The effects of high intensity functional exercise and simultaneous dual-task training in older adults

a randomized controlled trial study protocol

Authors

DOI:

https://doi.org/10.15448/2357-9641.2026.1.48581

Keywords:

Dual task, Older adults, Functional capacity, Cognition

Abstract

Aims: This study aims to evaluate the impact of a high intensity functional exercise program, with or without simultaneous cognitive training in a dual-task format, on the primary outcomes of balance, functional capacity, and cognitive performance in community-dwelling older adults, with the primary outcome of improved gait quality, measured by the reduction in execution time on the three meter walk test.

Methods: A double-blind randomized controlled trial will be conducted with older adults aged 60 years or older. Participants will be randomly assigned to either a standalone high-intensity functional exercise program (single-task group) or the same program combined with simultaneous cognitive challenges (dual-task group) over 12 weeks. Physical and cognitive outcomes will be assessed before and after the intervention using validated measures, including the Timed Up and Go test, Mini-BESTest, Montreal
Cognitive Assessment, Trail Making Test, and Digit Span Test, among others. The sample size was estimated at 44 participants (22 per group), considering a statistical power of 95% and a dropout rate of 20%, based on previous studies with a similar design.

Results: The dual-task group is expected to show more significant improvements in balance, physical function, and cognitive performance compared to the single-task group, demonstrating the superiority of high-intensity motor-cognitive training.

Conclusions: If confirmed, dual-task training may be considered an effective and accessible intervention to improve the physical and cognitive health of older adults, contributing to a reduced risk of falls and associated healthcare costs. This study will provide important evidence supporting the integration of cognitive challenges into exercise programs aimed at maximizing benefits for this population.

Trial registration: The trial has been prospectively registered in the Brazilian Registry of Clinical Trials (RBR-107mtjc8).

Downloads

Download data is not yet available.

Author Biographies

João Vítor El H. Szortyka, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.

Undergraduate student in Physiotherapy at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA). Has academic interest in aging, cognition, and dual-task training in older adults.

Mariane Ronconi, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.

Undergraduate student in Physiotherapy at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA). Has academic interest in aging, cognition, and dual-task training in older adults.

Adriana T. de Lemos, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.

Holds a degree in Physiotherapy from Centro Universitário Metodista (2003), a degree in Physical Education from the Federal University of Rio Grande do Sul (2007), a Master’s degree in Human Movement Sciences from the Federal University of Rio Grande do Sul (2007), and a PhD in Human Movement Sciences from the same institution (2012). Currently, she is an Associate Professor at the Federal University of Health Sciences of Porto Alegre. She has experience in the fields of Physiotherapy, Public Health, and Occupational Health.

Felipe de S. Stigger, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.

Holds a degree in Physiotherapy from Centro Universitário Metodista IPA (2004), a Master’s degree in Neurosciences from the Federal University of Rio Grande do Sul (UFRGS – 2010), and a PhD from the same graduate program (2013). During the Master’s and PhD studies, worked at the Comparative Histophysiology Laboratory of the Institute of Basic Health Sciences (ICBS/UFRGS). Currently an Assistant Professor in the Physiotherapy program at the Federal University of Health Sciences of Porto Alegre. Has experience in Clinical and Neurofunctional Physiotherapy, with a focus on geriatrics and gerontology. Current research focuses on the Neurobiology of Rehabilitation, investigating the effects of different exercise modalities on nervous system plasticity and functional outcomes.

References

1. Chalise HN. Aging: Basic Concept. Am J Biomed Sci Res [Internet]. 2019 [cited 2025 Dec 23];1(1):8–10. Available from: https://biomedgrid.com/fulltext/volume1/aging-basic-concept.ID.000503.php.

2. Minetto MA, Giannini A, McConnell R, Busso C, Torre G, Massazza G. Common Musculoskeletal Disorders in the Elderly: The Star Triad. J Clin Med [Internet]. 2020 [cited 2025 Dec 23];9(4):1216. Available from: https://doi.org/10.3390/jcm9041216.

3. Blanco‐Blanco J, Albornos‐Muñoz L, Costa‐Menen MÀ, García‐Martínez E, Rubinat‐Arnaldo E, Martínez‐Soldevila J, et al. Prevalence of falls in noninstitutionalized people aged 65−80 and associations with sex and functional tests: A multicenter observational study. Res Nurs Health [Internet]. 2022 [cited 2025 Dec 23];45(4):433–45. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9543892/.

