Neither uni- nor multi-modal exercise interventions improve single- and dual-task gait performance in physically active healthy elderly – a pilot study

Neither uni- nor multi-modal exercise interventions improve single- and dual-task gait performance in physically active healthy elderly – a pilot study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Neither uni- nor multi-modal exercise interventions improve single- and dual-task gait performance in physically active healthy elderly – a pilot study Constantin Wilhelm Freitag, Martin Behrens, Robert Bielitzki, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5910496/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Nov, 2025 Read the published version in BMC Geriatrics → Version 1 posted 16 You are reading this latest preprint version Abstract Purpose: Aging is an inevitable process leading, inter alia, to the loss of muscle mass as well as the decrease in physical and cognitive function. These age-related impairments translate into a reduced gait performance and an increased risk of falls, which can be tackled with resistance training, Unimodal intervention (UMI). However, Multimodal intervention (MMI), i.e. combined motor-cognitive and resistance training, might be a more promising approach to increase physical and cognitive function in old adults. Therefore, this pilot study aimed to investigate the effects of MMI, compared to UMI, on gait and cognitive performance in elderly participants. We hypothesized that MMI will increase gait and cognitive performance to a larger extent than UMI. Methods: In this two-arm randomized controlled pilot study, 29 healthy active elderly participantswere assigned to MMI (15 participants, 72.0±5.5 years) and UMI (14 participants, 70.1±4.7 years). Both groups trained for 12 weeks, two times a week for 60 min, respectively. MMI consisted of motor-cognitive training directly followed by resistance training, while UMI consisted of a stand-alone resistance training. Three weeks before and after the interventions, gait performance (e.g., stride length, velocity, minimum toe clearance) was assessed during single- and dual-task walking trials using inertial measurement units. During dual-task walking, participants walked and concurrently performed different cognitive tasks in a random order: (i) reaction time task, (ii) N-back-task, and (iii) letter fluency task with two difficulty levels, respectively. Data were analyzed with repeated measures analyses of covariance (Time×Intervention×Condition). Results: Although the analyses of the progression of the external load used during resistance training showed a significant increase over the training period (e.g. leg press p<0.001, η 2 p =0.618), there was no improvement of gait or cognitive performance in active old adults after neither MMI nor UMI. Conclusion: Against our hypothesis, the present pilot study indicated that neither a 12-week MMI nor UMI seems to have a sizable impact on gait parameters and cognitive performance in physically active healthy adults. Still, a significant increase in the external load used during resistance training was observed, implying neuromuscular adaptations, which, however, did not translate into a higher gait and/or cognitive performance. Figures Figure 1 Introduction Aging is a continuous process resulting in, inter alia, skeletal muscle atrophy (sarcopenia) 1 and a reduction in neural drive to the muscles finally causing a decline in maximal and explosive muscle strength (dynapenia) 2 , 3 and function. Moreover, aging might impair cognitive function and potentially lead decreasing executive functions 4 . Both age-related decline in strength and cognitive function can affect daily activities by deteriorating gait performance and increasing the risk of falls 5 , 6 , a major cause of injuries in the elderly 7 . Several spatiotemporal gait parameters, such as stride length, gait velocity, and gait variability measures have been shown to be predictive for the risk of falls 8 , 9 . In particular, minimum toe clearance (MTC) appears to be a promising marker for evaluating motor control during walking and perhaps the risk of falling in older adults 10 . The MTC describes the smallest distance between the ground and toe during the mid-swing phase of the gait cycle 8 and the lower the MTC and the larger its variability, the higher the risk of sustaining a fall 10 . Gait performance, i.e., motor control during walking, is often evaluated during motor-cognitive dual-task walking 11 – 16 , which is characterized by performing a concurrent cognitive task during walking and often results in an increased gait variability 8 , 17 . The worsening of gait performance might be attributable to the reduced processing capacity for the motor task (central capacity sharing model) and/or the sequential neural processing of the motor and cognitive interference task (bottleneck model) 18 . Consequently, performance in at least one task diminishes, e.g., gait performance, a phenomenon known as dual-task costs (DTC). This is of particular importance, given that daily activities often require multitasking, such as walking while thinking, texting, or phoning. Importantly, a lower motor-cognitive dual-task walking performance, i.e., higher DTC, is related to a higher risk of falling 19 . Since falls can lead to fear of future falls 20 , a loop of physical inactivity might begin promoting sarcopenia, dynapenia, as well as cognitive dysfunction 21 , and thus, increasing the risk of falling. To counteract this, resistance training promises a suitable interventional strategy that has been shown to increase postural control and gait performance in older adults 22 . Furthermore, resistance training might also have positive effects on cognitive performance 23 . Further, there is evidence that motor-cognitive dual-task training (i.e., the concurrent execution of motor and cognitive tasks) 24 elicits structural and functional changes in the aging brain, which were associated with an improved cognitive performance 25 – 28 . Although the evidence is inconclusive, concurrent training of motor and cognitive tasks might be a more promising approach for enhancing cognitive performance compared with single motor or cognitive training 13 , 29 . Given that both, the age-related decline in strength and cognitive performance, can impact on gait performance, a multimodal intervention (MMI) combining resistance training and motor-cognitive dual-task training 24 could be more effective in reducing the risk of falls than resistance training alone. As far as the authors of the present study are aware, there is no experimental trial that has investigated the effect of motor-cognitive dual-task training directly followed by a resistance training on gait and cognitive performance in healthy elderly. Therefore, the present study compared the influence of a 12-week MMI (motor-cognitive dual-task training + resistance training) and a unimodal intervention (UMI, stand-alone resistance training, twice a week, lasting 60 min each, 24 training sessions in total) on gait performance and cognitive performance in healthy old adults. For that purpose, gait parameters (i.e., stride length, gait velocity, MTC), and their respective coefficient of variation (CoV) 8 were recorded during single-task and motor-cognitive dual-task walking before and after the training intervention. Additionally, the DTC (relative changes between single-task and dual-task performance) were calculated to assess the cognitive demands during walking 30 . It was hypothesized that the MMI leads to higher improvements in gait performance, especially during dual-task walking, and cognitive performance compared to UMI. Furthermore, a decrease in DTC was expected after the MMI. Methods Study Design This two-arm randomized controlled pilot study was conducted from August 2020 to December 2022. The interventions and measurements were performed in the laboratories of the Sport Science Department at the Otto von Guericke University Magdeburg. The study was carried out in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University Medical Faculty Magdeburg (32/18). Reporting was performed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) Statement for randomized pilot trials 31 . The data presented in this article are part of a larger study investigating the effects of a MMI versus UMI on visual, motor, and cognitive performance as well as structural and functional brain adaptations in glaucoma patients and healthy controls (German Clinical Trial Register, ID: DRKS00022519/05.08.2020, https://drks.de/search/de/trial/DRKS00022519 ). All participants signed the informed consent form before participating in this study. Participants Participants were eligible when they met the following inclusion criteria: (i) age ≥ 60 and (ii) the ability to walk at least six minutes without support. Exclusion criteria were defined as follows: (i) eye diseases/surgeries affecting visual function, (ii) neurological disorders, (iii) rheumatism, (iv) cardiovascular disorders, (v) stroke, (vi) orthopedic diseases including arthrosis (grade II or higher), musculoskeletal impairment, tendinitis, tenosynovitis, myositis, prosthesis in the lower extremities, and joint replacements. Participants gave their informed consent to voluntarily participate in the present study and were randomly assigned to either the MMI or the UMI using counterbalanced randomization (allocation ratio was 1:1) by a computer-generated table of random numbers, see Fig. 1 . General Procedure All outcomes were assessed during a period of three weeks before and after the interventions, respectively. At the beginning of the measurements, participants signed the informed consent and were given the Freiburger Questionnaire on Physical Activity 32 to assess the level of physical activity. Furthermore, age, height, and weight of each participant were recorded. The complete testing procedure including the methods for recording and calculating the spatiotemporal gait parameters have been described in detail by Freitag et al. 30 . Briefly, over two consecutive days, participants performed single-tasks (at the beginning of each day) and three dual-task walking tasks at individuals’ comfort velocity over a 10 m track back and forth for 180 s, respectively. The dual-task walking tasks were conducted in a random order and in this regard, one was performed on day one and the other on day two. During dual-task walking, the participants performed three cognitive tasks: (i) reaction time task, (ii) N-back-task, and (iii) letter fluency task with two levels of difficulty, respectively. Additionally, all cognitive tasks were performed as a separate single-task to