The Physician and Sportsmedicine

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Dual-task training on cognition and resistance

training improved both balance and working
memory in older people

Ebrahim Norouzi, Mohammad Vaezmosavi, Markus Gerber, Uwe Pühse &

Serge Brand

To cite this article: Ebrahim Norouzi, Mohammad Vaezmosavi, Markus Gerber, Uwe Pühse
& Serge Brand (2019): Dual-task training on cognition and resistance training improved
both balance and working memory in older people, The Physician and Sportsmedicine, DOI:
10.1080/00913847.2019.1623996

To link to this article: https://doi.org/10.1080/00913847.2019.1623996

Published online: 03 Jun 2019.

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THE PHYSICIAN AND SPORTSMEDICINE
https://doi.org/10.1080/00913847.2019.1623996

CLINICAL FEATURE
ORIGINAL RESEARCH

Dual-task training on cognition and resistance training improved both balance and
working memory in older people
a
Ebrahim Norouzi , Mohammad Vaezmosavib, Markus Gerber c
, Uwe Pühsec and Serge Brand c,d,e,f

a
Department of Motor Behavior, Faculty of Sport Science, Urmia University, Urmia, Iran; bDepartment of physical education, Emam Hossien
University, Tehran, Iran; cDepartment of Sport, Exercise and Health, Division of Sport and Psychosocial Health, University of Basel, Basel,
Switzerland; dSubstance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; eSleep Disorders
Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; fPsychiatric Clinics (UPK), Centre for Affective, Stress and Sleep
Disorders, University of Basel, Basel, Switzerland

ABSTRACT ARTICLE HISTORY

Objectives: With increasing age, declines in executive functions and basic motor skills such as posture Received 17 October 2018
control, muscle strength, and balance performance have been observed. However, no intervention has Accepted 23 April 2019
focused on enhancing both executive functions and balance performance concomitantly. Accordingly, KEYWORDS
the aim of the present study is to investigate whether and to what extent two different dual-task Older adults; dual task
interventions improved both working memory and balancing. Specifically, we examined whether either training; resistance training;
a motor-cognitive dual task training (mCdtt) or a motor-motor dual-task training (mMdtt) impacted cognitive training; balance
more favorably on working memory and on balance performance among a sample of older adults. performance; working
Methods: A total of 60 older males (mean age: 68.31 years; SD = 3.83) were randomly assigned either to memory performance
the mCdtt, the mMdtt or to control condition. Balance performance and working memory performance
were tested at baseline, four weeks later at study completion, and again 12 weeks later at follow-up.
Results: Balance and working memory improved from baseline to post-intervention and to follow-up
(significant Time effect), but more so in the mCdtt compared to the mMdtt condition (significant Time ×
Group interaction). Further, compared to the mMdtt condition, higher scores were observed in the
mCdtt condition (significant Group effect).
Conclusion: Dual-task interventions improved both balance performance and working memory, but
more so if cognitive performance was specifically trained along with resistance training.

Introduction Moreover, older adults are more likely to fall when performing
concurrent tasks, such as walking while performing other
Epidemiological studies show a shift towards an aging popu-
cognitive or motor tasks [3,8]. Given that everyday life consists
lation [1]. Getting older is associated with a broad variety of
of a broad and continuous variety of dual- and multi-tasks
physical and mental declines. Compared to younger people,
such as shopping, counting coins while queuing up, or walk-
older adults are at increased risk of experiencing gradual
ing while answering a mobile phone call, the aim of the
regression of balance. Balance impairment is an important
present study was to investigate whether and to what extent
modifiable risk factor for falls in older adults. Indeed, the
a specific training of both cognitive and motor skills might
severities of fall-related complications increase with age [2,3].
have a favorable impact on both memory and gross motor
These observations are in according with those theories of
performance such as balance.
aging which claim that motor function and motor reaction
times of older adults may decrease, which in turn might lead
to a decrease in motor performance [4,5] and ultimately result Exercise-related optimization of motor function
in a higher risk of falling-related accidents [6].
Research supports the view of positive acute and long-term
Besides a possible decline in motor performance, older
effects of exercise-based interventions on motor function in
adults might also show impairments in cognitive functions.
older people [2,3]. In this view, various training methods have
Neurodegenerative disorders such as Alzheimer ’s disease,
been used effectively to enhance balance outcomes, e.g.,
Dementia, and mild cognitive impairment are considered
endurance training, strength training, multisensory and whole-
important examples of cognitive impairments among older
body vibration training [3,9,10]. However, knowledge on the
people, and all these disorders are closely related to older
efficiency of specific exercise-based interventions such as dual-
age [7].
task training (DTT) in older people is still lacking [2,11,12].
Further, there is evidence that sedentary older adults are at
Previous studies have investigated combined aerobic and
greater risk of memory decline and a greater risk of falls [3,8].
resistance training [13] or flexibility and resistance training

