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

I-Ching Chuang,1,2 Hui-Ju Wu,1 Hui-Ing Ma,3,4 Yih-Ru Wu,2,5 Ching-Yi Wu1,6,7 1Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 2Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 3Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan; 4Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan; 5School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 6Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; 7Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, TaiwanCorrespondence: Ching-Yi Wu, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259 Wen-Hwa 1st Road, Taoyuan, Taiwan, Email [email protected]: 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.Purpose: 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.Patients and Methods: 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).Results: 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.Conclusion: 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.Keywords: incorporated dual-task training, additional dual-task training, cognitive function, motor performance