calculate DTC for cognitive performance. DTC for gait performance were calculated using the single-task and dual-task walking performance. Spatiotemporal gait parameters (stride length, gait velocity, MTC) and their respective CoV (CoV = 100 x standard deviation/mean) were assessed using inertial measurement units (XSENS MTW Awinda, Movella, Delft, Netherlands; sampling frequency 100 Hz) placed proximal on each foot and the sternum. The gait parameters were calculated using the algorithm developed by Hamacher et al. 8 . Due to the corona virus pandemic, participants were advised to wear a FFP2 face mask. Intervention Both intervention groups completed a 12-week training program with two sessions per week (i.e., a total of 24 sessions) on non-consecutive days. Each exercise session lasted 60 min and was guided by experienced instructors. The MMI was split into the following sequences: (i) motor-cognitive training based on the Life Kinetik program 33 and (ii) resistance training. The Life Kinetik program consisted of simultaneously performed motor-cognitive dual-tasks. The exercises are designed to be complex and intense enough to ensure that successful completion is unattainable. If the exercises were correctly performed in 6 out of 10 trials, the instructor continued to a more difficult exercise 33 . The training sessions included exercises such as: (i) balls with different colors (e.g., yellow, green, red) were thrown in a circle, whereby a corresponding name must be said for each color (e.g, yellow = persons own name, green = name of the person to whom the ball has to be thrown. (ii) Participants stand next to each other. After an announcement (e.g., left, right, front, back) the participants walked in the corresponding direction (line of vision remained the same, i.e., no turning of the body), whereby the corresponding name for each direction was varied (e.g., right = 1, left = 2, front = 3, back = 4). The duration of the motor-cognitive training and the resistance training varied from month to month (Table 1 ). The duration was increased and the exercises changed every month with weekly variations from the beginning of the 2th month resulting in a progressive reduction in the time for the resistance training. The UMI consisted of nine exercises. Prior to the main exercises, a 10-minute standardized warmup was performed containing fast walking and dynamic stretching of the upper and lower extremities. The resistance exercises were performed using free weights and exercise machines in a fixed order. Subjects had to perform 2 sets with 7 repetitions of each exercise using an external load (i.e., weight) that corresponded to a moderate to somewhat severe (3–4) rating on a perceived exertion (RPE) scale (Borg scale, 1–10) 34 . The exercises were metronome paced at a cadence of 30 bpm (i.e., 2 s concentric/2 s eccentric). Both interventions were completed with a cool down of 10-min static stretching for the major muscle groups (e.g., standing side stretch, standing forward fold, overhead triceps stretch). Table 1 MMI training schedule Training components Months 1st Month 2nd Month 3th Month Life Kinetik® 10 min 20 min 30 min Resistance Training 40 min 30 min 20 min Cool Down 10 min 10 min 10 min Due to the fact that this intervention was part of a larger study investigating the effects of a MMI versus UMI on visual, motor, and cognitive performance as well as structural and functional brain adaptations in glaucoma patients, all exercises were performed while sitting or standing because exercising in a supine position affects the intraocular pressure 35 , 36 , which represents a major risk factor of open angle glaucoma 37 . From the second month of the intervention period, both intervention groups trained with two training plans that were performed alternately. A detailed overview of the training program with exercise variables is provided in the Table 2 . The participants were allowed to continue with their usual physical activities. Table 2 Overview of the resistance training for the unimodal intervention and multimodal intervention throughout the intervention period. Letter in brackets indicate the major muscles involved in the exercise according to the Haff and Triplett (2016) 38 . Week Unimodal Intervention Multimodal Intervention Major Muscles Involved Weeks 1–4 1. Seated leg press (A) 2. Lever Pulldown (B) 3. Lever seated twist (C) 4. Lever chest press (D) 5. Cable curl (E) 6. Lever back extension (F) 7. Cable pushdown (G) 8. Cable upright row (H) 9. Seated leg curl (I) 1. Seated leg press (A) 2. Lever Pulldown (B) 3. Lever seated twist (C) 4. Lever chest press (D) 5. Cable curl (E) 6. Lever back extension (F) 7. Cable pushdown (G) 8. Cable upright row (H) 9. Seated leg curl (I) A. Gluteus maximus, Semimembranosus, Semitendinosus, Biceps femoris, Vastus lateralis, Vastus intermedius, Vastus medialis, Rectus femoris B. Latissimus dorsi, Teres major, Middle trapezius, Rhomboids, Posterior deltoids C. External abdominal oblique, Internal abdominal oblique D. Pectoralis major, Anterior deltoids, Triceps brachii E. Biceps brachii Brachialis, Brachioradialis F. Erector spinae G. Triceps brachii H. Deltoids, Upper trapezius I. Semimembranosus, Semitendinosus, Biceps femoris J. Vastus lateralis, Vastus intermedius, Vastus medialis, Rectus femoris K. Deltoids L. Latissimus dorsi, Triceps brachii Weeks 5–8 Day 1 1. Seated leg press (A) 2. Cable straight back seated row (B) 3. Lever seated twist (C) 4. Lever chest press (D) 5. Cable curl (E) 6. Lever back extension (F) 7. Cable pushdown (G) 8. Cable upright row (H) 9. Lever leg extension (J) 1. Seated leg press (A) 2. Cable straight back seated row (B) 3. Lever seated twist (C) 4. Lever pec dec fly (D) 5. Cable upright row (H) 6. Cable curl (E) Day 2 1. Seated leg press (A) 2. Lever pulldown (B) 3. Lever seated twist (C) 4. Lever pec dec fly (D) 5. Reverse cable curl (E) 6. Lever back extension (F) 7. Cable pushdown (G) 8. Dumbell seated lateral raise (K) 9. Seated leg curl (I) 1. Cable pushdown (G) 2. Lever pulldown (B) 3. Lever back extension (F) 4. Lever chest press (D) 5. Dumbbell seated lateral raise (K) 6. Seated leg curl (I) Weeks 9–12 Day 1 1. Seated leg press (A) 2. Cable straight back seated row (B) 3. Lever chest press (D) 4. Lever seated twist (C) 5. Cable Curl (E) 6. Dumbbell seated front raise (K) 7. Seated leg curl (I) 8. Lever back extension (F) 9. Cable pushdown (G) 1. Seated leg press (A) 2. Dumbbell seated front raise (H) 3. Reverse cable curl (E) 4. Lever chest press (D) 5. Lever seated twist (C) Day 2 1. Seated leg press (A) 2. Cable seated straight arm pulldown (L) 3. Lever seated twist (C) 4. Lever pec dec fly (D) 5. Reverse cable curl (E) 6. Seated triceps press (G) 7. Dumbbell seated lateral raise (K) 8. Lever leg extension (J) 9. Lever back extension (F) 1. Seated leg curl (I) 2. Lever pec dec fly (D) 3. Lever back extension (F) 4. Seated triceps press (G) 5. Cable seated straight arm pulldown (L) Motor and Cognitive Dual-Task Costs DTC were calculated as follows: $$\:\begin{array}{c}DTC=\frac{Single\:task-Dual\:task}{Single\:task}\times\:100\#\left(1\right)\end{array}$$ $$\:\begin{array}{c}DTC=\frac{Dual\:task-Single\:task}{Dual\:task}\times\:100\#\left(2\right)\end{array}$$ Single task and Dual task are the single- and dual-task performance, respectively. Equation \(\:\left(1\right)\) was used when a higher measurement value reflected a better performance. Otherwise, when a lower measurement value reflected a better performance, equation \(\:\left(2\right)\) was used. Hence, positive values indicate higher DTC, while negative values reflect a better Dual task performance compared with the Single task performance. Statistical Analysis Data were analyzed using the JASP Statistics (Version 0.18.1.0, University of Amsterdam, Amsterdam, Netherlands). Differences between groups in the anthropometric data were checked with independent t-tests. Since previous studies have shown repeated measures analysis of covariance (ANCOVA) to be robust against moderate violation of normality 39 , nonparametric tests were not used to check for differences. Consequently, a three-way repeated measures ANCOVA with the factors INTERVENTION (MMI vs UMI), CONDITION (single- vs dual-task), and TIME (pre vs post) was conducted. Due to differences in weight, height, and distribution of sex between groups, these variables were used as covariates. If a violation of sphericity was detected, the Greenhouse-Geisser correction was applied. To interpret the results and to clarify the practical/clinical relevance of interventional studies it is advisable to use effect sizes 40 . Thus, the effect size partial-eta squared ( \(\:{{\eta\:}}_{\text{p}}^{2}\) ) as well as Cohen’s d (d) were calculated and interpreted according to Lakens 40 : small ( \(\:{{\eta\:}}_{\text{p}}^{2}\) ≥ 0.01, d ≥ 0.2), medium ( \(\:{{\eta\:}}_{\text{p}}^{2}\) ≥ 0.06, d ≥ 0.5), and large ( \(\:{{\eta\:}}_{\text{p}}^{2}\) ≥ 0.14, d ≥ 0.8). In case of TIME x INTERVENTION x CONITION or TIME x INTERVENTION effects as well main effects of TIME, Bonferroni-corrected post-hoc tests were performed. In case of large main effects, the results were interpreted as relevant if \(\:{{\eta\:}}_{\text{p}}^{2}\) ≥ 0.14 or d ≥ 0.8. Due to pilot character of the present study, a post-hoc power and sample size calculation, based on the observed effect sizes, was conducted (G*Power 3.1.9.7, Heinrich Heine University Düsseldorf, Düsseldorf, Germany) to provide data on sufficient sample sizes for future randomized controlled trials. In addition, a two-way repeated ANOVA was performed with the factors INTERVENTION (MMI vs UMI) and TIME (first, second, and third month) to analyze the progression of the external load during the resistance training (i.e., leg press, leg extension, seated leg curls) as an indirect marker of neuromuscular adaptations, which could have an impact especially on the spatiotemporal gait parameters. The external load per exercise was averaged over each month. Results Characteristics of participants In total, 29 healthy participants were recruited. Fifteen participants (11 females, age: 72.0 ± 5.5 years, height: 161.0 ± 5.8 cm, body mass: 68.0 ± 13.8 kg) received the MMI and 14 participants (6 females, age: 70.1 ± 4.7 years, height: 174.5 ± 8.1 cm, body mass: 83.1 ± 18.7 kg) received the UMI. The Freiburger Questionnaire on Physical Activity 32 indicated that overall physical activity was on average 12 h for the MMI group and 14.7 h per week for the UMI group. All participants had an attendance rate of at least 80%. Due to dropouts only data from 24 participants (11 MMI, 13 UMI) were included in the final analysis. Due to processing issues regarding the MTC