CONTACT Ebrahim Norouzi [email protected] Department of Motor Behavior, Faculty of Sport Science, Urmia University, Urmia, Iran
© 2019 Informa UK Limited, trading as Taylor & Francis Group
2 E. NOROUZI ET AL.

[14] and also the cognitive training only [15,16] or cognitive tasks such as driving, and a risk factor for falls and instability
dual-task training [17,18] while, to our knowledge, very few among older people [2]. Accordingly, there has been recent
studies [3,9,10,19] have investigated the combination of both interest into whether motor-motor dual-task training (mMdtt:
cognitive training and resistance training. Accordingly, the aim two motor tasks such as strength training and balance training
of the present study was to shed light on this kind of are exercised simultaneously) or motor-cognitive dual task
intervention. training (mCdtt: cognitive tasks are performed simultaneously
with resistance training) might result in greater improvements
in global cognitive functions than either exercise or cognitive
Exercise-related optimization of cognitive function
training alone [19,27].
Previous research has mainly focused on the effects of aerobic Dual-task interventions resulted in enhanced-divided atten-
exercise on cognitive functions, whereas possible benefits tion and the use of optimal attention resources in motor control
following resistance training have received far less attention [28]. Moreover, this attention allocation on two tasks during dual-
[20,21]. Resistance training is categorized as a form of anaero- task training leads to reduces dual-task costs [17]. Studies that
bic exercise, in which a muscle contraction is opposed by examine the capacity to divide one’s attention to perform two
force, leading to increased lactate levels, and blood pressure tasks simultaneously during gait and balance training suggests
[21]. Increased muscular strength as a result of resistance that both younger and older adults involve some executive
training has been associated with improved memory perfor- processes in order to manage these dual-task situations [28].
mance, body composition, balance and motor reaction time Moreover, executive functions are related to balance, working
[10,21]. Recently a systematic review has shown that resistance memory, and divided attention [5]. Therefore, executive function
training had positive effects on global cognitive function in training as a form of cognitive training may be an important
older adults [22]. Previous studies have shown that working strategy to prevent falling in older people [26]. Moreover, based
memory (WM) is one of several cognitive functions that on training studies, most dual-task interventions have focused
decline with advancing age. WM can be defined as on two cognitive tasks [22] or two motor skills [11], but dual-task
a dynamic processing system that is capable of temporarily training containing motor-cognitive training simultaneously has
storing and manipulating information [23]. For the following less frequently been examined.
reasons, we hold that focusing on WM is particularly impor- With the first hypothesis, in line with past studies
tant: First, working memory, which underlies the temporary [6,7,20,26,27,29], we assumed that compared to an mMdtt
storage and manipulation of information, is critical for multiple condition, mCdtt would improve WM over time to a greater
aspects of cognition and everyday life. Second, WM in older extent. Second, in line with previous research [2,6,10,11], we
adults declines with age. Third, research examining WM spe- expected that participation in the mCdtt condition would be
cifically in older adults remains limited, despite the global associated with an increase in balance over time compared to
rapid increase in human life expectancy [24]. the mMdtt condition.

