VR-based cognitive–motor dual-task training may improve gait in older adults with MCI.A study from Singapore shows the potential of a virtual reality (VR)-based cognitive–motor dual-task training (CDTT) programme to improve gait performance in functionally independent older adults with mild cognitive impairment (MCI).
The study included 41 community-dwelling older adults with MCI (mean age 71.4 years, 51.2 percent women). They were randomized 1:1:1 to 16 sessions of CDTT, cognitive single-task training (CSTT), or motor single-task training (MSTT) over 8 weeks. The cognitive component used a VR-based fruit-catching game that progresses in difficulty for a graded attentional load. The motor component consisted of treadmill walking only.
Compared with baseline, the postintervention period saw improvements in most single-task gait parameters with CDTT, including gait speed (mean change score [MCS], 0.0707 m/s; p<0.001), step time (MCS, –0.0220 s; p=0.016), cadence (MCS, 4.29 steps/min; p=0.011), and double-support time (DST; MCS, –0.0275; p=0.018).
These improvements were sustained at the 6-month follow-up (gait speed: MCS, 0.1020 m/s; p=0.002; step time: MCS, –0.030 s; p=0.001; cadence: MCS, 6.30 steps/min; p=0.003; DST: MCS, –0.0369; p=0.029).
CDTT trumped CSTT in improving all gait parameters at postintervention in the post hoc analysis (p<0.05 for all). [J Am Med Dir Assoc 2026;27:106290]
With CSTT, modest improvements in gait parameters were reported at 6 months, but these failed to achieve statistical significance. “This may reflect the absence of treadmill walking during the intervention, as participants in this group did not engage in gait-related motor activity during training,” the researchers noted.
With MSTT, gait parameters were largely unchanged at both the postintervention period and the 6-month follow-up.
Other improvements
The CDTT group showed significant reductions in dual-task costs for gait speed (MCS, –8.22 percent; p=0.003), step length (MCS, –3.83 percent; p<0.001), step time (MCS, –7.25 percent; p=0.031), and DST (MCS, –13.14 percent; p=0.045) postintervention. According to the investigators, these reflect the participants’ improved ability to maintain gait performance while performing concurrent cognitive tasks.
The CDTT group also showed a significant improvement in Timed UP and Go (TUG) test postintervention (MCS, –0.45 s; p=0.004). However, this did not reach the minimal clinically important difference (approximately 3.4 s in other studies). [Neurosurgery 2017;80:380-385]
The investigators attributed the modest improvement to ceiling effects, as participants generally had high baseline TUG scores, which limit the potential for measurable change. [J Geriatr Phys Ther 2003;26:14-22]
“[Moreover,] our intervention design differed from previous studies incorporating diverse exercises … Our physical component was primarily restricted to treadmill walking, which may have limited impact on functional tests that assess broader mobility and balance domains rather than attentional control specifically,” they said.
Divided attention = increased fall risk
Traditional exercises to reduce falls usually focus on training physical capabilities. [Front Public Health 2022;10:953593] However, the researchers pointed out that these do not address the complex demands of real-world scenarios, which require the performance of concurrent motor and cognitive tasks frequently.
“The divided attention between two concurrent tasks then leads to increased fall risk. This is exacerbated in older adults with cognitive impairment, where attentional capacity is more limited,” they said. “Hence, to reduce fall risk, interventions that enhance the ability of older adults to effectively allocate attention and switch between cognitive and motor demands are needed.”
“This pilot trial, with its unique integration of VR training tools … contributes to the nascent but encouraging body of evidence for VR-based DTT in [the relatively understudied population of] older adults with MCI and may provide a foundation for future studies examining this technology,” the investigators said.
The researchers called for larger, adequately powered trials to validate the results and evaluate the relative efficacy of DTT compared with cognitive or motor training alone.