and the MTC CoV , only 23 participants (10 MMU, 13 UMI) were included in the final analysis. Furthermore, due to technical issues during the single-task walking trial at baseline measurement only 23 participants (11 MMI, 12 UMI) were included intro the final DTC analysis. The results of the post-hoc power and sample size calculations are presented in supplementary Table A and B). An overview of all parameters including the p-values and effect sizes is presented in supplementary Tables C-E). Outcome measures No relevant interactions and main effects were found for gait velocity, stride length, MTC, and their respective CoVs (Supplementary table C) as well as for cognitive performance (Supplementary table E). Based on the effect sizes, there was a main effect of TIME for DTC MTC (F(1,17) = 4.070, p = 0.060, \(\:{{\eta\:}}_{\text{p}}^{2}\) = 0.193) and DTC MTC CoV (F(1,17) = 3.203, p = 0.091, \(\:{{\eta\:}}_{\text{p}}^{2}\) = 0.159), but post-hoc analysis showed no difference between baseline and post assessment for all variables (d < 0.8) (Supplementary table D). The analysis of the external load progression showed no TIME x INTERVENTION interaction for all three exercises. However, TIME effects were detected for leg press (F(1.24,29.91) = 38.89, p < 0.001, \(\:{{\eta\:}}_{\text{p}}^{2}\) = 0.618), leg extension (F(1,10) = 2.030, p = 0.185, \(\:{{\eta\:}}_{\text{p}}^{2}\) = 0.169), and seated leg curls (F(1.340,32.17) = 23.933, p < 0.001, \(\:{{\eta\:}}_{\text{p}}^{2}\) = 0.499). Post-hoc analysis showed a significant increase in external load over the three months for the leg press: 1st and 2nd month (p < 0.001, d = 0.482, mean difference = 7.915, 95% CI = 11.216–7.915%, 95% CI for d = -0.209–0.754%), 2nd and 3rd month (p < 0.032, d = 0.216, mean difference = 3.545, 95% CI = 6.846–3.545%, 95% CI for d = 0.006–0.437). Furthermore, the post-hoc analysis showed an increase in external load between the 1st and 2nd months for the leg curl (p 0.05, d < 0.8). Discussion The present pilot-study investigated the effect of a 12-week MMI versus UMI on spatiotemporal gait parameters recorded during single- and dual-task walking as well as cognitive performance in healthy older adults. Contrary to our hypothesis, both training interventions failed to improve gait parameters, their respective CoVs, cognitive performance as well as motor and cognitive DTC. Nevertheless, both interventions provoked progress regarding the external load during the training period indicating increased strength capabilities due to training-induced neuromuscular adaptations. To the knowledge of the authors, no previous study has investigated the influence of a comparable MMI on gait performance, cognitive performance, as well as motor and cognitive DTC in healthy elderly participants. In this context, Wollesen et al. 41 showed that a progressive stand-alone resistance training and dual-task training (e.g. fast walking in combination with visual and balance tasks, 12 sessions, 60 min, 12 weeks) led to an improved gait performance in healthy elderly participants (i.e., increased step length). Furthermore, Singh et al. 42 demonstrated that a resistance training (2–3 days/week, 75 min, 24 weeks) increased cognitive performance in patients with mild cognitive impairment. Moreover, Castano et al. 43 showed that combining resistance training with a verbal fluency task (2 days/week, 60 min, 16 weeks) enhanced plasma brain-derived neurotrophic factor level, which is associated with cognitive performance, compared to traditional resistance training in healthy elderly participants. The results of the present study revealed that none of the two interventions positively influenced gait or cognitive performance. This finding is surprising as positive intervention effects on the dependent variables were expected for both the MMI and the UMI in healthy elderly. It could be assumed that the external load used during resistance training, which was prescribed based on the RPE, was too low to induce neuromuscular adaptations translating in an improvement in gait performance 6 . Of note, this exercise intensity was deliberately chosen because the present study was part of a larger randomized controlled trial investigating the effect of a MMI compared to a UMI in glaucoma patients, for which this approach was selected to keep intraocular pressure low 44 . Nevertheless, the analysis of the training progression using the external load data revealed an increase in external load over the three months period indicating neuromuscular adaptations. Although this analysis is only a crude measure of training-related strength increases, the potential neuromuscular adaptations have not led to improvements in gait performance. In this regard, it should also be considered that the MMI group and the UMI group had a high physical activity (12 h/week and 14.8 h/week, respectively), which is above the average compared to the same age (≥ 70 years, 9.9 h/per week 32 ). Speculatively, the absence of improvements in gait performance due to the resistance training in both intervention groups seems to follow the law of diminishing returns, i.e., when total physical activity increases, adaptation decreases 45 . Interestingly, Hamacher 13 and colleagues have shown that a six-month dancing program significantly reduced the MTC CoV compared to a combined exercises intervention (e.g., endurance training, strength training, flexibility training) in older adults. This finding might be related to the fact that dancing requires the incorporation of cognitive demands into the motor task 46 . In contrast, in the Life Kinetik program, the cognitive tasks are used as distractor (additional) during the motor tasks and are thus not directly relevant for motor task completion 24 . Consequently exercises in which the cognitive task is a prerequisite for the motor task execution, might be better suited to improve gait performance compared to exercises using the cognitive task as a distractor during the motor task 24 . The present study has some limitations. First, single-task walking was always conducted before dual-task walking, which might have promoted sequential effects. However, the possible sequential effects were systematic as well as stable and might therefore have not affect group comparisons. Second, the sensitivity of the calculated gait parameters might be too low to detect differences in the dependent variables in our healthy elderly cohort. For instance, Kulmala et al. (2014) have shown that joint power of the lower extremities during walking are affected by age and shift from distal to proximal 47 . Therefore, it might be possible that other gait measures are more sensitive to the interventions used in healthy elderly people. However, it was shown that the calculated gait parameters are sensitive to differentiate between glaucoma patients and healthy controls (e.g., slower gait velocity 48 and higher MTC CoV 30 in glaucoma patients). Third, the lack of improvements in gait performance might be due to a lack of isolated training of the triceps surae muscle, which is essential for plantar flexion and propulsive torque production during walking 49 , 50 . This muscle group is also affected by the aging process resulting in shorter steps and a higher power production in the hip and knee joints 47 . Moreover, the triceps surae muscle is also important for remaining gait stability after stumbling 51 . Therefore, an increase in exercises dedicated to the plantar flexors is warranted, which might lead to positive changes in gait performance 49 – 51 . Fourth, due to the Covid-19 pandemic the number of participants was relatively low 52 and, therefore, a profound interpretation of the results is complicated. However, the present study was conducted as pilot study and provides a positive glimpse of the effects of the used MMI. Thus, future studies should consider the provided sample size calculations to substantiate the present results. In conclusion, the present study showed that neither a 12-week MMI nor UMI seems to have relevant impact on specific gait parameters (i.e., stride length, gait velocity, MTC) or their respective CoVs in physically active healthy elderly participants. Abbreviations ANCOVA: analysis of covariance CoV: coefficient of variation DT: dual task DTC: dual-task costs Hz: Herz MMI: multimodal Intervention MTC: minimum toe clearance ST: single task UMI: unimodal intervention 95% CI: 95% confidence interval Declarations Ethics approval and consent to participate The study was carried out in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University Medical Faculty Magdeburg (32/18). All participants signed the informed consent form before participating in this study. Consent for publication N/A Availability of data and materials Data are available on reasonable request to the corresponding author. Competing interests The authors declare that they have no competing interests. Funding Supported by funding of the German Research Foundation (DFG; #423926179) to MBH (HO-2002/20-1) & LS (SCHE 1584/5-1). Clinical trial number German Clinical Trial Register, ID: DRKS00022519/05.08.2020, https://drks.de/search/de/trial/DRKS00022519 Authors' contributions MH and LS contributed to conception and design of the study. CF, FS, GP, RB and KA carried out the experiment. CF performed the data analysis. CF and MB contributed to the acquisition and interpretation of the data. CF contributed to the manuscript drafting with support from MB, RB, TB and LS. HT, MH, FS, GP, RB, KA contributed to the review of the final manuscript. All authors have read and approved the submitted version of the manuscript. Acknowledgements The authors thank all the participants for their participation in the present study. References Izquierdo, M. et al. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. The journal of nutrition, health & aging 25, 824–853; 10.1007/s12603-021-1665-8 (2021). Clark, B. C. & Manini, T. M. What is dynapenia? Nutrition (Burbank, Los Angeles County, Calif.) 28, 495–503; 10.1016/j.nut.2011.12.002 (2012). Mau-Moeller, A., Behrens, M., Lindner, T., Bader, R. & Bruhn, S. Age-related changes in neuromuscular function of the quadriceps muscle in physically active adults. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology 23, 640–648; 10.1016/j.jelekin.2013.01.009 (2013). Cohen, J. A., Verghese, J. & Zwerling, J. L. Cognition and gait in older people. 