Are resistance trainings able to lead to balance Materials and methods

improvement and to the enhancement of working
memory? Procedure

Based on the current state of literature [2,19], resistance training as Participants were informed about the general aims and the
a sole intervention does not appear to be the optimal intervention. exact procedure of the study, and about the anonymous data
However, past studies [6,25–27] indicate that multimodal exercise handling. Before study enrollment, they all signed a written
interventions performed under dual-task conditions appear to informed consent sheet. Male adults 65 years old or older
provide more consistent cognitive or motor function benefits in were recruited to take part in the present interventional
older adults. For example, Delbroek et al. (2017) found that study. Next, they were randomly assigned either to a motor-
a 6-week training program of dual-task training resulted in motor dual-task condition (mMtt), a motor-cognition dual-task
improved memory and balance performance in older adults with condition (mCtt) or to a control condition. The mCdtt and the
mild cognitive impairment. Further, Fraser et al. (2017) found dual- mMdtt interventions consisted of three 60 –80-min group
task benefits of combined training, such as aerobic plus cognitive sessions per week for four consecutive weeks. Participants
training or stretching plus cognitive training, in walking speed and underwent a balance test and WM test at baseline, four
accuracy in a sample of sedentary older adults. Moreover, in weeks later after completion of the intervention, and again
a systematic review, Schoene et al. (2014) summarized the results 12 weeks later at follow-up. The Review Board of the Urmia
of 37 studies addressing interactive cognitive-motor training. They University (Urmia, Iran) approved the study, which was con-
found that interactive cognitive-motor interventions improve phy- ducted in accordance with the ethical principles laid down in
sical and cognitive functioning in older people [19]. the Declaration of Helsinki and its later amendments.

Dual-task training-related optimization of motor and Participants

cognitive functions
Participants were eligible for the present study if they met the
In conjunction with age-associated deterioration in cognitive following inclusion criteria: 1) male, 2) aged ≥65 years, 3)
function, deficits in divided attention can be problematic for ability to stand upright for at least 2 min, 4) no injuries of
 THE PHYSICIAN AND SPORTSMEDICINE 3

the lower extremities, 5) score 24 or above in Mini-Mental presented on a light gray background. Each letter in the
State Examination (MMSE; see Table 2) test, 6) ability to walk sequence was displayed for 500 ms, and a response window of
20 m without auxiliary equipment. 7) willing and able to 1,500 ms was provided. The inter-stimulus interval was set at
comply with the study conditions, 8) good physical activity 1,000 ms. In each block, targets (letter matching the letter pre-
status (evaluated by using Persian version of Baecke question- sented n trials earlier) occurred with a probability of 20%. Task
naire [30] and 9) written informed consent. Exclusion criteria performance was assessed by averaging the mean reaction time
were: 1) recent myocardial infarction, 2) uncontrolled blood for correct responses. Reliability of the measure of working
pressure, 3) Alzheimer’s disease, 4) mental disorders such as memory as performance across the difficulty levels did not
substance use disorder, major depressive disorder (MDD) or change from baseline to retest after 1 week (one-back, r = .79;
posttraumatic stress disorder (PTSD), 5) neurological disorders two-back, r = .72).
such as seizures, multiple sclerosis (MS) or Parkinson’s disease To assess balance by direct observation, we used the Berg
(PD), and 6) visual impairments. Next, participants were ran- Balance Scale (BBS) [33]. This test was used to examine
domly assigned either to mMdtt, mCdtt or control (sees improvement in balance performance as a function of the
Figure 1). intervention. The test consists of movements such as sitting
to standing, standing unsupported, standing with eyes closed,
reaching forward with outstretched arm, turning to look
Outcome measures behind, turning 360 degrees, placing alternate foot on stool,
standing with one foot in front, and standing on one foot. The
Working-memory performance was assessed using the n-back movements were performed under single-task. The scale
task [31]. In the present study, participants completed requires 10–20 min to complete and measures the partici-
a computer-based version of the n-back task. In order to calculate pant’s ability to maintain balance either statically or while
the reliability of this test in the present study, a preliminary (pilot) performing various functional movements over a specified
study was conducted with 13 participants, and Inter-Class time duration. This instrument has excellent validity (0.96)
Correlation (ICC) was calculated (r= 0.77). In the present study, and reliability (0.98).
participants completed a computer-based version of the test,
previously used by Ruiz-Contreras et al. [32]. The task involves
the presentation of a sequence of letters, and respondents have
Interventions
to detect whether or not the current letter matched the letter
presented one or two trials earlier in the series. For each trial, Resistance training
participants are asked to respond by pressing a button corre- Both mMdtt and mCdtt groups engaged in resistance training.
sponding to yes or no. In the present study, participants com- The resistance training was carried out using an isokinetic
pleted the task at two levels of difficulty (one-back and two-back) exercise device (Isokinetic programmed with the Cybex II
. The stimuli were dark gray letters (vertical visual angle = 0.7°) Model). Isokinetic exercise is a form of resistance training

