Physical Exercises and Functional Mobility in Single and Dual-Task in the Elderly: Relationship with Cognitive Function

Research Article

Austin Alzheimers J Parkinsons Dis. 2016; 3(1): 1025.

Physical Exercises and Functional Mobility in Single and Dual-Task in the Elderly: Relationship with Cognitive Function

Nascimento CMC1,2*, Ayan C¹, Lirani-Silva E², Montes L¹ and Cancela JM¹

¹Faculty of Sports Science, University of Vigo, Spain

²Department of Physical Education, Universidade Estadual Paulista, Brazil

*Corresponding author: Nascimento CMC, Faculty of Sports Science, University of Vigo, Facultad de Ciencias de la Educación y del Deporte, Campus a Xunqueira - Universidade de Vigo A Xunqueira s/n - 36005 Pontevedra, Spain

Received: February 01, 2016; Accepted: March 03, 2016; Published: March 10, 2016


The aim of this study was to determine the effects of a 20 week program of multimodal physical exercises on functional performance in mobility considering single and dual-tasks conditions, as well as assessing the cognitive components that may affect this performance in the elderly. 49 elders (65.6 ± 2.8 years) participated in the study. The groups were distributed according to the participation in the proposed protocol: a) Trained Group (TG), composed of 21 participants who attended at least 75% of the total generalized exercise sessions; b) Control Group (CG), participants who were included in a group of social gathering with cognitive stimulation activities, but without any systematized physical activity. Functional mobility was assessed using the Timed-Up-and-Go (TUG) test. Participants performed a single-task and would later associate the test with a verbal fluency task (dual task condition). For analysis, we considered the time spent to perform the two conditions. Cognitive functions were measured by the Mini-Mental State Examination (MMSE). Results showed that the elderly in the TG showed better performance on the TUG for the conditions of single and dualtasks after performing the 20-week of physical exercises proposed protocol. The cognitive status showed a significant association with the time spent to perform TUG test during the dual-task (r²=46%, p = 0.01). Thus our results indicated that for twice a week doing physical exercises during 20 weeks, may promote functional performance benefits in the elderly, especially in situations that require performance of dual tasks.

Keywords: Aging; Exercise; Cognition; Functional mobility; Dual-task


Elderly population frequently experience functional deficits during the ageing process. Their changes are common, mainly during they have to perform multiple tasks in which may demand the integration between cognitive and motor functions. Most of the daily instrumental activities require these abilities, such as walking, carrying a cup of water or count money to pay their expenses. The ability to perform dual-task activities is important to ensure the maintenance of a functional and independent lifestyle [1]. The ageing process is directly linked to impairments in information [2] and functional fitness [3,4], which become the performance on dual-tasks more complex for these people [5-8].

Voelcker-Rehage & Alberts [9] e Jamet et al. [10] verified that during the performance on motor tasks, elderly are able to maintain body balance when it is focused on achieving a specific activity, but they did not show the same pattern of performance when they need to perform multiple tasks simultaneously. While performing concurrent tasks, a primary and/or secondary task are assigned mainly by competition between the attentional demands. This competition is triggered by the decline in frontal lobe functions, particularly in executive functions, which are responsible for organizing, planning, scheduling and executing tasks [5, 11-13].

Thus, the need of attentional demand for accomplishment and monitoring the environment, might cause difficulties in motor performance [10] and increase the risk of falling when the subject is performing dual task activities [14-16], which is currently in activities of daily living.

Fallen reduce independence and consequently the quality of life of these individuals [15-18]; and is currently treated as a public health issue. In this sense, the practice of physical exercise has been widely recommended as a way to minimize the deficits in functional and cognitive systems [19-22] due to the aging process, as well as the important to the prevention of falls [23].

Some studies have been conducted with functional mobility and simultaneous cognitive tasks in elderly subjects [24,25], additionally to motor benefits, some investigations found a positive effect of an exercise program on the achievement of dual tasks. However, few researches linked this performance with the cognitive status of the elderly.

Thus, this study contributes to partial reduction in the gap of knowledge in the context presented above, analyzing the effects of a generalized program of physical exercises on dual and single tasks in the elderly, as well as the connection between performance and cognitive status. Therefore the objective of this study was to investigate the effects of a dual task exercise program in general for the functional mobility of older people, as well as the association of cognitive performance with the same status.