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M. Influence of Sequential vs. Simultaneous Dual-Task Exercise Training on Cognitive Function in Older Adults. Frontiers in aging neuroscience 9, 368; 10.3389/fnagi.2017.00368 (2017). Bliss, E. S., Wong, R. H. X., Howe, P. R. C. & Mills, D. E. Benefits of exercise training on cerebrovascular and cognitive function in ageing. J Cereb Blood Flow Metab 41, 447–470; 10.1177/0271678X20957807 (2021). Lauenroth, A., Ioannidis, A. E. & Teichmann, B. Influence of combined physical and cognitive training on cognition: a systematic review. BMC Geriatr 16, 141; 10.1186/s12877-016-0315-1 (2016). Law, L. L. F., Barnett, F., Yau, M. K. & Gray, M. A. Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review. Ageing Research Reviews 15, 61–75; 10.1016/j.arr.2014.02.008 (2014). Freitag, C. W. et al. Single- and Dual-Task Gait Performance in Patients With Open-Angle Glaucoma: A Cross-sectional Study. Translational vision science & technology 12, 31; 10.1167/tvst.12.11.31 (2023). Eldridge, S. M. et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ (Clinical research ed.) 355, i5239; 10.1136/bmj.i5239 (2016). Frey, I., Berg, A., Grathwohl, D. & Keul, J. Freiburger Fragebogen zur körperlichen Aktivität--Entwicklung, Prüfung und Anwendung. Sozial- und Praventivmedizin 44, 55–64; 10.1007/BF01667127 (1999). Lutz, H. Life Kinetik®. Gehirntraining durch Bewegung. 8th ed. (BLV, München, 2021). Pageaux, B. Perception of effort in Exercise Science: Definition, measurement and perspectives. European journal of sport science 16, 885–894; 10.1080/17461391.2016.1188992 (2016). Lara, P. M. et al. Influence of the body positions adopted for resistance training on intraocular pressure: a comparison between the supine and seated positions. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie 261, 1971–1978; 10.1007/s00417-023-06009-0 (2023). Najmanová, E., Pluháček, F. & Haklová, M. Intraocular pressure response affected by changing of sitting and supine positions. Acta ophthalmologica 98, e368-e372; 10.1111/aos.14267 (2020). European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition. British Journal of Ophthalmology 105, 1–169; 10.1136/bjophthalmol-2021-egsguidelines (2021). Essentials of Strength Training and Conditioning, 4th Edition. Medicine & Science in Sports & Exercise 48, 2073; 10.1249/MSS.0000000000001081 (2016). Vickers, A. J. Parametric versus non-parametric statistics in the analysis of randomized trials with non-normally distributed data. BMC medical research methodology 5, 35; 10.1186/1471-2288-5-35 (2005). Lakens, D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in psychology 4, 863; 10.3389/fpsyg.2013.00863 (2013). Wollesen, B. et al. Effects of Dual-Task Management and Resistance Training on Gait Performance in Older Individuals: A Randomized Controlled Trial. Frontiers in aging neuroscience 9, 415; 10.3389/fnagi.2017.00415 (2017). Fiatarone Singh, M. A. et al. The Study of Mental and Resistance Training (SMART) study—resistance training and/or cognitive training in mild cognitive impairment: a randomized, double-blind, double-sham controlled trial. Journal of the American Medical Directors Association 15, 873–880; 10.1016/j.jamda.2014.09.010 (2014). Castaño, L. A. A. et al. Resistance Training Combined With Cognitive Training Increases Brain Derived Neurotrophic Factor and Improves Cognitive Function in Healthy Older Adults. Frontiers in psychology 13, 870561; 10.3389/fpsyg.2022.870561 (2022). Ong, S. R., Crowston, J. G., Loprinzi, P. D. & Ramulu, P. Y. Physical activity, visual impairment, and eye disease. Eye (London, England) 32, 1296–1303; 10.1038/s41433-018-0081-8 (2018). McMaster, D. T., Gill, N., Cronin, J. & McGuigan, M. The development, retention and decay rates of strength and power in elite rugby union, rugby league and American football: a systematic review. Sports Med 43, 367–384; 10.1007/s40279-013-0031-3 (2013). Hamacher, D., Hamacher, D., Rehfeld, K. & Schega, L. Motor-cognitive dual-task training improves local dynamic stability of normal walking in older individuals. Clinical biomechanics (Bristol, Avon) 32, 138–141; 10.1016/j.clinbiomech.2015.11.021 (2016). Kulmala, J.-P. et al. Which muscles compromise human locomotor performance with age? Journal of the Royal Society, Interface 11, 20140858; 10.1098/rsif.2014.0858 (2014). Lee, H.-S. et al. Gait characteristics during crossing over obstacle in patients with glaucoma using insole foot pressure. Medicine 100, e26938; 10.1097/MD.0000000000026938 (2021). Burke, R. et al. Exercise Selection Differentially Influences Lower Body Regional Muscle Development. J. of SCI. IN SPORT AND EXERCISE ; 10.1007/s42978-024-00299-4 (2024). Kinoshita, M. et al. Triceps surae muscle hypertrophy is greater after standing versus seated calf-raise training. Frontiers in physiology 14, 1272106; 10.3389/fphys.2023.1272106 (2023). Pijnappels, M., Bobbert, M. F. & van Dieën, J. H. Control of support limb muscles in recovery after tripping in young and older subjects. Exp Brain Res 160, 326–333; 10.1007/s00221-004-2014-y (2005). Xue, J. Z. et al. Clinical trial recovery from COVID-19 disruption. Nature reviews. Drug discovery 19, 662–663; 10.1038/d41573-020-00150-9 (2020). Additional Declarations No competing interests reported. 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Al-Nosairy","email":"","orcid":"","institution":"Ophthalmic Department, University Hospitals Magdeburg","correspondingAuthor":false,"prefix":"","firstName":"Khaldoon","middleName":"O.","lastName":"Al-Nosairy","suffix":""},{"id":413184054,"identity":"d7d9af6b-645e-4fe0-9ef4-d526d7116596","order_by":5,"name":"Francie H. Stolle","email":"","orcid":"","institution":"Ophthalmic Department, University Hospitals Magdeburg","correspondingAuthor":false,"prefix":"","firstName":"Francie","middleName":"H.","lastName":"Stolle","suffix":""},{"id":413184055,"identity":"41183348-ddbb-497c-802e-1cdce45295f0","order_by":6,"name":"Gokulraj T. Prabhakaran","email":"","orcid":"","institution":"Ophthalmic Department, University Hospitals Magdeburg","correspondingAuthor":false,"prefix":"","firstName":"Gokulraj","middleName":"T.","lastName":"Prabhakaran","suffix":""},{"id":413184056,"identity":"0fbb64ee-299e-4e65-a82d-867594d2dc08","order_by":7,"name":"Rosalie Beyer","email":"","orcid":"","institution":"Ophthalmic Department, University Hospitals Magdeburg","correspondingAuthor":false,"prefix":"","firstName":"Rosalie","middleName":"","lastName":"Beyer","suffix":""},{"id":413184057,"identity":"db11aa15-d488-4f7c-88ea-5f10b120c6b2","order_by":8,"name":"Hagen Thieme","email":"","orcid":"","institution":"Ophthalmic Department, University Hospitals Magdeburg","correspondingAuthor":false,"prefix":"","firstName":"Hagen","middleName":"","lastName":"Thieme","suffix":""},{"id":413184058,"identity":"f0e57db1-41c8-4a51-9a3b-a58deb9afa55","order_by":9,"name":"Michael Hoffmann","email":"","orcid":"","institution":"Ophthalmic Department, University Hospitals Magdeburg","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Hoffmann","suffix":""},{"id":413184059,"identity":"921aae6f-075a-4019-ba6c-ae7f3abe666c","order_by":10,"name":"Lutz Schega","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBACPiidAMSMDxBsPICNgRmujNmAZC1sEsRpkcg//IHhj10eP//iZxUf22oTG9iTDxDQksxgwNiWXCw545nZzZltxxMbeJ7htwakJYGx4UDihhsHzG7znDmW2CCRY0BQywGGPwcS9984/q0YoiX/AyEtjA0MbEBb+HvMmHkqakC24NXBwMbz2JghsS05ccYNHqB/Kg4Yt/E8w+8wfvbExx8+/LFL7O8/vvHDB4M62X725Af4rQGBBBAhASYPA2OKaMB/AETWEa9hFIyCUTAKRgwAAMRhSAUJoZmGAAAAAElFTkSuQmCC","orcid":"","institution":"Otto-von-Guericke University Magdeburg","correspondingAuthor":true,"prefix":"","firstName":"Lutz","middleName":"","lastName":"Schega","suffix":""}],"badges":[],"createdAt":"2025-01-27 08:08:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5910496/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5910496/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-025-06537-w","type":"published","date":"2025-11-04T15:58:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75896528,"identity":"54d661f5-f3cf-44d6-a5ed-f447dc8bcf18","added_by":"auto","created_at":"2025-02-10 10:35:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":298083,"visible":true,"origin":"","legend":"\u003cp\u003eStudy schedule of enrollment, intervention and assessments\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5910496/v1/3cf1ce99c8ae549e9e058862.png"},{"id":95564104,"identity":"5fa2b93e-4539-4c39-acf0-2e483505cd44","added_by":"auto","created_at":"2025-11-10 16:07:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1135325,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5910496/v1/e8b61b4e-b3ac-419a-8671-39a055c39f1e.pdf"},{"id":75898012,"identity":"7f1d0c81-a9fc-45bd-af5a-ef392ebe1a26","added_by":"auto","created_at":"2025-02-10 10:43:42","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":125024,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-5910496/v1/99102981457f649dcd2a95ba.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Neither uni- nor multi-modal exercise interventions improve single- and dual-task gait performance in physically active healthy elderly – a pilot study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAging is a continuous process resulting in, inter alia, skeletal muscle atrophy (sarcopenia)\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e and a reduction in neural drive to the muscles finally causing a decline in maximal and explosive muscle strength (dynapenia)\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and function. Moreover, aging might impair cognitive function and potentially lead decreasing executive functions\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Both age-related decline in strength and cognitive function can affect daily activities by deteriorating gait performance and increasing the risk of falls\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, a major cause of injuries in the elderly\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSeveral spatiotemporal gait parameters, such as stride length, gait velocity, and gait variability measures have been shown to be predictive for the risk of falls\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. In particular, minimum toe clearance (MTC) appears to be a promising marker for evaluating motor control during walking and perhaps the risk of falling in older adults\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. The MTC describes the smallest distance between the ground and toe during the mid-swing phase of the gait cycle\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and the lower the MTC and the larger its variability, the higher the risk of sustaining a fall\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Gait performance, i.e., motor control during walking, is often evaluated during motor-cognitive dual-task walking\u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, which is characterized by performing a concurrent cognitive task during walking and