Original research| Volume 101, ISSUE 11, P1849-1856.e1, November 2020

Effects of Dual-Task Group Training on Gait, Cognitive Executive Function, and Quality of Life in People With Parkinson Disease: Results of Randomized Controlled DUALGAIT Trial

  • Constanza San Martín Valenzuela
    Unit of Personal Autonomy, Dependency and Mental Disorder Assessment, Faculty of Medicine, Universitat de València, València, Spain

    Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain

    UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain

    Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
    Search for articles by this author
  • Lirios Dueñas Moscardó
    Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain
    Search for articles by this author
  • Juan López-Pascual
    Instituto de Biomecánica de Valencia, Universitat Politècnica de València, València, Spain
    Search for articles by this author
  • Pilar Serra-Añó
    Corresponding author Pilar Serra-Añó, PhD, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, C/Gascó Oliag 5, 46010 València, Spain.
    Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain

    UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain
    Search for articles by this author
  • José M. Tomás
    Department of Behavioral Sciences Methodology, Faculty of Psychology, Universitat de València, València, Spain
    Search for articles by this author
Published:August 11, 2020DOI:


      • This was a single-blind randomized controlled trial, with 8 weeks of follow-up study.
      • Dual-task gait training was compared with gait training in Parkinson disease.
      • Training effects were evaluated in single- and dual-task conditions.
      • The dual-task training group demonstrated improved velocity, stride length, and double support time.
      • Dual-task training has a greater effect on single gait and visual dual-task gait.



      The aims of this study were to analyze the effects of a dual-task group program, to compare it with the effects of a single-task group program, and to analyze the effects of functional secondary tasks.


      Single-blind randomized controlled trial.


      University laboratory and a rehabilitation gym at a health center.


      Patients (N=40) with a diagnosis of Parkinson disease (mean age, 66.72y; age range, 44-79y) with Hoehn and Yahr stage I to III who were on medication were randomized to either a group with dual-task training or a group with single-task training (only gait).


      Both interventions involved 20 sessions lasting 1 hour each and conducted twice a week. Dual-task training included walking exercises and cognitive or motor tasks carried out separately, then later performed together as a dual-task according to a progressive protocol in the same training session.

      Main Outcome Measures

      Velocity and spatiotemporal parameters of gait were measured without a secondary task and during dual-task gait combined with a visual, verbal, auditory, and motor task. In addition, executive cognitive function and quality of life were measured. Assessments were conducted at baseline, postrehabilitation, and at the 8-week follow-up.


      The dual-task group demonstrated improved velocity and stride length time in all assessment conditions after training (P<.05), as well as perceived quality of life (P<.05). The single-task group experienced improvements in the same outcomes for only the motor condition (P<.05) after training, but failed to improve perceived quality of life (P>.05). Likewise, the dual-task group showed higher velocity and stride length after treatment than the single-task group across conditions. No significant changes were observed in cognitive performance (P>.05), although the dual-task group tended to improve performance during the executive function test.


      Dual-task training in functional contexts is associated with greater improvements in velocity and stride length in patients with PD compared with regular physiotherapy without secondary tasks. Dual-task training also improves perceived quality of life.


      List of abbreviations:

