Additional Functional Performance Gains After 24-Week Unstable Strength Training With Cognitive Training in Community-Dwelling Healthy Older Adults: A Randomized Trial

in Journal of Aging and Physical Activity
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The authors investigated the effects of unstable strength training (UST) without or with cognitive training (C+UST) on functional performance in community-dwelling older adults. A total of 50 participants were randomly assigned (1:1) to either 24 weeks of thrice-weekly UST (n = 25) or C+UST (n = 25). All participants performed moderate-intensity strength exercises using unstable surfaces, and C+UST participants simultaneously received cognitive training in addition to UST. Primary outcomes included measures of functional performance: single- and dual-task timed up and go tests. Secondary outcomes included dynamic balance, mobility, handgrip strength, flexibility, quality of life, and concern about falling. The authors observed similar improvements on functional performance through the interventions. The C+UST group experienced additional gains at completion (single-task timed up and go: −0.90 s, 95% confidence interval [–2.38, –0.03]; dual-task timed up and go: –4.80 s, 95% confidence interval [–8.65, –0.95]) compared with the UST group. Moreover, significant differences were observed in mobility (sitting-rising test: −1.34, 95% confidence interval [−2.00, −0.20]) at 24 weeks. Both exercise modes improved single-task functional performance, while adding cognitive-training-optimized dual-task functional performance gains.

de Oliveira, Cavalcante, de Farias, and de Araújo are with the Associated Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil; and the Federal University of Paraíba (UPE/UFPB), João Pessoa, Brazil. Pirauá and Beltrão are with the Department of Physical Education, Federal Rural University of Pernambuco (UFRPE), Recife, Brazil. Pirauá is also with the Physical Education Post—Graduation Program, Federal University of Pernambuco (UFPE), Recife, Brazil. Pitangui and de Araújo are with the Department of Physical Therapy, University of Pernambuco (UPE), Petrolina, Brazil.

de Oliveira (valeria.mayaly@gmail.com) is corresponding author.
  • Anderson, K., & Behm, D.G. (2005). The impact of instability resistance training on balance and stability. Sports Medicine, 35(1), 4353. PubMed ID: 15651912 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Al-Yahya, E., Dawes, H., Smith, L., Dennis, A., Howells, K., & Cockburn, J. (2011). Cognitive motor interference while walking: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 35(3), 715728. PubMed ID: 20833198 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ansai, J.H., de Andrade, L.P., de Souza Buto, M.S., de Vassimon Barroso, V., Farche, A.C., … de Medeiros Takahashi, A.C. (2016). Effects of the addition of a dual task to a supervised physical exercise program on older adults’ cognitive performance. Journal of Aging and Physical Activity, 25(2), 234239. PubMed ID: 27705074 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Beauchet, O., Annweiler, C., Dubost, V., Allali, G., Kressig, R.W., Bridenbaugh, S., … Herrmann, F.R. (2009). Stops walking when talking: A predictor of falls in older adults? European Journal of Neurology, 16(7), 786795. PubMed ID: 19473368 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Beck, T.W. (2013). The importance of a priori sample size estimation in strength and conditioning research. Journal of Strength & Conditioning Research, 27(8), 23232337. PubMed ID: 23880657 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Behm, D., Muehlbauer, T., Kibele, A., & Granacher, U. (2015). Effects of strength training using unstable surfaces on strength, power and balance performance across the lifespan: A systematic review and meta-analysis. Sports Medicine, 45(12),16451669. PubMed ID: 26359066 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Behm, D.G., & Anderson, K. (2006). The role of instability with resistance training. Journal of Strength & Conditioning Research, 20(3), 716722. PubMed ID: 16937988 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Behm, D.G., & Colado, J.C.S. (2013). Instability resistance training across the exercise continuum. Sports Health, 5(6), 500503. PubMed ID: 24427423 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Berg, K.O., Wood-Dauphine, S.L., Williams, J.I., & Maki, B. (1992). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health, 83(2), 711. PubMed ID: 1468055.