Figure 1. Participant flow chart.

4 E. NOROUZI ET AL.

Table 1. Content of the sessions on resistance training by Isokinetic exercise refrain from additional exercise or sport activities during the
machine.
4-week intervention period.
Speed
(degrees
per second) Statistical analysis
Number of Rest between sets With a series of one way ANOVA and χ2-tests, we compared
sets Repeat Knee Ankle (s) age, time since retirement, physical activity status and scores
Session 1 to 4 4 8 60 30 60 on the MMSE between the three groups.
Session 5 to 8 4 8 75 45 60 Next, two separate ANOVAs for repeated measures were
Session 9 to 12 4 8 90 60 60
performed with the factors Time (baseline, study end, follow-
up), Group (mCdtt, mMdtt, and control) and Time by Group
interaction, and balance and WM performance as dependent
that permits maximum muscle contraction throughout the full variables. Post-hoc analyses were performed using Bonferroni-
range of joint movement. Trained clinical physiotherapists Holm corrections for p-values. For single t-tests, Cohen’s
supervised the resistance training, which lasted about 60–80 d effect sizes were reported. Indicate here how Cohen’s
min. Following each exercise, a rest period of 1 min was taken. d effect sizes should be interpreted. The level of significance
The content of the whole resistance training sessions is was set at p ≤ 0.05, and all statistics were processed using
described in more detail in Table 1. SPSS® 20.0 (IBM Corporation, Armonk, N.Y., USA) for Apple
MacIntosh®.
Motor-motor dual-task training (mMdtt) condition
Resistance training plus simultaneous motor (skill) training as
Results
a dual-task paradigm involved throwing a ball up and down,
throwing a bag, holding a bag, balancing the cup on the palm Sample characteristics
of the hand, and holding a medicine ball in both hands [6,34].
Table 2 provides information about the sociodemographic
The mMdtt intervention consisted of three 60- to 80-min
background of the sample, separately for participants assigned
group sessions per week.
to the mCdtt, the mMdtt, and the control groups.
The three groups did not differ with regard to age, marital
Motor-cognitive dual-task training (mCdtt) condition status, time since retirement, mental state (it is noted that
Resistance training plus 12 cognitive tasks simultaneously a Persian version of a test was used, so this explain the
included: 1) matching a card with a card previously shown (8 lower MMSE scores), and level of physical activity (Table 2).
s ago); 2) backward number counting, 3) mental arithmetic, 4) Accordingly, no further covariates were considered in the
calculate the assignment to front, 5) spelling particular names subsequent analyses.
backward, 6) counting numbers backward in intervals of 3, 7) Means and standard deviations for all outcomes at base-
remembering words given in 300 ms intervals, 8) remember- line, post-intervention, and follow-up are shown in Table 3
ing visual images, 9) remembering shapes, 10) remembering and Figure 2, separately for participants assigned to the
colors, 11) differentiating between shapes, and 12) remember- mMdtt, the mCdtt and the control conditions. Table 3 also
ing the order of a word list [6]. provides all inferential statistics.

