Incorporated vs Additional Dual-Task Training in Community-Dwelling Older Adults

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Abstract
Aging involves declines in cognitive and physical functions, raising risks of falls, loss of independence, and poorer quality of life. Dual-task training, integrating cognitive and motor activities, has shown benefits, but direct comparisons of additional dual-task training (ADT), which embeds cognitive demands within motor tasks, and incorporated dual-task training (IDT), which requires concurrent yet independent cognitive tasks, are limited. This study compared the effects of ADT and IDT on cognitive function, physical performance, instrumental activities of daily living (IADL), and quality of life in community-dwelling older adults. Seventy-four participants (≥60 years) were randomized to ADT (n = 34) or IDT (n = 40) and completed a 12-week group program. Cognitive outcomes were measured with the Montreal Cognitive Assessment, Digit Symbol Substitution Test, Wechsler Memory Scale-III Word List, and Stroop Color Word Test; motor outcomes with the Box and Block Test, Timed Up and Go, and dual-task indices (BBT-SST, BBT-FD); functional outcomes with the Lawton IADL and Community Integration Questionnaire (CIQ). A significant group × time effect was found for BBT-SST number scores (p =0.002), with IDT yielding greater dual-task cognitive gains. Both groups improved in global cognition, processing speed, and working memory, while only IDT enhanced motor performance and motor-cognitive coordination. No significant changes were observed in TUG, dual-task cost, IADL, or CIQ. IDT showed superior benefits for dual-task cognition and coordination, suggesting greater ecological validity, more efficient resource allocation, and closer alignment with real-world demands. Future studies should investigate electroencephalography (EEG) based neural mechanisms and develop VR approaches for at-risk older adults.

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