often results in an increased gait variability\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The worsening of gait performance might be attributable to the reduced processing capacity for the motor task (central capacity sharing model) and/or the sequential neural processing of the motor and cognitive interference task (bottleneck model)\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Consequently, performance in at least one task diminishes, e.g., gait performance, a phenomenon known as dual-task costs (DTC). This is of particular importance, given that daily activities often require multitasking, such as walking while thinking, texting, or phoning. Importantly, a lower motor-cognitive dual-task walking performance, i.e., higher DTC, is related to a higher risk of falling\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSince falls can lead to fear of future falls\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, a loop of physical inactivity might begin promoting sarcopenia, dynapenia, as well as cognitive dysfunction\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, and thus, increasing the risk of falling. To counteract this, resistance training promises a suitable interventional strategy that has been shown to increase postural control and gait performance in older adults\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Furthermore, resistance training might also have positive effects on cognitive performance\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurther, there is evidence that motor-cognitive dual-task training (i.e., the concurrent execution of motor and cognitive tasks)\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e elicits structural and functional changes in the aging brain, which were associated with an improved cognitive performance\u003csup\u003e\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Although the evidence is inconclusive, concurrent training of motor and cognitive tasks might be a more promising approach for enhancing cognitive performance compared with single motor or cognitive training\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Given that both, the age-related decline in strength and cognitive performance, can impact on gait performance, a multimodal intervention (MMI) combining resistance training and motor-cognitive dual-task training\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e could be more effective in reducing the risk of falls than resistance training alone.\u003c/p\u003e \u003cp\u003eAs far as the authors of the present study are aware, there is no experimental trial that has investigated the effect of motor-cognitive dual-task training directly followed by a resistance training on gait and cognitive performance in healthy elderly. Therefore, the present study compared the influence of a 12-week MMI (motor-cognitive dual-task training\u0026thinsp;+\u0026thinsp;resistance training) and a unimodal intervention (UMI, stand-alone resistance training, twice a week, lasting 60 min each, 24 training sessions in total) on gait performance and cognitive performance in healthy old adults. For that purpose, gait parameters (i.e., stride length, gait velocity, MTC), and their respective coefficient of variation (CoV)\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e were recorded during single-task and motor-cognitive dual-task walking before and after the training intervention. Additionally, the DTC (relative changes between single-task and dual-task performance) were calculated to assess the cognitive demands during walking \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIt was hypothesized that the MMI leads to higher improvements in gait performance, especially during dual-task walking, and cognitive performance compared to UMI. Furthermore, a decrease in DTC was expected after the MMI.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis two-arm randomized controlled pilot study was conducted from August 2020 to December 2022. The interventions and measurements were performed in the laboratories of the Sport Science Department at the Otto von Guericke University Magdeburg. The study was carried out in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University Medical Faculty Magdeburg (32/18). Reporting was performed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) Statement for randomized pilot trials\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. The data presented in this article are part of a larger study investigating the effects of a MMI versus UMI on visual, motor, and cognitive performance as well as structural and functional brain adaptations in glaucoma patients and healthy controls (German Clinical Trial Register, ID: DRKS00022519/05.08.2020, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://drks.de/search/de/trial/DRKS00022519\u003c/span\u003e\u003cspan address=\"https://drks.de/search/de/trial/DRKS00022519\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). All participants signed the informed consent form before participating in this study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eParticipants were eligible when they met the following inclusion criteria: (i) age\u0026thinsp;\u0026ge;\u0026thinsp;60 and (ii) the ability to walk at least six minutes without support. Exclusion criteria were defined as follows: (i) eye diseases/surgeries affecting visual function, (ii) neurological disorders, (iii) rheumatism, (iv) cardiovascular disorders, (v) stroke, (vi) orthopedic diseases including arthrosis (grade II or higher), musculoskeletal impairment, tendinitis, tenosynovitis, myositis, prosthesis in the lower extremities, and joint replacements. Participants gave their informed consent to voluntarily participate in the present study and were randomly assigned to either the MMI or the UMI using counterbalanced randomization (allocation ratio was 1:1) by a computer-generated table of random numbers, see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eGeneral Procedure\u003c/h3\u003e\n\u003cp\u003eAll outcomes were assessed during a period of three weeks before and after the interventions, respectively. At the beginning of the measurements, participants signed the informed consent and were given the Freiburger Questionnaire on Physical Activity\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e to assess the level of physical activity. Furthermore, age, height, and weight of each participant were recorded. The complete testing procedure including the methods for recording and calculating the spatiotemporal gait parameters have been described in detail by Freitag et al.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Briefly, over two consecutive days, participants performed single-tasks (at the beginning of each day) and three dual-task walking tasks at individuals\u0026rsquo; comfort velocity over a 10 m track back and forth for 180 s, respectively. The dual-task walking tasks were conducted in a random order and in this regard, one was performed on day one and the other on day two.\u003c/p\u003e \u003cp\u003e During dual-task walking, the participants performed three cognitive tasks: (i) reaction time task, (ii) N-back-task, and (iii) letter fluency task with two levels of difficulty, respectively. Additionally, all cognitive tasks were performed as a separate single-task to calculate DTC for cognitive performance. DTC for gait performance were calculated using the single-task and dual-task walking performance.\u003c/p\u003e \u003cp\u003eSpatiotemporal gait parameters (stride length, gait velocity, MTC) and their respective CoV (CoV\u0026thinsp;=\u0026thinsp;100 x standard deviation/mean) were assessed using inertial measurement units (XSENS MTW Awinda, Movella, Delft, Netherlands; sampling frequency 100 Hz) placed proximal on each foot and the sternum. The gait parameters were calculated using the algorithm developed by Hamacher et al.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Due to the corona virus pandemic, participants were advised to wear a FFP2 face mask.\u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eBoth intervention groups completed a 12-week training program with two sessions per week (i.e., a total of 24 sessions) on non-consecutive days. Each exercise session lasted 60 min and was guided by experienced instructors.\u003c/p\u003e \u003cp\u003eThe MMI was split into the following sequences: (i) motor-cognitive training based on the Life Kinetik program\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e and (ii) resistance training. The Life Kinetik program consisted of simultaneously performed motor-cognitive dual-tasks. The exercises are designed to be complex and intense enough to ensure that successful completion is unattainable. If the exercises were correctly performed in 6 out of 10 trials, the instructor continued to a more difficult exercise\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. The training sessions included exercises such as: (i) balls with different colors (e.g., yellow, green, red) were thrown in a circle, whereby a corresponding name must be said for each color (e.g, yellow\u0026thinsp;=\u0026thinsp;persons own name, green\u0026thinsp;=\u0026thinsp;name of the person to whom the ball has to be thrown. (ii) Participants stand next to each other. After an announcement (e.g., left, right, front, back) the participants walked in the corresponding direction (line of vision remained the same, i.e., no turning of the body), whereby the corresponding name for each direction was varied (e.g., right\u0026thinsp;=\u0026thinsp;1, left\u0026thinsp;=\u0026thinsp;2, front\u0026thinsp;=\u0026thinsp;3, back\u0026thinsp;=\u0026thinsp;4). The duration of the motor-cognitive training and the resistance training varied from month to month (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The duration was increased and the exercises changed every month with weekly variations from the beginning of the 2th month resulting in a progressive reduction in the time for the resistance training.\u003c/p\u003e \u003cp\u003eThe UMI consisted of nine exercises. Prior to the main exercises, a 10-minute standardized warmup was performed containing fast walking and dynamic stretching of the upper and lower extremities. The resistance exercises were performed using free weights and exercise machines in a fixed order. Subjects had to perform 2 sets with 7 repetitions of each exercise using an external load (i.e., weight) that corresponded to a moderate to somewhat severe (3\u0026ndash;4) rating on a perceived exertion (RPE) scale (Borg scale, 1\u0026ndash;10)\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. The exercises were metronome paced at a cadence of 30 bpm (i.e., 2 s concentric/2 s eccentric).