Control condition
Working memory
Participants in the control condition met two or three per
week in small groups of six to nine participants for four con- Table 3 highlights that WM performance improved over time from
secutive weeks (duration: 60 min per session). The aims of the baseline to study completion and to follow-up (significant Time
informal meetings were to discuss issues and hassles related effect), but more so in the mCdtt, than in the mMdtt and the
to daily life and to retirement and to explore coping strategies. control conditions (significant Time × Group interaction).
The control condition sessions could not be considered as Compared to the mMdtt conditions, the mCdtt condition leads
active control condition. Additionally, they were asked to to higher WM scores (significant Group effect). In addition, post-
maintain their current daily physical activity levels and to hoc tests performed for the post-intervention and follow-up

Table 2. Descriptive information about sociodemographic background, and test of group differences between participants assigned to the mMdtt, mCdtt and
control groups.
Group
mMdtt mCdtt control Statistics
N 20 20 20
Age (years) 68.31 (4.12) 68.51 (3.65) 68.10 (3.71) F(2, 57) = 0.428, p = 0.65
Age range (years) 65–75 65–75 65–75
Score on the MMSE test 26.41(2.14) 26.67 (2.56) 25.83 (2.43) F(2, 57) = 0.38, p = 0.72
Physical activity level (min/week) 150.21 (11.49) 151.32 (16.78) 152.02 (12.33) F(2, 57) = 0.42, p = 0.67
Time since retirement (years) 13.12 12.93 11.97 F(2, 57) = 0.61, p = 0.88
Marital status (single/married) 4/16 3/17 5/15 χ2(N = 60, df = 3) = 0.86, p = 0.61
Notes: mCdtt = Motor-cognitive dual-task training; mMdtt = Motor-motor dual-task training; MMSE: Mini-Mental State Examination.
 THE PHYSICIAN AND SPORTSMEDICINE 5

Table 3. Means and standard deviations for working memory, and balance, separately for groups (mMdtt, mCdtt and control) and for each measurement occasion
(baseline, post-intervention, and 3-month follow-up), and inferential statistical indices of working memory, and balance with the factors time (baseline vs. follow-up), group
(mMdtt, mCdtt and control) and the time x group-interaction.
Groups Factors
Greenhouse- Geisser
mMdtt mCdtt control Time Group Time x Group interaction Epsilon
N 20 M (SD) 20 M (SD) 20 M (SD) F ηp 2 F ηp 2 F ηp2
WM 145.55 ** 0.61 19.90 ** 0.47 11.17 ** 0.38 0.632
Baseline 6.26 (0.15) 6.19 (0.13) 6.23 (0.21)
Post-test 7.72 (0.11) 7.82 (0.15) 6.87 (0.16)
Follow-up 6.89 (0.31) 7.01 (0.25) 6.54 (0.18)
Balance 189.49 ** 0.66 23.38 *** 0.51 18.44 ** 0.43 0.671
Baseline 44.84 (5.13) 44.73 (4.99) 44.56 (5.02)
Posttest 48.13 (5.21) 50.48 (5.11) 45.66 (4.34)
Follow-up 45.07 (5.02) 49.05 (4.31) 44.92 (4.07)
Notes: mCdtt = Motor-cognitive dual-task training; mMdtt = Motor-motor dual-task training; WM = working memory, [L] = Large statistic power, Degrees of
freedom: Time: (2, 38), Group: (2, 38), Time × Group (4, 38).
*p < 0.05. **p < 0.01. ***p < 0.001.

