A randomised controlled trial of a walking training with simultaneous cognitive demand (dual task) in chronic stroke.
Meester D., Al-Yahya E., Dennis A., Collett J., Wade DT., Ovington M., Liu F., Andy M., Janet C., Johansen-Berg H., Dawes H.
OBJECTIVE: To evaluate the tolerability of, adherence to and efficacy of a community walking training programme with simultaneous cognitive demand (dual-task) compared to a control walking training programme without cognitive distraction. METHODS: Adult stroke survivors, at least 6 months after stroke with a visibly obvious gait abnormality or reduced two-minute walk distance were included into a 2-arm parallel randomized controlled trial of complex intervention with blinded assessments. Participants received a 10 week, bi-weekly, 30 minutes treadmill program at an aerobic training intensity (55-85% heart rate maximum), either with, or without simultaneous cognitive demands. Outcome measured at 0, 11 and 22 weeks. Primary: two-minute-walk tests with and without cognitive distraction, dual task effect on walking and cognition; secondary: SF-36, EuroQol-5D-5L, Physical Activity Scale for Elderly (PASE), and step activity. RESULTS: Fifty stroke patients were included, 43 received allocated training and 45 completed all assessments. The experimental group (n = 26) increased mean (SD) two-minute walking distance from 90.7 (8.2) to 103.5 (8.2) metres, compared with 86.7 (8.5) to 92.8 (8.6) in the control group, and their PASE score from 74.3 (9.1) to 89.9 (9.4), compared with 94.7 (9.4) to 77.3 (9.9) in the control group. Statistically, only the change in the PASE differed between the groups (p = 0.029), with the dual-task group improving more. There were no differences in other measures. CONCLUSIONS: Walking with specific additional cognitive distraction (dual-task training) might increase activity more over 12 weeks, but the data are not conclusive. This article is protected by copyright. All rights reserved.