Efficacy of dual-task training in improving balance, mobility,and cognitive-motor function in the geriatric population

Abstract

Ageing is accompanied by progressive alterations in neuromuscular, sensory, cognitive, and executive functions that collectively affect postural control, gait, mobility, and the ability to safely perform complex activities of daily living. Older adults frequently encounter situations in which walking or maintaining balance must be performed simultaneously with another cognitive or motor activity, such as talking while walking, carrying an object while navigating obstacles, counting while walking, or responding to environmental stimuli. The ability to successfully manage these simultaneous demands is commonly referred to as dual-task performance. Agerelated reductions in attentional capacity, executive functioning, processing speed, sensory integration, muscle strength, and automaticity of gait can increase dual-task interference and consequently contribute to instability, mobility limitation, and falls. Dual-task training (DTT), particularly cognitive-motor dual-task training, has therefore emerged as an important rehabilitation strategy designed to simultaneously challenge motor and cognitive systems under functionally relevant conditions. Evidence accumulated over the last decade suggests that DTT can improve dynamic balance, functional mobility, gait performance, executive functioning, divided attention, and dual-task ability in many older adults. Recent systematic reviews and metaanalyses indicate that DTT produces clinically relevant benefits for balance and mobility, although the magnitude of benefit varies according to intervention design, task complexity, training dose, participant characteristics, adherence, and the type of comparator used. A 2024 systematic review and meta-analysis involving 14 studies and 691 participants reported significant improvements in balance following DTT, while a 2025 systematic review incorporating 44 studies and 2,782 older adults found significant improvements in dynamic balance and functional mobility and reductions in fall frequency. Evidence also indicates that cognitive-motor DTT may improve executive function and working memory, although cognitive outcomes are less consistently reported than physical outcomes. Emerging approaches include variable-priority training, exergaming, virtual reality, rhythm-based interventions, home-based programs, and technology-assisted telerehabilitation. The present article reviews the physiological and cognitive basis of dual-task interference, mechanisms of DTT, intervention modalities, evidence for balance and mobility improvement, effects on cognitive-motor function, clinical assessment, dosage considerations, safety, limitations, and future directions. Overall, DTT represents a promising multidimensional intervention for maintaining independence and reducing functional decline among older adults, although standardized protocols and larger longterm trials are required to establish optimal training parameters and durability of benefits.