Dual-Task Exercise Reduces Cognitive-Motor Interference in Walking and Falls After Stroke

<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Functional community ambulation requires the ability to perform mobility and cognitive task simultaneously (dual-tasking). This single-blinded randomized controlled study aimed to examine the effects of dual-task exercise in chronic stroke patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>Eighty-four chronic stroke patients (24 women; age, 61.2±6.4 years; time since stroke onset, 75.3±64.9 months) with mild to moderate motor impairment (Chedoke-McMaster leg motor score: median, 5; interquartile range, 4–6) were randomly allocated to the dual-task balance/mobility training group, single-task balance/mobility group, or upper-limb exercise (control) group. Each group exercised for three 60-minute sessions per week for 8 weeks. The dual-task interference effect was measured for the time to completion of 3 mobility tests (forward walking, timed-up-and-go, and obstacle crossing) and for the correct response rate during serial-3-subtractions and verbal fluency task. Secondary outcomes included the Activities-specific Balance Confidence Scale, Frenchay Activities Index, and Stroke-specific Quality of Life Scale. The above outcomes were measured at baseline, immediately after, and 8 weeks after training. Fall incidence was recorded for a 6-month period posttraining.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> Only the dual-task group exhibited reduced dual-task interference in walking time posttraining (forward walking combined with verbal fluency [9.5%, <jats:italic>P</jats:italic> =0.014], forward walking with serial-3-subtractions [9.6%, <jats:italic>P</jats:italic> =0.035], and the timed-up-and-go with verbal fluency [16.8%, <jats:italic>P</jats:italic> =0.001]). The improvements in dual-task walking were largely maintained at the 8-week follow-up. The dual-task cognitive performance showed no significant changes. The dual-task program reduced the risk of falls and injurious falls by 25.0% (95% CI, 3.1%–46.9%; <jats:italic>P</jats:italic> =0.037) and 22.2% (95% CI, 4.0%–38.4%; <jats:italic>P</jats:italic> =0.023), respectively, during the 6-month follow-up period compared with controls. There was no significant effect on other secondary outcomes ( <jats:italic>P</jats:italic> >0.05). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>The dual-task program was effective in improving dual-task mobility, reducing falls and fall-related injuries in ambulatory chronic stroke patients with intact cognition. It had no significant effect on activity participation or quality of life.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical trial registration—</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> . Unique identifier: NCT02270398. </jats:p> </jats:sec>