Abstract
Objective
To explore the effects of dual task (DT) training on DT gait performance and cognitive
function in individuals with Parkinson disease (PD) and to examine factors that might
influence the effects of DT training.
Data Sources
PubMed, Wiley Online Library, Cochrane Library, CINAHL, and Medline were searched
for articles published from January 2006 to December 2021.
Study Selection
Randomized controlled trials comparing DT training with usual care or general exercise
were included.
Data Extraction
The outcomes studied were DT gait parameters including speed, step and stride length,
cadence, step and stride time variability, dual-task cost on gait speed, and Trail
Making Tests presented as standardized mean differences (SMDs). The Grading of Recommendations,
Assessment, Development, and Evaluation was used to evaluate the quality of evidence.
Data Synthesis
Ten randomized controlled trials with 466 participants were included in the meta-analysis.
The included studies presented, in general, with a low to high risk of bias. Meta-analyses
used a random-effects model for all analyses. The meta-analysis showed the DT training
effects on DT gait speed (SMD=0.825, P=.012), DT step and stride length (SMD=0.400, P=.015), Trail Making Tests-part A (TMT-A; SMD=0.533, P=.010), and Trail Making Tests-part B (SMD=0.516, P=.012) compared with the control group. Only the effect on TMT-A was maintained at
the follow-up assessment. The results of meta-regression showed that participants
with slower initial single task gait speed improved more after DT training on DT step
and stride length.
Conclusions
The DT training improved more in DT gait speed with moderate-quality evidence as compared
with usual care or conventional physical training in individuals with PD. The beneficial
effects of DT training on DT step and stride length, attention, and executive function
were also demonstrated in this meta-analysis. Furthermore, the improvement in the
DT walking step and stride length was related to the participant's initial single
task gait speed.
Keywords
List of abbreviations:
CI (confidence interval), DT (dual task), DTC (dual-task cost), GRADE (Grading of Recommendations Assessment, Development and Evaluation), PD (Parkinson disease), SMD (standardized mean difference), TMT-A (Trail Making Tests-part A), TMT-B (Trail Making Tests-part B), RCT (randomized controlled trial)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 accessOne-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:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Gait progression over 6 years in Parkinson disease: effects of age, medication, and pathology.Front Aging Neurosci. 2020; 12577435
- Gait coordination in Parkinson disease: effects of step length and cadence manipulations.Gait Posture. 2013; 38: 340-344
- Gait parameters of Parkinson's disease compared with healthy controls: a systematic review and meta-analysis.Sci Rep. 2021; 11: 752
- The relative contribution of physical and cognitive fall risk factors in people with Parkinson's disease: a large prospective cohort study.Neurorehabil Neural Repair. 2014; 28: 282-290
- Gait characteristics and falls in Parkinson's disease: a systematic review and meta-analysis.Parkinsonism Relat Disord. 2018; 57: 1-8
- Parkinson disease-associated cognitive impairment.Nat Rev Dis Primers. 2021; 7: 47
- The role of executive function and attention in gait.Mov Disord. 2008; 23: 329-342
- Associations between cognitive and gait performance during single- and dual-task walking in people with Parkinson disease.Phys Ther. 2014; 94: 757-766
- The role of the frontal lobe in complex walking among patients with Parkinson's disease and healthy older adults: an fNIRS study.Neurorehabil Neural Repair. 2016; 30: 963-971
- Characterization of cognitive and motor performance during dual-tasking in healthy older adults and patients with Parkinson's disease.J Neurol. 2013; 260: 580-589
- A meta-analysis: Parkinson's disease and dual-task walking.Parkinsonism Relat Disord. 2019; 62: 28-35
- Dual tasking in Parkinson's disease: cognitive consequences while walking.Neuropsychology. 2017; 31: 613-623
- Everyday tasks impair spatiotemporal variables of gait in older adults with Parkinson's disease.Hum Mov Sci. 2020; 70102591
- Dual task interference on postural sway, postural transitions and gait in people with Parkinson's disease and freezing of gait.Gait Posture. 2017; 56: 76-81
- Postural instability and fall risk in Parkinson's disease: impaired dual tasking, pacing, and bilateral coordination of gait during the “ON” medication state.Exp Brain Res. 2011; 210: 529-538
- Limited effect of dopaminergic medication on straight walking and turning in early-to-moderate Parkinson's disease during single and dual tasking.Front Aging Neurosci. 2016; 8: 4
- Treatment of Parkinson's disease with cognitive impairment: current approaches and future directions.Behav Sci (Basel). 2021; 11: 54
- Dual tasking in Parkinson's disease: should we train hazardous behavior?.Expert Rev Neurother. 2015; 15: 1031-1039
- The source of execution-related dual-task interference: motor bottleneck or response monitoring?.J Exp Psychol Hum Percept Perform. 2009; 35: 1413-1426
- The automaticity of complex motor skill learning as a function of attentional focus.Q J Exp Psychol A. 2001; 54: 1143-1144
- Practice-related optimization of dual-task performance: efficient task instantiation during overlapping task processing.J Exp Psychol Hum Percept Perform. 2018; 44: 1884-1904