60
Baseline
Balance per for mance

Post-intervention
40 Follow-up

20

0
t

t
l
ro

dt
t
Cd

M
nt

m
co

groups

10
Baseline
8 Post-intervention
W orking memor y

Follow-up
6

0
tt
l

t
ro

dt
Cd

M
nt

m
co

groups

Figure 2. Above: the balance performance in the study groups at baseline, post-intervention, and follow-up. Below: the working memory in the study groups at
baseline, post-intervention, and follow-up.

stages across the three groups showed the WM in mCdtt group pre- to follow-up test (small ES = 0.19). ES calculations for
was significantly higher compared to other groups (all p ≤ .001). differences between the mCdtt, the mMdtt, and the control
Effect size (ES) calculations showed large ESs for WM group showed that WM did not differ at pre-test (small ES =
improvements within the mCdtt group both from pre- to post- 0.18), but ESs were large at post-test and at follow-up.
test (large ES = 2.31) and from pre- to follow-up test (large ES
= 1.49). Also, within the mMdtt group, WM scores improved
Balance
from pre- to post-test (large ES = 1.38), and from pre- to
follow-up test (large ES = 1.16) but not as much as the As shown in Table 3, balance scores increased from baseline to
mCdtt Group. Within the control group, WM scores remained study completion and to follow-up (significant Time effect),
unchanged from pre- to post-test (small ES = 0.21), and from but more so in the mCdtt, than in the mMdtt condition
6 E. NOROUZI ET AL.