    • Search Google Scholar
    • Export Citation
  • Boa Sorte Silva, N.C., Gill, D.P., Gregory, M.A., Bocti, J., & Petrella, R.J. (2018). Multiple-modality exercise and mind-motor training to improve mobility in older adults: A randomized controlled trial. Experimental Gerontology, 103, 1726. PubMed ID: 29262308 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bouaziz, W., Lang, P.O., Schmitt, E., Kaltenbach, G., Geny, B., & Vogel, T. (2016). Health benefits of multicomponent training programmes in seniors: A systematic review. The International Journal of Clinical Practice, 70(7), 520536. PubMed ID: 27291143 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brito, L.B.B., Ricardo, D.R., Araújo, D.S.M.S., Ramos, P.S., Myers J., & Araújo, C.G.S. (2012). Ability to sit and rise from the floor as a predictor of all-cause mortality. European Journal of Preventive Cardiology, 21(7), 892898. PubMed ID: 23242910 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brucki, S.M.D., Nitrini, R., Caramelli, P., Bertolucci, P.H.F., & Okamoto, I.H. (2003). Suggestions for utilization of the mini-mental state examination in Brazil. Arquivos de Neuropsiquiatria, 61(3-B), 777781. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Camargos, F.F., Dias, R.C., Dias, J.M., & Freire, M.T. (2010). Cross-cultural adaptation and evaluation of the psychometric properties of the Falls Efficacy Scale—International Among Elderly Brazilians (FES-I-BRAZIL). Brazilian Journal of Physical Therapy, 14(3), 237243. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carey, J.R., Bhatt, E., & Nagpal, A. (2005). Neuroplasticity promoted by task complexity. Exercise and Sport Sciences Reviews, 33(1), 2431. PubMed ID: 15640717.

