington, DC.

Leach (sleach@salud.unm.edu) is corresponding author.
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  • Al-YahyaE.DawesH.SmithL.DennisA.HowellsK. & CockburnJ. (2011). Cognitive motor interference while walking: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews 35(3) 715728. PubMed ID: 20833198 doi:10.1016/j.neubiorev.2010.08.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • American Thoracic Society. (2002). ATS statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine 166(1) 111117. doi:10.1164/ajrccm.166.1.at1102

    • Search Google Scholar
    • Export Citation
  • BeauchetO.AnnweilerC.DubostV.AllaliG.KressigR.W.BridenbaughS. . . . HerrmannF.R. (2009). Stops walking when talking: A predictor of falls in older adults? European Journal of Neurology 16(7) 786795. PubMed ID: 19473368 doi:10.1111/j.1468-1331.2009.02612.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • BergK.O.Wood-DauphineeS.L.WilliamsJ.I. & MakiB. (1992). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health 83(Suppl. 2) 711.

    • Search Google Scholar
    • Export Citation
  • BorgG.A.V. (1982). Psychophysical bases of perceived exertion. Medicine & Science in Sports & Exercise 14(5) 377381. PubMed ID: 7154893

    • Crossref
    • Search Google Scholar
    • Export Citation
  • CarterV.JainT.JamesJ.CornwallM.AldrichA. & deHeerH.D. (2017). The 3-m backwards walk and retrospective falls: Diagnostic accuracy of a novel clinical measure. Journal of Geriatric Physical Therapy17. doi:10.1519/JPT0000000000000149

    • Crossref
    • Search Google Scholar
    • Export Citation
  • ChapmanS.B.AslanS.SpenceJ.S.DefinaL.F.KeebelerM.W.DidenhbaniN. & LuH. (2013). Shorter term aerobic exercise improves brain, cognition and cardiovascular fitness in aging. Frontiers in Aging Neuroscience 5(75) 110.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • ChoB.L.ScarpaceD. & AlexanderN.B. (2004). Tests of stepping as indicators of mobility, balance, and fall risk in balance-impaired older adults. Journal of the American Geriatrics Society 52(7) 11681173. PubMed ID: 15209657 doi:10.1111/j.1532-5415.2004.52317.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • ChoS.I. & Duk-HyunA. (2014). Effects of a fall prevention exercise program on muscle strength and balance of the old-old elderly. Journal of Physical Therapy Science 26(11) 17711774. PubMed ID: 25435697 doi:10.1589/jpts.26.1771

    • Crossref
    • Search Google Scholar
    • Export Citation
  • CoetseeC. & TerblancheE. (2017). The effect of three different exercise training modalities on cognitive and physical function in a healthy older population. European Review of Aging and Physical Activity 14(13) 110.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • DonoghueD.Physiotherapy Research and Older People (PROP) Group & StokesE.K. (2009). How much change is true change? The minimum detectable change of the berg balance scale in elderly people. Journal of Rehabilitation Medicine 41(5) 343346. PubMed ID: 19363567 doi:10.2340/16501977-0337

    • Crossref
    • Search Google Scholar
    • Export Citation
  • FaulknerK.A.RedfernM.S.CauleyJ.A.LandsittelD.P.StudenskiS.A. & RosanoC. (2007). Multitasking: Association between poorer performance and a history of recurrent falls. Journal of the American Geriatrics Society 55(4) 570576. PubMed ID: 17397436 doi:10.1111/j.1532-5415.2007.01147.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • FittsP.M. & PosnerM.I. (1967). Human performance. Belmont, TN: Brooks/Cole.

  • FoxS.M.NaughtonJ.P. & HaskellW.L. (1971). Physical activity and the prevention of coronary heart disease. Annals of Clinical and Laboratory Research 3(6) 404432.

    • Search Google Scholar
    • Export Citation
  • GentileA.M. (1998). Implicit and explicit processes during acquisition of functional skills. Scandinavian Journal of Occupational Therapy 5716. doi:10.3109/11038129809035723

    • Crossref
    • Search Google Scholar
    • Export Citation
  • GoldbergA.SchepensS. & WallaceM. (2010). Concurrent validity and reliability of the maximum step length test in older adults. Journal of Geriatric Physical Therapy 33(3) 122127. PubMed ID: 21155507

    • Search Google Scholar
    • Export Citation
  • HiyamizuM.MoriokaS.ShomotoK. & ShimadaT. (2012). Effects of dual task balance training on dual task performance in elderly people: A randomized controlled trial. Clinical Rehabilitation 26(1) 5867. PubMed ID: 21421689 doi:10.1177/0269215510394222