- Mechanisms of practice-related reductions of dual-task interference with simple tasks: data and theory.Adv Cogn Psychol. 2017; 13: 28-41
- The effects of highly challenging balance training in elderly with Parkinson's disease: a randomized controlled trial.Neurorehabil Neural Repair. 2015; 29: 827-836
- Training dual tasks together or apart in Parkinson's disease: results from the DUALITY trial.Mov Disord. 2017; 32: 1201-1210
- Can dual task walking improve in Parkinson's disease after external focus of attention exercise? A single blind randomized controlled trial.Neurorehabil Neural Repair. 2018; 32: 18-33
- Does dual-task training improve spatiotemporal gait parameters in Parkinson's disease?.Parkinsonism Relat Disord. 2018; 55: 86-91
- Tai Chi for reducing dual-task gait variability, a potential mediator of fall risk in Parkinson's disease: a pilot randomized controlled trial.Glob Adv Health Med. 2018; 72164956118775385
- Cognitive and motor dual task gait training exerted specific training effects on dual task gait performance in individuals with Parkinson's disease: a randomized controlled pilot study.PLoS One. 2019; 14e0218180
- The effects of integrated single- and dual-task training on automaticity and attention allocation in Parkinson's disease: a secondary analysis from a randomized trial.Neuropsychology. 2019; 33: 147-156
- The adapted resistance training with instability randomized controlled trial for gait automaticity.Mov Disord. 2021; 36: 152-163
- 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.Arch Phys Med Rehabil. 2020; 101: 1849-1856
- Effects of the agility boot camp with cognitive challenge (ABC-C) exercise program for Parkinson's disease.NPJ Parkinsons Dis. 2020; 6: 31
- Motor-cognitive dual-task training in persons with neurologic disorders: a systematic review.J Neurol Phys Ther. 2015; 39: 142-153
- The effects of dual task gait and balance training in Parkinson's disease: a systematic review.Physiother Theory Pract. 2020; 36: 1088-1096
- Dual-task training on gait, motor symptoms, and balance in patients with Parkinson's disease: a systematic review and meta-analysis.Clin Rehabil. 2020; 34: 1355-1367
- Gait pattern and cognitive performance during treadmill walking in Parkinson disease.Am J Phys Med Rehabil. 2015; 94: 931-940
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Ann Intern Med. 2009; 151: 264-269
- Marche et double tâche: définition, intérêts et perspectives chez le sujet âgé [Gait and dual-task: definition, interest, and perspectives in the elderly].Psychol Neuropsychiatr Vieil. 2006; 4: 215-225
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.J Clin Epidemiol. 2011; 64: 383-394
- Statistical power analysis for the behavioral sciences.2nd ed. Routledge, New York, NY1988
- Measuring inconsistency in meta-analyses.BMJ Br Med J. 2003; 327: 557-560
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- Dual-task prioritization during overground and treadmill walking in healthy adults.Gait Posture. 2020; 75: 109-114
- A feasibility study of dual-task strategy training to improve gait performance in patients with Parkinson's disease.Sci Rep. 2021; 11: 12416
- Causal relationship between spatiotemporal parameters of walking and the locomotor rehabilitation index in healthy people.Gait Posture. 2021; 90: 320-325
- Timed up and go test with a cognitive task: correlations with neuropsychological measures in people with Parkinson's disease.Cureus. 2020; 12: e10604
- Mental slowness in patients with Parkinson's disease: associations with cognitive functions?.J Clin Exp Neuropsychol. 2016; 38: 844-852
- Trail making test, part B as a measure of executive control: validation using a set-switching paradigm.J Clin Exp Neuropsychol. 2000; 22: 518-528
- Mechanisms underlying training-induced cognitive change.Nat Rev Psychol. 2022; 1: 30-41
- The trail making test, part B: cognitive flexibility or ability to maintain set?.Appl Neuropsychol. 2002; 9: 106-109
- Dual-task training to improve cognitive impairment and walking function in Parkinson's disease patients: a brief review.Sports Med Health Sci. 2021; 3: 202-206
- Effects of exergame-based dual-task training on executive function and dual-task performance in community-dwelling older people: a randomized-controlled trial.Games Health J. 2021; 10: 347-354
- Cognition and gait show a selective pattern of association dominated by phenotype in incident Parkinson's disease.Front Aging Neurosci. 2014; 6: 249
- Functional capacity and dual-task cost in the institutionalized older adults, both affected and unaffected by mild cognitive impairment.Eur Rev Aging Phys Act. 2021; 18: 16
- Dual-task effects during a motor-cognitive task in Parkinson's disease: patterns of prioritization and the influence of cognitive status.Neurorehabil Neural Repair. 2021; 35: 356-366
- Determinants of dual-task training effect size in Parkinson disease: who will benefit most?.J Neurol Phys Ther. 2019; 43: 3-11
Article info
Publication history
Published online: November 26, 2022
Accepted:
November 16,
2022
Received in revised form:
November 12,
2022
Received:
March 3,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This work was supported by grants from the Ministry of Science and Technology, Taiwan (MOST-106-2314-B-010-037-MY3) and National Health Research Institutes, Taiwan (NHRI-EX110-10913PI).
PROSPERO Registration Number: CRD42022301175.
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