62 volunteer subjects participated in this study without prior history of neurodegenerative diseases or functional changes that could affect neither their motor function or the performance of the proposed training protocol (independent gait). Participants’ age ranged between 63 to 75 years (mean age 65.6 ± 2.8 years).

The participants were distributed into two different groups as follows: a) experimental group: 28 individuals who taking part in a specific and generalized program of physical activity during 20 weeks. All participants included in our sample took part in at least 75% of all sessions of the proposed training; b) Control group: 34 subjects who participated in social gathering events. These participants did not perform any kind of systematic physical activity during the same period.

This prospective interventional study was approved by the Ethical Committee of the UNESP – São Paulo State University. All participants signed the consent term certifying that all procedures were planned according the ethical standards of the Committee on Human Experimentation of the institution and with the Helsinki Declaration of 1975.

Experimental group

Training protocol: In the present study, the experimental group underwent a multimodal training, with two weekly sessions on nonconsecutive days, each session have a 60 minutes of duration. All sessions started with a 10 minute short warm-up and simple stretches, followed by the main activity aimed to work components of functional capacity (aerobic endurance, strength endurance, coordination and balance). The main part of the session has approximately 45 minutes. At the end of each session, it was suggested a five minutes cool-down activity. The workloads applied for the experimental group were calculated to ranges between 70 and 75% of the maximum heart rate.

Control group: The control group did not take part of any kind of systematic and regular motor intervention during the research period and on the six months before the beginning of the research. These individuals were participants in a project of social gathering with multidisciplinary activities (crafts, lectures, tours, etc.). This interventional project included two weekly meetings. All participants underwent the same evaluation protocol as the experimental group.

Evaluation protocol: The evaluations were conducted by “singleblind” instructors regarding the distribution of each group assessed. For the evaluation of functional mobility, participants were instructed to perform the Timed Up and Go test protocol [26]. The test begins with the participant sitting on a chair and at the signal of the evaluator, the participant should get up and walk as fast as they can, covering a distance of three meters in a straight line and returning around a cone that marked such away and returning to the starting position on the chair. The instructor marks the time taken for completing the task. High values of time and/or number of steps represent a higher risk of falls. After an attempt to ensure familiarization with the test, the tasks were performed under two different conditions: in the first condition, the elderly should focus exclusively on the attainment of motor action and at the second time, the test should be accompanied by a fluency verbal assessment (participants should nominate animals that begins with the letter “C” as many as possible he was able to recall). Verbal fluency task is often used for dual tasks in order to demand the attention under execution [13]. Each trial was performed with intervals of 2 minutes.

The adapted version of the Mini-Mental State Examination (MMSE) [27] was applied to assess cognitive deficits. This assessment tool consists of seven categories, each designed with the objective to evaluate specific cognitive functions. They are: orientation regarding time and place, registration of three words, attention and calculation, recall of three words, language and visual constructive praxis.

Data Analysis

The Outcomes of the variables are shown by descriptive statistics. The analysis to verify the normality of the data consisted of: a) A Two- Way ANOVA to verify the interaction between the balance/mobility conditions in single and dual-tasks between pre and post-motor intervention in the experimental and control group; b) Pearson correlation coefficient was calculated to investigate the association between functional mobility performance in dual-task condition and cognitive status and; c) Multiple Linear Regression, to analyze the relationship of the independent variables (age, sex, and cognitive status) as predictors of performance in mobility functional in dual task condition. For our statistical tests we adopted a significance level of 5% (p <0.05). All analysis´ were performed using SPSS software version 10.0 for Windows.


Sixty-two elderly were included for the data analysis. Twentyeight of these elderly performed the proposed training protocol for a period of 20 weeks and had a frequency equal to or greater than 75% of the total meetings held during the development of the research. Seven of the total subjects who participate initially of the intervention, did not complete the participation in the study (2 withdrew, 3 did not achieve the minimum frequency and,2 did not attend the complete evaluation protocol). Regarding the 34 participants of the control group, only 28 completed the evaluation protocol and were included in the sample. Data regarding age, education, functional mobility and cognitive functions are presented in Table 1. Participants did not present significant differences between baseline characteristics evaluated.