\u003c/p\u003e \u003cp\u003eBoth interventions were completed with a cool down of 10-min static stretching for the major muscle groups (e.g., standing side stretch, standing forward fold, overhead triceps stretch).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMMI training schedule\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTraining components\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMonths\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st Month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2nd Month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3th Month\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLife Kinetik\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 min\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResistance Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 min\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCool Down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 min\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDue to the fact that this intervention was part of a larger study investigating the effects of a MMI versus UMI on visual, motor, and cognitive performance as well as structural and functional brain adaptations in glaucoma patients, all exercises were performed while sitting or standing because exercising in a supine position affects the intraocular pressure\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, which represents a major risk factor of open angle glaucoma\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. From the second month of the intervention period, both intervention groups trained with two training plans that were performed alternately. A detailed overview of the training program with exercise variables is provided in the Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The participants were allowed to continue with their usual physical activities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of the resistance training for the unimodal intervention and multimodal intervention throughout the intervention period. Letter in brackets indicate the major muscles involved in the exercise according to the Haff and Triplett (2016)\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWeek\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnimodal Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultimodal Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMajor Muscles Involved\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeeks 1\u0026ndash;4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Seated leg press (A)\u003c/p\u003e \u003cp\u003e2. Lever Pulldown (B)\u003c/p\u003e \u003cp\u003e3. Lever seated twist (C)\u003c/p\u003e \u003cp\u003e4. Lever chest press (D)\u003c/p\u003e \u003cp\u003e5. Cable curl (E)\u003c/p\u003e \u003cp\u003e6. Lever back extension (F)\u003c/p\u003e \u003cp\u003e7. Cable pushdown (G)\u003c/p\u003e \u003cp\u003e8. Cable upright row (H)\u003c/p\u003e \u003cp\u003e9. Seated leg curl (I)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Seated leg press (A)\u003c/p\u003e \u003cp\u003e2. Lever Pulldown (B)\u003c/p\u003e \u003cp\u003e3. Lever seated twist (C)\u003c/p\u003e \u003cp\u003e4. Lever chest press (D)\u003c/p\u003e \u003cp\u003e5. Cable curl (E)\u003c/p\u003e \u003cp\u003e6. Lever back extension (F)\u003c/p\u003e \u003cp\u003e7. Cable pushdown (G)\u003c/p\u003e \u003cp\u003e8. Cable upright row (H)\u003c/p\u003e \u003cp\u003e9. Seated leg curl (I)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eA. Gluteus maximus, Semimembranosus, Semitendinosus, Biceps femoris, Vastus lateralis, Vastus intermedius, Vastus medialis, Rectus femoris\u003c/p\u003e \u003cp\u003eB. Latissimus dorsi, Teres major, \u003c/p\u003e \u003cp\u003eMiddle trapezius, Rhomboids, Posterior deltoids\u003c/p\u003e \u003cp\u003eC. External abdominal oblique,\u003c/p\u003e \u003cp\u003eInternal abdominal oblique\u003c/p\u003e \u003cp\u003eD. Pectoralis major,\u003c/p\u003e \u003cp\u003eAnterior deltoids,\u003c/p\u003e \u003cp\u003eTriceps brachii\u003c/p\u003e \u003cp\u003eE. Biceps brachii\u003c/p\u003e \u003cp\u003eBrachialis,\u003c/p\u003e \u003cp\u003eBrachioradialis\u003c/p\u003e \u003cp\u003eF. Erector spinae\u003c/p\u003e \u003cp\u003eG. Triceps brachii\u003c/p\u003e \u003cp\u003eH. Deltoids, \u003c/p\u003e \u003cp\u003eUpper trapezius\u003c/p\u003e \u003cp\u003eI. Semimembranosus, Semitendinosus, Biceps femoris\u003c/p\u003e \u003cp\u003eJ. Vastus lateralis, Vastus intermedius, Vastus medialis, Rectus femoris\u003c/p\u003e \u003cp\u003eK. Deltoids\u003c/p\u003e \u003cp\u003eL. Latissimus dorsi, Triceps brachii\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWeeks 5\u0026ndash;8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDay 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Seated leg press (A)\u003c/p\u003e \u003cp\u003e2. Cable straight back seated row (B)\u003c/p\u003e \u003cp\u003e3. Lever seated twist (C)\u003c/p\u003e \u003cp\u003e4. Lever chest press (D)\u003c/p\u003e \u003cp\u003e5. Cable curl (E)\u003c/p\u003e \u003cp\u003e6. Lever back extension (F)\u003c/p\u003e \u003cp\u003e7. Cable pushdown (G)\u003c/p\u003e \u003cp\u003e8. Cable upright row (H)\u003c/p\u003e \u003cp\u003e9. Lever leg extension (J)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Seated leg press (A)\u003c/p\u003e \u003cp\u003e2. Cable straight back seated row (B)\u003c/p\u003e \u003cp\u003e3. Lever seated twist (C)\u003c/p\u003e \u003cp\u003e4. Lever pec dec fly (D)\u003c/p\u003e \u003cp\u003e5. Cable upright row (H)\u003c/p\u003e \u003cp\u003e6. Cable curl (E)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDay 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Seated leg press (A)\u003c/p\u003e \u003cp\u003e2. Lever pulldown (B)\u003c/p\u003e \u003cp\u003e3. Lever seated twist (C)\u003c/p\u003e \u003cp\u003e4. Lever pec dec fly (D)\u003c/p\u003e \u003cp\u003e5. Reverse cable curl (E)\u003c/p\u003e \u003cp\u003e6. Lever back extension (F)\u003c/p\u003e \u003cp\u003e7. Cable pushdown (G)\u003c/p\u003e \u003cp\u003e8. Dumbell seated lateral raise (K)\u003c/p\u003e \u003cp\u003e9. Seated leg curl (I)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Cable pushdown (G)\u003c/p\u003e \u003cp\u003e2. Lever pulldown (B)\u003c/p\u003e \u003cp\u003e3. Lever back extension (F)\u003c/p\u003e \u003cp\u003e4. Lever chest press (D)\u003c/p\u003e \u003cp\u003e5. Dumbbell seated lateral raise (K)\u003c/p\u003e \u003cp\u003e6. Seated leg curl (I)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWeeks 9\u0026ndash;12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDay 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Seated leg press (A)\u003c/p\u003e \u003cp\u003e2. Cable straight back seated row (B)\u003c/p\u003e \u003cp\u003e3. Lever chest press (D)\u003c/p\u003e \u003cp\u003e4. Lever seated twist (C)\u003c/p\u003e \u003cp\u003e5. Cable Curl (E)\u003c/p\u003e \u003cp\u003e6. Dumbbell seated front raise (K)\u003c/p\u003e \u003cp\u003e7. Seated leg curl (I)\u003c/p\u003e \u003cp\u003e8. Lever back extension (F)\u003c/p\u003e \u003cp\u003e9. Cable pushdown (G)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Seated leg press (A)\u003c/p\u003e \u003cp\u003e2. Dumbbell seated front raise (H)\u003c/p\u003e \u003cp\u003e3. Reverse cable curl (E)\u003c/p\u003e \u003cp\u003e4. Lever chest press (D)\u003c/p\u003e \u003cp\u003e5. Lever seated twist (C)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDay 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Seated leg press (A)\u003c/p\u003e \u003cp\u003e2. Cable seated straight arm pulldown (L)\u003c/p\u003e \u003cp\u003e3. Lever seated twist (C)\u003c/p\u003e \u003cp\u003e4. Lever pec dec fly (D)\u003c/p\u003e \u003cp\u003e5. Reverse cable curl (E)\u003c/p\u003e \u003cp\u003e6. Seated triceps press (G)\u003c/p\u003e \u003cp\u003e7. Dumbbell seated lateral raise (K)\u003c/p\u003e \u003cp\u003e8. Lever leg extension (J)\u003c/p\u003e \u003cp\u003e9. Lever back extension (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Seated leg curl (I)\u003c/p\u003e \u003cp\u003e2. Lever pec dec fly (D)\u003c/p\u003e \u003cp\u003e3. Lever back extension (F)\u003c/p\u003e \u003cp\u003e4. Seated triceps press (G)\u003c/p\u003e \u003cp\u003e5. Cable seated straight arm pulldown (L)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eMotor and Cognitive Dual-Task Costs\u003c/h3\u003e\n\u003cp\u003eDTC were calculated as follows:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\begin{array}{c}DTC=\\frac{Single\\:task-Dual\\:task}{Single\\:task}\\times\\:100\\#\\left(1\\right)\\end{array}$$\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:\\begin{array}{c}DTC=\\frac{Dual\\:task-Single\\:task}{Dual\\:task}\\times\\:100\\#\\left(2\\right)\\end{array}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSingle task and Dual task are the single- and dual-task performance, respectively. Equation \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\left(1\\right)\\)\u003c/span\u003e\u003c/span\u003e was used when a higher measurement value reflected a better performance. Otherwise, when a lower measurement value reflected a better performance, equation \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\left(2\\right)\\)\u003c/span\u003e\u003c/span\u003e was used. Hence, positive values indicate higher DTC, while negative values reflect a better Dual task performance compared with the Single task performance.