      DT (dual-task), MANOVA (multivariate analysis of variance), PD (Parkinson disease), ST (single-task)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kelly V.E.
        • Eusterbrock A.J.
        • Shumway-Cook A.
        A review of dual-task walking deficits in people with Parkinson’s disease: motor and cognitive contributions, mechanisms, and clinical implications.
        Parkinsons Dis. 2012; 2012: 918719
        • Sofuwa O.
        • Nieuwboer A.
        • Desloovere K.
        • Willems A.-M.
        • Chavret F.
        • Jonkers I.
        Quantitative gait analysis in Parkinson’s disease: comparison with a healthy control group.
        Arch Phys Med Rehabil. 2005; 86: 1007-1013
        • Strouwen C.
        • Molenaar E.A.L.M.
        • Münks L.
        • et al.
        Training dual tasks together or apart in Parkinson’s disease: results from the DUALITY trial.
        Mov Disord. 2017; 32: 1201-1210
        • Geroin C.
        • Nonnekes J.
        • de Vries N.M.
        • et al.
        Does dual-task training improve spatiotemporal gait parameters in Parkinson’s disease?.
        Parkinsonism Relat Disord. 2018; 55: 86-91
        • Brauer S.G.
        • Woollacott M.H.
        • Lamont R.
        • et al.
        Single and dual task gait training in people with Parkinson’s disease: a protocol for a randomised controlled trial.
        BMC Neurol. 2011; 11: 90
        • Fok P.
        • Farrell M.
        • McMeeken J.
        The effect of dividing attention between walking and auxiliary tasks in people with Parkinson’s disease.
        Hum Mov Sci. 2012; 31: 236-246
        • Fok P.
        • Farrell M.
        • McMeeken J.
        Prioritizing gait in dual-task conditions in people with Parkinson’s.
        Hum Mov Sci. 2010; 29: 831-842
        • Yogev-Seligmann G.
        • Giladi N.
        • Brozgol M.
        • Hausdorff J.M.
        A training program to improve gait while dual tasking in patients with Parkinson’s disease: a pilot study.
        Arch Phys Med Rehabil. 2012; 93: 176-181
        • Mirelman A.
        • Maidan I.
        • Herman T.
        • Deutsch J.E.
        • Giladi N.
        • Hausdorff J.M.
        Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson’s disease?.
        J Gerontol A Biol Sci Med Sci. 2011; 66: 234-240
        • Brauer S.G.
        • Morris M.E.
        Can people with Parkinson’s disease improve dual tasking when walking?.
        Gait Posture. 2010; 31: 229-233
        • Isella V.
        • Mapelli C.
        • Morielli N.
        • et al.
        Validity and metric of MiniMental Parkinson and MiniMental State Examination in Parkinson’s disease.
        Neurol Sci. 2013; 34: 1751-1758
        • Reyes A.
        • Ziman M.
        • Nosaka K.
        respiratory muscle training for respiratory deficits in neurodegenerative disorders: a systematic review.
        Chest. 2013; 143: 1386-1394
        • Ory Magne F.
        • Fabre N.
        • Gu C.
        • et al.
        An individual rehabilitation program: evaluation by Parkinsonian patients and their physiotherapists.
        Rev Neurol (Paris). 2014; 170: 680-684
        • Uhrbrand A.
        • Stenager E.
        • Pedersen M.S.
        • Dalgas U.
        Parkinson’s disease and intensive exercise therapy – a systematic review and meta-analysis of randomized controlled trials.
        J Neurol Sci. 2015; 353: 9-19
        • Mavrommati F.
        • Collett J.
        • Franssen M.
        • et al.
        Exercise response in Parkinson’s disease: insights from a cross-sectional comparison with sedentary controls and a per-protocol analysis of a randomised controlled trial.
        BMJ Open. 2017; 7: e017194
        • van der Kolk N.M.
        • de Vries N.M.
        • Kessels R.P.C.
        • et al.
        Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson’s disease: a double-blind, randomised controlled trial.
        Lancet Neurol. 2019; 18: 998-1008
        • Gandolfi M.
        • Tinazzi M.
        • Magrinelli F.
        • et al.
        Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson’s disease: a single-blinded, randomized controlled trial.
        Parkinsonism Relat Disord. 2019; 64: 268-274
        • Peto V.
        • Jenkinson C.
        • Fitzpatrick R.
        • Greenhall R.
        The development and validation of a short measure of functioning and well being for individuals with Parkinson’s disease.
        Qual Life Res. 1995; 4: 241-248
        • Romann A.J.
        • Dornelles S.
        • Maineri N.L.
        • Rieder C.R.M.
        • Olchik M.R.
        Cognitive assessment instruments in Parkinson’s disease patients undergoing deep brain stimulation.
        Dement Neuropsychol. 2012; 6: 2-11
        • Yogev-Seligmann G.
        • Rotem-Galili Y.
        • Mirelman A.
        • Dickstein R.
        • Giladi N.
        • Hausdorff J.M.
        How does explicit prioritization alter walking during dual-task performance? Effects of age and sex on gait speed and variability.
        Phys Ther. 2010; 90: 177-186
        • Faul F.
        • Erdfelder E.
        • Lang A.-G.
        • Buchner A.G.
        ∗Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Conradsson D.
        • Löfgren N.
        • Nero H.
        • et al.
        The effects of highly challenging balance training in elderly with Parkinson’s disease: a randomized controlled trial.
        Neurorehabil Neural Repair. 2015; 29: 827-836
        • Canning C.G.
        The effect of directing attention during walking under dual-task conditions in Parkinson’s disease.
        Parkinsonism Relat Disord. 2005; 11: 95-99
        • Pau M.
        • Corona F.
        • Pili R.
        • et al.
        Effects of physical rehabilitation integrated with rhythmic auditory stimulation on spatio-temporal and kinematic parameters of gait in Parkinson’s disease.
        Front Neurol. 2016; 7: 126
        • Morris M.E.
        • McGinley J.
        • Huxham F.
        • Collier J.
        • Iansek R.
        Constraints on the kinetic, kinematic and spatiotemporal parameters of gait in Parkinson’s disease.
        Hum Mov Sci. 1999; 18: 461-483
        • Paul S.S.
        • Dibble L.E.
        • Peterson D.S.
        Motor learning in people with Parkinson’s disease: Implications for fall prevention across the disease spectrum.
        Gait Posture. 2018; 61: 311-319
        • Davie K.L.
        • Oram Cardy J.E.
        • Holmes J.D.
        • et al.
        The effects of word length, articulation, oral-motor movement, and lexicality on gait: a pilot study.
        Gait Posture. 2012; 35: 691-693