    • Search Google Scholar
    • Export Citation
  • Cavalcante, B.R., Souza, M.F., Falck, R.S., Liu-Ambrose, T., Behm, D.G., Pitangui, A.C.R., & De Araújo, R.C. (2020). Effects of resistance exercise with instability on cognitive function (REI study): A proof-of-concept randomized controlled trial in older adults with cognitive complaints. Journal of Alzheimer’s Disease, 77(1). 227239. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Delbaere, K.I.M., Close, J.A.C.T., Mikolaizak, A.S.T., & Sachdev, P.E.S. (2010). The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age and Ageing, 39(2), 210216. PubMed ID: 20061508 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Eckardt, N., Braun, C., & Kibele, A. (2020). Instability resistance training improves working memory, processing speed and response inhibition in healthy older adults: A double-blinded randomised controlled trial. Scientific Reports, 10(1), 2506. PubMed ID: 32054896 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Eggenberger, P., Theill, N., Holenstein, S., Schumacher, V., & de Bruin, E.D. (2015). Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up. Clinical Interventions in Aging, 10, 17111732. PubMed ID: 26604719 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Figueiredo, I.M., Sampaio, R.F., Mancini, M.C., Caetano, F., & Silva, M. (2007). Test of grip strength using the Jamar dynamometer. Acta Fisiátrica, 14(2), 104110. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fissler, P., Küster, O., Schlee, W., & Kolassa, I.T. (2013). Novelty interventions to enhance broad cognitive abilities and prevent dementia: Synergistic approaches for the facilitation of positive plastic change. Progress in Brain Research, 207, 403434. PubMed ID: 24309264 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fleck, M.P.A., Louzada, S., Xavier M, Chachamovich, E., Vieira, G., … Pinzon, V. (2000). Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Revista de Saúde Pública, 34(2),178183. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189198. PubMed ID: 1202204 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ghai, S., Ghai, I., & Effenberg, A.O. (2017). Effects of dual tasks and dual-task training on postural stability: A systematic review and meta-analysis. Clinical Interventions in Aging, 23(12), 557577. PubMed ID: 28356727 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gray-Miceli, D. (2017). Impaired mobility and functional decline in older adults: evidence to facilitate a practice change. The Nursing Clinics of North America, 52(3), 469487. PubMed ID: 28779827 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gregory, M.A., Gill, D.P., Zou, G., Liu-Ambrose, T., Shigematsu, R., Fitzgerald, C., … Petrella, R.J. (2016). Group-based exercise combined with dual-task training improves gait but not vascular health in active older adults without dementia. Archives of Gerontology and Geriatrics, 63, 1827. PubMed ID: 26791167 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Handing, E.P., Chen, H., Rejeski, W.J., Rosso, A.L., Balachandran, A.T., … Kritchevsky, S.B. (2019). Cognitive Function as a Predictor of Major Mobility Disability in Older Adults: Results From the LIFE Study. Innovation in Aging, 3(2), 18. PubMed ID: 31065597 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hiyamizu, M., Morioka, S., Shomoto, K., & Shimada, T. (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:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraft, E. (2012). Cognitive function, physical activity, and aging: Possible biological links and implications for multimodal interventions. Aging, Neuropsychology and Cognition, 19(1–2), 248263. PubMed ID: 22313174 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lacas, A., & Rockwood, K. (2012). Frailty in primary care: A review of its conceptualization and implications for practice. BMC Medicine, 10(1), 4. PubMed ID: 22236397 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Li, K., Bherer, L., Mirelman, A., Maidan, I., & Hausdorff, J.M. (2018). Cognitive involvement in balance, gait and dual-tasking in aging: A focused review from a neuroscience of aging perspective. Frontiers in Neurology, 9, 913. PubMed ID: 30425679 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Li, Z., Peng, X., Xiang, W., Han, J., & Li, K. (2018). The effect of resistance training on cognitive function in the older adults: A systematic review of randomized clinical trials. Aging Clinical and Experimental Research, 30(11), 12591273. PubMed ID: 30006762 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Liu-Ambrose, T., & Donaldson, M.G. (2009). Exercise and cognition in older adults: Is there a role for resistance training programmes?. British Journal of Sports Medicine, 43(1), 2527. PubMed ID: 19019904 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lusardi, M., Pellecchia, G.L., & Schulman, M. (2003). Functional performance in community living older adults. Journal of Geriatric Physical Therapy, 26(3), 1422. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Marusic, U., Verghese, J., & Mahoney, J.R. (2018). Cognitive-based interventions to improve mobility: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 19(6), 484491. PubMed ID: 29680203 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Melo, D.M., Barbosa, A.J.G., & Neri, A.L. (2017). Miniexame do Estado Mental: Evidências de validade baseadas na estrutura interna. Avaliação Psicológica, 16(2), 161168. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Paraschiv-Ionescu, A., Büla, C.J., Major, K., Lenoble-Hoskovec, C., Krief, H., El-Moufawad, C., & Aminian, K. (2018). Concern about falling and complexity of free-living physical activity patterns in well-functioning older adults. Gerontology, 64(6), 603611. PubMed ID: 29972821 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pirauá, A.L.T., Cavalcante, B.R., Oliveira, V.M.A., Beltrão, N.B., de Amorim Batista, G., Pitangui, A.C.R., … de Araújo, R.C. (2019). Effect of 24 weeks strength training on unstable surfaces on mobility, balance and concern about falling in older adults. Scandinavian Journal of Medicine & Science in Sports, 29(11), 18051812. PubMed ID: 31273863 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Plummer-D’Amato, P., Cohen, Z., Daee, N.A., Lawson, S.E., Lizotte, M.R., & Padilla, A. (2012). Effects of once weekly dual-task training in older adults: A pilot randomized controlled trial. Geriatrics & Gerontology International, 12(4), 622629. PubMed ID: 22300013 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Podsiadlo, D., & Richardson, S. (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:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Robertson, R.J., Goss, F.L., Rutkowski, J., Lenz, B., Dixon, C., Timmer, J., Frazee, K., Dube, J., & Andreacci, J. (2003). Concurrent validation of the OMNI perceived exertion scale for resistance exercise. Medicine and Science in Sports and Exercise, 35(2), 333341. PubMed ID: 12569225 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rubenstein, L.Z. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(Suppl. 2), 3741. PubMed ID: 16926202 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Strobach, T., Salminen, T., Karbach, J., & Schubert, T. (2014). Practice-related optimization and transfer of executive functions: A general review and a specific realization of their mechanisms in dual tasks. Psychological Research, 78(6), 836851. PubMed ID: 24668506 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Thompson, P.D., Arena, R., Riebe, D., Pescatello, L.S., & American College of Sports Medicine. (2013). ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Current Sports Medicine Reports, 12(4), 215217. PubMed ID: 23851406 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tinetti, M.E., & Kumar, C. (2010). The patient who falls: “It’s always a trade-off”. Journal of the American Medical Association, 303(3), 258266. PubMed ID: 20085954 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • van het Reve, E., & de Bruin, E.D. (2014). Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: A multicenter randomized-controlled trial. BMC Geriatrics, 14(1), 134. PubMed ID: 25511081 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wells, K.F., & Dillon, E.K. (1952). The sit and reach-a test of back and leg flexibility. Research Quarterly. American Association for Health, Physical Education and Recreation, 23(1), 115118.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wongcharoen, S., Sungkarat, S., Munkhetvit, P., Lugade, V., & Silsupadol, P. (2017). Home-based interventions improve trained, but not novel, dual-task balance performance in older adults: A randomized controlled trial. Gait & Posture, 52, 147152. PubMed ID: 27912155 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zhu, X., Yin, S., Lang, M., He, R., & Li, J. (2016). The more the better? A meta-analysis on effects of combined cognitive and physical intervention on cognition in healthy older adults. Ageing Research Reviews, 31, 6779. PubMed ID: 27423932 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
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