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using the JASP Statistics (Version 0.18.1.0, University of Amsterdam, Amsterdam, Netherlands). Differences between groups in the anthropometric data were checked with independent t-tests. Since previous studies have shown repeated measures analysis of covariance (ANCOVA) to be robust against moderate violation of normality\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e, nonparametric tests were not used to check for differences. Consequently, a three-way repeated measures ANCOVA with the factors INTERVENTION (MMI vs UMI), CONDITION (single- vs dual-task), and TIME (pre vs post) was conducted. Due to differences in weight, height, and distribution of sex between groups, these variables were used as covariates. If a violation of sphericity was detected, the Greenhouse-Geisser correction was applied. To interpret the results and to clarify the practical/clinical relevance of interventional studies it is advisable to use effect sizes\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Thus, the effect size partial-eta squared (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e) as well as Cohen\u0026rsquo;s d (d) were calculated and interpreted according to Lakens \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e: small (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e \u0026ge; 0.01, d\u0026thinsp;\u0026ge;\u0026thinsp;0.2), medium (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e \u0026ge; 0.06, d\u0026thinsp;\u0026ge;\u0026thinsp;0.5), and large (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e \u0026ge; 0.14, d\u0026thinsp;\u0026ge;\u0026thinsp;0.8). In case of TIME x INTERVENTION x CONITION or TIME x INTERVENTION effects as well main effects of TIME, Bonferroni-corrected post-hoc tests were performed. In case of large main effects, the results were interpreted as relevant if \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e \u0026ge; 0.14 or d\u0026thinsp;\u0026ge;\u0026thinsp;0.8. Due to pilot character of the present study, a post-hoc power and sample size calculation, based on the observed effect sizes, was conducted (G*Power 3.1.9.7, Heinrich Heine University D\u0026uuml;sseldorf, D\u0026uuml;sseldorf, Germany) to provide data on sufficient sample sizes for future randomized controlled trials. In addition, a two-way repeated ANOVA was performed with the factors INTERVENTION (MMI vs UMI) and TIME (first, second, and third month) to analyze the progression of the external load during the resistance training (i.e., leg press, leg extension, seated leg curls) as an indirect marker of neuromuscular adaptations, which could have an impact especially on the spatiotemporal gait parameters. The external load per exercise was averaged over each month.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of participants\u003c/h2\u003e \u003cp\u003eIn total, 29 healthy participants were recruited. Fifteen participants (11 females, age: 72.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 years, height: 161.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 cm, body mass: 68.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8 kg) received the MMI and 14 participants (6 females, age: 70.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 years, height: 174.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1 cm, body mass: 83.1\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7 kg) received the UMI. The Freiburger Questionnaire on Physical Activity\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e indicated that overall physical activity was on average 12 h for the MMI group and 14.7 h per week for the UMI group. All participants had an attendance rate of at least 80%. Due to dropouts only data from 24 participants (11 MMI, 13 UMI) were included in the final analysis. Due to processing issues regarding the MTC and the MTC\u003csub\u003eCoV\u003c/sub\u003e, only 23 participants (10 MMU, 13 UMI) were included in the final analysis. Furthermore, due to technical issues during the single-task walking trial at baseline measurement only 23 participants (11 MMI, 12 UMI) were included intro the final DTC analysis. The results of the post-hoc power and sample size calculations are presented in supplementary Table A and B). An overview of all parameters including the p-values and effect sizes is presented in supplementary Tables C-E).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cp\u003eNo relevant interactions and main effects were found for gait velocity, stride length, MTC, and their respective CoVs (Supplementary table C) as well as for cognitive performance (Supplementary table E). Based on the effect sizes, there was a main effect of TIME for DTC MTC (F(1,17)\u0026thinsp;=\u0026thinsp;4.070, p\u0026thinsp;=\u0026thinsp;0.060, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e = 0.193) and DTC MTC\u003csub\u003eCoV\u003c/sub\u003e (F(1,17) = 3.203, p = 0.091, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e = 0.159), but post-hoc analysis showed no difference between baseline and post assessment for all variables (d \u0026lt; 0.8) (Supplementary table D).\u003c/p\u003e \u003cp\u003eThe analysis of the external load progression showed no TIME x INTERVENTION interaction for all three exercises. However, TIME effects were detected for leg press (F(1.24,29.91)\u0026thinsp;=\u0026thinsp;38.89, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e = 0.618), leg extension (F(1,10) = 2.030, p = 0.185, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e = 0.169), and seated leg curls (F(1.340,32.17) = 23.933, p \u0026lt; 0.001, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\eta\\:}}_{\\text{p}}^{2}\\)\u003c/span\u003e\u003c/span\u003e = 0.499). Post-hoc analysis showed a significant increase in external load over the three months for the leg press: 1st and 2nd month (p \u0026lt; 0.001, d = 0.482, mean difference = 7.915, 95% CI = 11.216\u0026ndash;7.915%, 95% CI for d = -0.209\u0026ndash;0.754%), 2nd and 3rd month (p \u0026lt; 0.032, d = 0.216, mean difference = 3.545, 95% CI = 6.846\u0026ndash;3.545%, 95% CI for d\u0026thinsp;=\u0026thinsp;0.006\u0026ndash;0.437). Furthermore, the post-hoc analysis showed an increase in external load between the 1st and 2nd months for the leg curl (p \u0026lt; 0.001, d = 0.443, mean difference = 2.674, 95% CI = 1.338\u0026ndash;4.010%, 95% CI for d\u0026thinsp;=\u0026thinsp;0.163\u0026ndash;0.723%). However, post-hoc analysis showed no increase in external load for leg extension (p \u0026gt; 0.05, d \u0026lt; 0.8).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present pilot-study investigated the effect of a 12-week MMI versus UMI on spatiotemporal gait parameters recorded during single- and dual-task walking as well as cognitive performance in healthy older adults. Contrary to our hypothesis, both training interventions failed to improve gait parameters, their respective CoVs, cognitive performance as well as motor and cognitive DTC. Nevertheless, both interventions provoked progress regarding the external load during the training period indicating increased strength capabilities due to training-induced neuromuscular adaptations.\u003c/p\u003e \u003cp\u003eTo the knowledge of the authors, no previous study has investigated the influence of a comparable MMI on gait performance, cognitive performance, as well as motor and cognitive DTC in healthy elderly participants. In this context, Wollesen et al.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e showed that a progressive stand-alone resistance training and dual-task training (e.g. fast walking in combination with visual and balance tasks, 12 sessions, 60 min, 12 weeks) led to an improved gait performance in healthy elderly participants (i.e., increased step length). Furthermore, Singh et al.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e demonstrated that a resistance training (2\u0026ndash;3 days/week, 75 min, 24 weeks) increased cognitive performance in patients with mild cognitive impairment. Moreover, Castano et al.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e showed that combining resistance training with a verbal fluency task (2 days/week, 60 min, 16 weeks) enhanced plasma brain-derived neurotrophic factor level, which is associated with cognitive performance, compared to traditional resistance training in healthy elderly participants.\u003c/p\u003e \u003cp\u003eThe results of the present study revealed that none of the two interventions positively influenced gait or cognitive performance. This finding is surprising as positive intervention effects on the dependent variables were expected for both the MMI and the UMI in healthy elderly. It could be assumed that the external load used during resistance training, which was prescribed based on the RPE, was too low to induce neuromuscular adaptations translating in an improvement in gait performance\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Of note, this exercise intensity was deliberately chosen because the present study was part of a larger randomized controlled trial investigating the effect of a MMI compared to a UMI in glaucoma patients, for which this approach was selected to keep intraocular pressure low\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Nevertheless, the analysis of the training progression using the external load data revealed an increase in external load over the three months period indicating neuromuscular adaptations. Although this analysis is only a crude measure of training-related strength increases, the potential neuromuscular adaptations have not led to improvements in gait performance. In this regard, it should also be considered that the MMI group and the UMI group had a high physical activity (12 h/week and 14.8 h/week, respectively), which is above the average compared to the same age (\u0026ge;\u0026thinsp;70 years, 9.9 h/per week\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e). Speculatively, the absence of improvements in gait performance due to the resistance training in both intervention groups seems to follow the law of diminishing returns, i.e., when total physical activity increases, adaptation decreases\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eInterestingly, Hamacher\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and colleagues have shown that a six-month dancing program significantly reduced the MTC\u003csub\u003eCoV\u003c/sub\u003e compared to a combined exercises intervention (e.g., endurance training, strength training, flexibility training) in older adults. This finding might be related to the fact that dancing requires the incorporation of cognitive demands into the motor task\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. In contrast, in the Life Kinetik program, the cognitive tasks are used as distractor (additional) during the motor tasks and are thus not directly relevant for motor task completion\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Consequently exercises in which the cognitive task is a prerequisite for the motor task execution, might be better suited to improve gait performance compared to exercises using the cognitive task as a distractor during the motor task\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe present study has some limitations. First, single-task walking was always conducted before dual-task walking, which might have promoted sequential effects. However, the possible sequential effects were systematic as well as stable and might therefore have not affect group comparisons. Second, the sensitivity of the calculated gait parameters might be too low to detect differences in the dependent variables in our healthy elderly cohort. For instance, Kulmala et al. (2014) have shown that joint power of the lower extremities during walking are affected by age and shift from distal to proximal\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. Therefore, it might