    • Crossref
    • Search Google Scholar
    • Export Citation
  • HorakF.B.WrisleyD.M. & FrankJ. (2009). The balance evaluation systems test (BESTest) to differentiate balance deficits. Physical Therapy 89(5) 484498. PubMed ID: 19329772 doi:10.2522/ptj.20080071

    • Crossref
    • Search Google Scholar
    • Export Citation
  • LeachS.J.MagillR.A. & MaringJ.M. (2017). Using a divided-attention stepping accuracy task to improve balance and functional outcomes in an individual with incomplete spinal cord injury: A case report. Physiotherapy Theory and Practice 33(1) 7281. PubMed ID: 27892796 doi:10.1080/09593985.2016.1247932

    • Crossref
    • Search Google Scholar
    • Export Citation
  • LesinskiM.HortobagyiT.MuehlbauerT.GollhoferA. & GranacherU. (2015). Effects of balance training on balance performance in healthy older adults: A systematic review and meta-analysis. Sports Medicine 45(12) 17211738. PubMed ID: 26325622 doi:10.1007/s40279-015-0375-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • LevinO.NetzY. & ZivG. (2017). The beneficial effects of different types of exercise interventions on motor and cognitive functions in older age: A systematic review. European Review of Aging and Physical Activity 14(20) 123.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • LiK.Z. & LindenbergerU. (2002). Relations between aging sensory/sensorimotor and cognitive functions. Neuroscience & Biobehavioral Reviews 26(7) 777783. PubMed ID: 12470689 doi:10.1016/S0149-7634(02)00073-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • LordS.R. & FitzpatrickR.C. (2001). Choice stepping reaction time: A composite measure of falls risk in older people. The Journals of Gerontology Series A: Biological Sciences & Medical Sciences 56(10) M627M632. doi:10.1093/gerona/56.10.M627

    • Crossref
    • Search Google Scholar
    • Export Citation
  • LovdenM.SchaeferS.PohlmeyerA.E. & LindenbergerU. (2008). Walking variability and working-memory load in aging: A dual-process account relating cognitive control to motor control performance. The Journals of Gerontology Series B: Psychological Sciences & Social Sciences 63(3) P121P128. doi:10.1093/geronb/63.3.P121

    • Crossref
    • Search Google Scholar
    • Export Citation
  • MedellJ.L. & AlexanderN.B. (2000). A clinical measure of maximal and rapid stepping in older women. The Journals of Gerontology Series A: Biological Sciences & Medical Sciences 55(8) M429M433. doi:10.1093/gerona/55.8.M429

    • Crossref
    • Search Google Scholar
    • Export Citation
  • PereraS.ModyS.H.WoodmanR.C. & StudenskiS.A. (2006). Meaningful change and responsiveness in common physical performance measures in older adults. Journal of the American Geriatrics Society 54(5) 743749. PubMed ID: 16696738 doi:10.1111/j.1532-5415.2006.00701.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • PlummerP.ZukowskiL.A.GiulianaC.HallA.M. & ZurakowskiD. (2016). Effects of physical exercise interventions on gait-related dual-task interference in older adults: A systematic review and meta-analysis. Gerontology 6294117. doi:10.1159/000371577

    • Crossref
    • Search Google Scholar
    • Export Citation
  • PodsiadloD. & RichardsonS. (1991). The timed “up & go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society 39(2) 142148. PubMed ID: 1991946 doi:10.1111/j.1532-5415.1991.tb01616.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • PowellL.E. & MyersA.M. (1995). The activities-specific balance confidence (ABC) scale. Journal of the American Geriatrics Society 50A(1) M28M34.

    • Search Google Scholar
    • Export Citation
  • SchlichtJ.CamaioneD.N. & OwenS.V. (2001). Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. The Journals of Gerontology Series A: Biological Sciences & Medical Sciences 56AM281M286. doi:10.1093/gerona/56.5.M281

    • Crossref
    • Search Google Scholar
    • Export Citation
  • SchulzB.W.Ashton-MillerJ.A. & AlexanderN.B. (2007). Maximum step length: Relationships to age and knee and hip extensor capacities. Clinical Biomechanics 22(6) 689696. PubMed ID: 17434245 doi:10.1016/j.clinbiomech.2007.02.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shumway-CookA.BaldwinM.PolissarN.L. & GruberW. (1997). Predicting the probability for falls in community-dwelling older adults. Physical Therapy 77(8) 812819. PubMed ID: 9256869 doi:10.1093/ptj/77.8.812

