Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline¹

Article type: Research Article

Authors: Gregory, Michael A.^{a; b} | Boa Sorte Silva, Narlon C.^{b; c} | Gill, Dawn P.^{a; b; d; e} | McGowan, Cheri L.^{b; d; f} | Liu-Ambrose, Teresa^{g; h} | Shoemaker, J. Kevin^c | Hachinski, Vladimirⁱ | Holmes, Jeff^j | Petrella, Robert J.^{a; b; c; d; *}

Affiliations: [a] Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada | [b] Lawson Health Research Institute, London, ON, Canada | [c] School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada | [d] Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada | [e] School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada | [f] Department of Kinesiology, University of Windsor, Windsor, ON, Canada | [g] Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada | [h] Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada | [i] Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada | [j] School of Occupational Therapy, Faculty of Health Sciences, Western University, London, ON, Canada

Correspondence: [*] Correspondence to: Robert J. Petrella, MD, PhD, Western Centre for Public Health and Family Medicine (2nd Floor), Western University, 1465 Richmond St., London, ON N6G 2M1, Canada. Tel.: +1 519 661 2111/Ext. 22119; Fax: +1 519 858 5167; E-mail: petrella@uwo.ca.

Note: [1] This work was conducted at the Parkwood Research Institute, in affiliation with the Lawson Health Research Institute and St. Joseph’s Health Care (London, ON, Canada).

Abstract: This 6-month experimental case series study investigated the effects of a dual-task gait training and aerobic exercise intervention on cognition, mobility, and cardiovascular health in community-dwelling older adults without dementia. Participants exercised 40 min/day, 3 days/week for 26 weeks on a Biodex GaitTrainer2 treadmill. Participants were assessed at baseline (V0), interim (V1: 12-weeks), intervention endpoint (V2: 26-weeks), and study endpoint (V3: 52-weeks). The study outcomes included: cognition [executive function (EF), processing speed, verbal fluency, and memory]; mobility: usual & dual-task gait (speed, step length, and stride time variability); and vascular health: ambulatory blood pressure, carotid arterial compliance, and intima-media thickness (cIMT). Fifty-six participants [age: 70(6) years; 61% female] were included in this study. Significant improvements following the exercise program (V2) were observed in cognition: EF (p = 0.002), processing speed (p < 0.001), verbal fluency [digit symbol coding (p < 0.001), phonemic verbal fluency (p < 0.001)], and memory [immediate recall (p < 0.001) and delayed recall (p < 0.001)]; mobility: usual & dual-task gait speed (p = 0.002 and p < 0.001, respectively) and step length (p = 0.001 and p = 0.003, respectively); and vascular health: cIMT (p = 0.002). No changes were seen in the remaining outcomes. In conclusion, 26 weeks of dual-task gait training and aerobic exercise improved performance on a number of cognitive outcomes, while increasing usual & dual-task gait speed and step length in a sample of older adults without dementia.

Keywords: Aging, dual-task exercise, executive function, laboratory-based, prevention

DOI: 10.3233/JAD-161240

Journal: Journal of Alzheimer's Disease, vol. 57, no. 3, pp. 747-763, 2017