be possible that other gait measures are more sensitive to the interventions used in healthy elderly people. However, it was shown that the calculated gait parameters are sensitive to differentiate between glaucoma patients and healthy controls (e.g., slower gait velocity\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e and higher MTC\u003csub\u003eCoV\u003c/sub\u003e\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e in glaucoma patients). Third, the lack of improvements in gait performance might be due to a lack of isolated training of the triceps surae muscle, which is essential for plantar flexion and propulsive torque production during walking\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. This muscle group is also affected by the aging process resulting in shorter steps and a higher power production in the hip and knee joints\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. Moreover, the triceps surae muscle is also important for remaining gait stability after stumbling\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. Therefore, an increase in exercises dedicated to the plantar flexors is warranted, which might lead to positive changes in gait performance\u003csup\u003e\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. Fourth, due to the Covid-19 pandemic the number of participants was relatively low\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e and, therefore, a profound interpretation of the results is complicated. However, the present study was conducted as pilot study and provides a positive glimpse of the effects of the used MMI. Thus, future studies should consider the provided sample size calculations to substantiate the present results.\u003c/p\u003e \u003cp\u003eIn conclusion, the present study showed that neither a 12-week MMI nor UMI seems to have relevant impact on specific gait parameters (i.e., stride length, gait velocity, MTC) or their respective CoVs in physically active healthy elderly participants.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANCOVA: analysis of covariance\u003c/p\u003e\n\u003cp\u003eCoV: coefficient of variation \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDT: dual task\u003c/p\u003e\n\u003cp\u003eDTC: dual-task costs\u003c/p\u003e\n\u003cp\u003eHz: Herz\u003c/p\u003e\n\u003cp\u003eMMI: multimodal Intervention\u003c/p\u003e\n\u003cp\u003eMTC: minimum toe clearance\u003c/p\u003e\n\u003cp\u003eST: single task\u003c/p\u003e\n\u003cp\u003eUMI: unimodal intervention\u003c/p\u003e\n\u003cp\u003e95% CI: 95% confidence interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was carried out in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University Medical Faculty Magdeburg (32/18). All participants signed the informed consent form before participating in this study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData are available on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eSupported by funding of the German Research Foundation (DFG; #423926179) to MBH (HO-2002/20-1) \u0026amp; LS (SCHE 1584/5-1).\u003c/p\u003e\n\u003cp\u003eClinical trial number\u003c/p\u003e\n\u003cp\u003eGerman Clinical Trial Register, ID: DRKS00022519/05.08.2020, https://drks.de/search/de/trial/DRKS00022519\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eMH and LS contributed to conception and design of the study. CF, FS, GP, RB and KA carried out the experiment. CF performed the data analysis. CF and MB contributed to the acquisition and interpretation of the data. CF contributed to the manuscript drafting with support from MB, RB, TB and LS. HT, MH, FS, GP, RB, KA contributed to the review of the final manuscript. All authors have read and approved the submitted version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors thank all the participants for their participation in the present study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eIzquierdo, M.\u003cem\u003e\u0026nbsp;et al.\u0026nbsp;\u003c/em\u003eInternational Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. \u003cem\u003eThe journal of nutrition, health \u0026amp; aging\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e25,\u0026nbsp;\u003c/strong\u003e824\u0026ndash;853; 10.1007/s12603-021-1665-8 (2021).\u003c/li\u003e\n \u003cli\u003eClark, B. C. \u0026amp; Manini, T. M. 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IN SPORT AND EXERCISE\u003c/em\u003e; 10.1007/s42978-024-00299-4 (2024).\u003c/li\u003e\n \u003cli\u003eKinoshita, M.\u003cem\u003e\u0026nbsp;et al.\u0026nbsp;\u003c/em\u003eTriceps surae muscle hypertrophy is greater after standing versus seated calf-raise training. \u003cem\u003eFrontiers in physiology\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e14,\u0026nbsp;\u003c/strong\u003e1272106; 10.3389/fphys.2023.1272106 (2023).\u003c/li\u003e\n \u003cli\u003ePijnappels, M., Bobbert, M. F. \u0026amp; van Die\u0026euml;n, J. H. Control of support limb muscles in recovery after tripping in young and older subjects. \u003cem\u003eExp Brain Res\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e160,\u0026nbsp;\u003c/strong\u003e326\u0026ndash;333; 10.1007/s00221-004-2014-y (2005).\u003c/li\u003e\n \u003cli\u003eXue, J. Z.\u003cem\u003e\u0026nbsp;et al.\u0026nbsp;\u003c/em\u003eClinical trial recovery from COVID-19 disruption. \u003cem\u003eNature reviews. Drug discovery\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e19,\u0026nbsp;\u003c/strong\u003e662\u0026ndash;663; 10.1038/d41573-020-00150-9 (2020).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5910496/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5910496/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Aging is an inevitable process leading, inter alia, to the loss of muscle mass as well as the decrease in physical and cognitive function. These age-related impairments translate into a reduced gait performance and an increased risk of falls, which can be tackled with resistance training, Unimodal intervention (UMI). However, Multimodal intervention (MMI), i.e. combined motor-cognitive and resistance training, might be a more promising approach to increase physical and cognitive function in old adults. Therefore, this pilot study aimed to investigate the effects of MMI, compared to UMI, on gait and cognitive performance in elderly participants. We hypothesized that MMI will increase gait and cognitive performance to a larger extent than UMI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn this two-arm randomized controlled pilot study, 29 healthy active elderly participantswere assigned to MMI (15 participants, 72.0±5.5 years) and UMI (14 participants, 70.1±4.7 years). Both groups trained for 12 weeks, two times a week for 60 min, respectively. MMI consisted of motor-cognitive training directly followed by resistance training, while UMI consisted of a stand-alone resistance training. Three weeks before and after the interventions, gait performance (e.g., stride length, velocity, minimum toe clearance) was assessed during single- and dual-task walking trials using inertial measurement units. During dual-task walking, participants walked and concurrently performed different cognitive tasks in a random order: (i) reaction time task, (ii) N-back-task, and (iii) letter fluency task with two difficulty levels, respectively. Data were analyzed with repeated measures analyses of covariance (Time×Intervention×Condition).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAlthough the analyses of the progression of the external load used during resistance training showed a significant increase over the training period (e.g. leg press p\u0026lt;0.001, η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e=0.618), there was no improvement of gait or cognitive performance in active old adults after neither MMI nor UMI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eAgainst our hypothesis, the present pilot study indicated that neither a 12-week MMI nor UMI seems to have a sizable impact on gait parameters and cognitive performance in physically active healthy adults. Still, a significant increase in the external load used during resistance training was observed, implying neuromuscular adaptations, which, however, did not translate into a higher gait and/or cognitive performance.\u003c/p\u003e","manuscriptTitle":"Neither uni- nor multi-modal exercise interventions improve single- and dual-task gait performance in physically active healthy elderly – a pilot study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-10 10:35:38","doi":"10.21203/rs.3.rs-5910496/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-23T16:50:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-23T13:38:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189885790048519205861939592671047574505","date":"2025-05-05T05:58:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227206772341462815256461588082422828219","date":"2025-05-02T06:45:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-30T18:28:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311329538329587414717721348936519844547","date":"2025-04-15T17:49:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T09:37:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32900881988403986180946441247376017936","date":"2025-03-21T16:40:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244413529128426133809200049706064429897","date":"2025-03-21T15:32:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26275777989666866198305869084897305832","date":"2025-02-23T15:41:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334770252431424322848150712382767458340","date":"2025-02-20T15:53:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-18T14:41:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-02-07T12:23:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-03T03:51:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-03T03:50:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-01-27T08:06:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4596816-7dad-4c41-8527-57ef7e928ef9","owner":[],"postedDate":"February 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T16:03:36+00:00","versionOfRecord":{"articleIdentity":"rs-5910496","link":"https://doi.org/10.1186/s12877-025-06537-w","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-11-04 15:58:11","publishedOnDateReadable":"November 4th, 2025"},"versionCreatedAt":"2025-02-10 10:35:38","video":"","vorDoi":"10.1186/s12877-025-06537-w","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06537-w","workflowStages":[]},"version":"v1","identity":"rs-5910496","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5910496","identity":"rs-5910496","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}