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shumway-CookA.BrauerS. & WoollacottM. (2000). Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Physical Therapy 80(9) 896903. PubMed ID: 10960937

    • Search Google Scholar
    • Export Citation
  • Shumway-CookA. & WoollacottM.H. (2001). Motor control: Theory and practical applications (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

    • Search Google Scholar
    • Export Citation
  • SilsupadolP.LugadeV.Shumway-CookA.van DonklaarP.ChouL.MayrU. & WoollacottM.H. (2009). Training-related changes in dual-task walking performance of elderly persons with balance impairment: A double-blind, randomized controlled trial. Gait & Posture 29(4) 634639. PubMed ID: 19201610 doi:10.1016/j.gaitpost.2009.01.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • SilsupadolP.Shumway-CookA.LugadeV.van DonkelaarP.ChouL.S.MayrU. & WoollacottM.H. (2009). Effects of single-task versus dual-task training on balance performance in older adults: A double-blind, randomized controlled trial. Archives of Physical Medicine and Rehabilitation 90(3) 381387. PubMed ID: 19254600 doi:10.1016/j.apmr.2008.09.559

    • Crossref
    • Search Google Scholar
    • Export Citation
  • SteffenT.M.HackerT.A. & MollingerL. (2002). Age- and gender-related test performance in community-dwelling elderly people: Six-minute walk test, Berg balance scale, timed up & go test, and gait speeds. Physical Therapy 82(2) 128137. PubMed ID: 11856064 doi:10.1093/ptj/82.2.128

    • Crossref
    • Search Google Scholar
    • Export Citation
  • StraubeD.D.HolleranC.L.KinnairdC.R.LeddyA.L.HennessyP.W. & HornbyT.G. (2014). Effects of dynamic stepping training on nonlocomotor tasks in individuals poststroke. Physical Therapy 94(7) 921933. doi:10.2522/ptj.20130544

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Total Gym Global Corporation. (2018). California/USA. Retrieved from https://www.medequipdepot.com/products/926660-patterson-medical-functional-testing-grid.html

  • ToulotteC.ThevenonA.WatelainE. & FabreC. (2006). Identification of healthy elderly fallers and non-fallers by gait analysis under dual-task conditions. Clinical Rehabilitation 20(3) 269276. PubMed ID: 16634347 doi:10.1191/0269215506cr929oa

    • Crossref
    • Search Google Scholar
    • Export Citation
  • TrombettiA.HarsM.HerrmannF.R.KressigR.W.FerrariS. & RizzoliR. (2011). Effect of music-based multitask training on gait, balance, and fall risk in elderly people: A randomized controlled trial. Archives of Internal Medicine 171(6) 525–533. PubMed ID: 21098340 doi:10.1001/archinternmed.2010.446

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Voelcker-RehageC. & AlbertsJ.L. (2007). Effect of motor practice on dual-task performance in older adults. The Journals of Gerontology Series B: Psychological Sciences & Social Sciences 62(3) P141P148. doi:10.1093/geronb/62.3.P141

    • Crossref
    • Search Google Scholar
    • Export Citation
  • WestlakeK.P. & CulhamE.G. (2007). Sensory-specific balance training in older adults: Effects on proprioceptive reintegration and cognitive demands. Physical Therapy 87(10) 12741283. PubMed ID: 17636154 doi:10.2522/ptj.20060263

    • Crossref
    • Search Google Scholar
    • Export Citation
  • WollesenB. & Voelcker-RehageC. (2014). Training effects on motor-cognitive dual-task performance in older adults. European Review of Aging and Physical Activity 11(1) 524. doi:10.1007/s11556-013-0122-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • WulfG.McConnelN.GartnerM. & SchwarzA. (2002). Enhancing the learning of sport skills through EF feedback. Journal of Motor Behavior 34(2) 171182. PubMed ID: 12057890 doi:10.1080/00222890209601939

    • Crossref
    • Search Google Scholar
    • Export Citation
  • WulfG. & PrinzW. (2001). Directing attention to movement effects enhances learning: A review. Psychonomic Bulletin & Review 8(4) 648660. PubMed ID: 11848583 doi:10.3758/BF03196201

    • Crossref
    • Search Google Scholar
    • Export Citation
  • YouJ.H.ShettyA.F.JonesT.F.ShieldsK.F.BelayY.F. & BrownD. (2009). Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: A preliminary investigation. Neuro Rehabilitation 24(2) 193198. PubMed ID: 19339758

    • Search Google Scholar
    • Export Citation
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