(significant Time × Group interaction). Compared to the involvement which requires parallel information processing,
mMdtt condition, the mCdtt condition showed higher balance manipulation of information, selective attention to task-
scores (significant Group effect). Moreover, post-hoc analyses relevant stimuli and decision-making with respect to the motor
showed that compared to the control and mMdtt groups, in execution [11,26]. This may explain why the mCdtt group had
the mCdtt group balance performance increased significantly greater improvements in WM scores. Therefore, this improve-
at post-intervention and follow-up (all p ≤ .001). In other ment in the WM is not simply another repetition of the baseline
words, the higher balance was observed in mCdtt group cognitive task.
across testing session and three groups. Another explanation for higher WM improvement as
ESs calculations showed that in the mCdtt group, balance a result of mCdtt compared to mMdtt might be the neural
scores largely increased from baseline to post-intervention (large efficacy resulting from training in the mCdtt condition. The
ES = 2.66), and from baseline to follow-up (large ES = 2.07). Within interaction of cognitive and motor networks as well as the
the mMdtt group, balance scores increased from baseline to post- enhancement of brain communication might be the results of
intervention (large ES = 1.59), and from baseline to follow-up mCdtt. In line with this, Oswald et al. (2006) found that cog-
(large ES = 1.31), but not as much as the mCdtt Group. Within nitive-motor training compared to motor training alone, had
the control group, balance performance scores remained relatively a more positive impact on cognitive function [25].
unchanged from pre- to post-test (small ES = 0.26), and from pre- With the second hypothesis we assumed that compared to
to follow-up test (small ES = 0.23). ES calculations for differences an mMdtt condition, an mCdtt intervention would lead to
between the mCdtt, the mMdtt, and the control group showed greater improvements in balancing performance, which was
that balance performance did not differ at pre-test, but ESs were supported in the present study. Accordingly, the present
large at post-test and at follow-up. results corroborate previous findings related to balancing per-
formance outcomes [2,10–12]. As suggested in a previous
study [4], sensory-motor integrity might be one of the out-
Discussion
comes of dual-task training pattern. Sensory-motor integrity
The key findings of the present study are that among older resulting from dual-task training might reduce postural
male adults, motor-cognitive dual task training (mCdtt) lasting instability and lead to increased balance performance [36]. In
for 12 sessions improved WM and balance more than a motor- addition, paying attention to the consequences of motor per-
motor dual-task training (mMdtt) condition. Most importantly, formance leads to external attention control. Accordingly,
the improvements were maintained 12 weeks after comple- external attention does not interfere with the motor control
tion of the mCdtt program. This finding is relevant because process and results in higher motor control and performance
older people are at increased risk for balance and cognitive [12,36]. Therefore, training in dual-task conditions leads to
impairments. external attention control which can enhance balance perfor-
With the first hypothesis, we assumed that compared to an mance through sensory-motor integrity [11,36].
mMdtt condition, mCdtt would show stronger improvements Others [2,17,26] have shown that dual-task training has
in WM over time, and this assumption was fully confirmed. a positive impact on divided attention, and this could lead
Therefore, the present results confirmed a number of previous to improved balance performance. The posture control does
studies by showing that dual-task cognition and physical not simply consist of automated motor tasks but depends on
training improved cognitive function [6–8,26,27,29]. input from higher cortical centers, especially from neural net-
Based on previous studies [22], exercise training is known works associated with executive functions [28]. In addition to
to improve cognitive function in older individuals through good evidence demonstrating cognitive functions improve
processes of neuroplasticity. Yet, emerging studies suggest following exercise-based interventions, there are also prelimin-
that larger cognitive gains may be induced when exercise ary findings suggesting seated cognitive training has benefi-
training interventions are combined with cognitive activity cial effects on motor functions [19]. This may explain why in
[35]. In the present study, mCdtt resulted in higher improve- the present study the mCdtt group showed more improve-
ments in WM compared to mMdtt. However, improvements ments in balance performance. In summary, mCdtt may also
were observed in the mMdtt condition that might be attrib- increase lower extremity muscle strength and challenging
uted to the use of the dual-task training pattern, which might executive functions, which may ultimately improve posture
have resulted in the engagement of higher centers of the control, and improvements reflected in the balance test scores
brain and consequently impact on the cognitive function post intervention.
[6,20]. Moreover, the potential plasticity of the brain and its The novelty of the findings should be balanced against the
association with executive functions and motor performance following limitations. First, participants were not blinded with
might be the reason for WM performance enhancement in the regard to treatment, and it is, therefore, possible that expec-
mMdtt condition. Additionally, these benefits might be attrib- tancies and motivational processes might have biased the
uted to a cascade of neurobiological mechanisms elicited by results. Second, and following on this observation, it is con-
resistance training, including increased insulin-like growth fac- ceivable that other latent but unassessed physiological and
tor-1 (IGF-1), as well as structural changes of the cortical and psychological factors might have biased the present pattern of
subcortical regions [20,21]. results in the same or opposite directions. Third, the sample
The present results showed that mCdtt produced greater size was rather small, although we focused on effect sizes
improvements in WM than either the mMdtt or control condi- when interpreting our findings as these are not sensitive to
tions. Specifically, mCdtt consists of both cognitive and motor sample size. Last, it remains to be determined whether and to
 THE PHYSICIAN AND SPORTSMEDICINE 7

what extent the present pattern of results can be replicated 6. Dorfman M, Herman T, Brozgol M, et al. Dual-task training on
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Declaration of interest (5882):1510–1512.
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The authors have no relevant affiliations or financial involvement with any tioning in young and older adults: immediate training gains, trans-
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the subject matter or materials discussed in the manuscript. This includes 17. Strobach T, Torsten S. Mechanisms of practice-related reductions of
employment, consultancies, honoraria, stock ownership or options, expert dual-task interference with simple tasks: data and theory. Adv Cogn
testimony, grants or patents received or pending, or royalties. Psychol. 2017;13(1):28.
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19. Schoene D, Valenzuela T, Lord SR, et al. The effect of interactive
Peer reviewers on this manuscript have no relevant financial or other cognitive-motor training in reducing fall risk in older people:
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ORCID BMC Neurosci. 2013;14(1):103.
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Markus Gerber http://orcid.org/0000-0001-6140-8948 resistance training on executive function. J Cognit Enhancement.
Serge Brand http://orcid.org/0000-0003-2175-2765 2018;2(2):200–207.
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