4. Souza AQ, Pegorari MS, Nascimento JS, Oliveira PB, Tavares DMS. Incidência e fatores preditivos de quedas em idosos na comunidade: um estudo longitudinal. Ciênc Saúde Colet [Internet]. 2019 [cited 2025 Dec 23];24(9):3507–16. Available from: https://doi.org/10.1590/1413-81232018249.30512017.

5. Sherrington C, Fairhall N, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev [Internet]. 2019 [cited 2025 Dec 23];1(1):CD012424. Available from: https://doi.org/10.1002/14651858.CD012424.pub2.

6. Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, et al. Exercise to Prevent Falls in Older adults: an Updated Systematic Review and meta-analysis. Br J Sports Med [Internet]. 2016 [cited 2025 Dec 23];51(24):1750–8. Available from: https://doi.org/10.1136/bjsports-2016-096547.

7. Rosendahl E, Lindelöf N, Littbrand H, Yifter-Lindgren E, Lundin-Olsson L, Håglin L, et al. High-intensity functional exercise program and proteinenriched energy supplement for older persons dependent in activities of daily living: A randomised controlled trial. Aust J Physiother [Internet]. 2006 [cited 2025 Dec 23];52(2):105–13. Available from: https://doi.org/10.1016/S0004-9514(06)70045-9.

8. Heinrich KM, Becker C, Carlisle T, Gilmore K, Hauser J, Frye J, et al. High-intensity functional training improves functional movement and body composition among cancer survivors: a pilot study. Eur J Cancer Care (Engl) [Internet]. 2015 [cited 2025 Dec 23];24(6):812–7. Available from: https://doi.org/10.1111/ecc.12338.

9. Harada CN, Natelson Love MC, Triebel KL. Normal Cognitive Aging. Clin Geriatr Med [Internet]. 2013 [cited 2025 Dec 23];29(4):737–52. Available from: https://www.geriatric.theclinics.com/article/S0749-0690(13)00059-1/abstract.

10. Varela-Vásquez LA, Minobes-Molina E, Jerez-Roig J. Dual-task exercises in older adults: A structured review of current literature. J Frailty Sarcopenia Falls [Internet]. 2020 [cited 2025 Dec 23];5(2):31–7. Available from: https://www.jfsf.eu/article/5/31.

11. Park JH. Is Dual-Task Training Clinically Beneficial to Improve Balance and Executive Function in Community-Dwelling Older Adults with a History of Falls? Int J Environ Res Public Health [Internet]. 2022 [cited 2025 Dec 23];19(16):10198. Available from: https://doi.org/10.3390/ijerph191610198.

12. Trombini-Souza F, Moura VTF, Silva LWN, Leal IS, Nascimento CA, Silva PST, et al. Effects of two different dual-task training protocols on gait, balance, and cognitive function in community-dwelling older adults: a 24-week randomized controlled trial [Internet]. 2023 [cited 2025 Dec 23];11:e15030–0. Available from: https://peerj.com/articles/15030/.

13. Ye JY, Chen R, Chu H, Lin HC, Liu D, Jen HJ, et al. Dual-task training in older adults with cognitive impairment: A meta-analysis and trial sequential analysis of randomized controlled trials. Int J Nurs Stud [Internet]. 2024 [cited 2025 Dec 23];155:104776. Available from: https://doi.org/10.1016/j.ijnurstu.2024.104776.

14. Liang W, Wang X, Cheng S, Jiao J, Zhu X, Duan Y. Effects of High-Intensity Interval Training on the Parameters Related to Physical Fitness and Health of Older Adults: A Systematic Review and Meta-Analysis. Sports Med [Internet] 2024 [cited 2025 Dec 23];10(1):98. Available from: https://link.springer.com/article/10.1186/s40798-024-00767-9.

15. McIsaac TL, Lamberg EM, Muratori LM. Building a Framework for a Dual Task Taxonomy. Biomed Res Int [Internet]. 2015 [cited 2025 Dec 23];2015:1–10. Available from: https://doi.org/10.1155/2015/591475.

16. Rosendahl E, Gustafson Y, Nordin E, Lundin-Olsson L, Nyberg L. A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities. Aging Clin Exp Res [Internet]. 2008 [cited 2025 Dec 23];20(1):67–75. Available from: https://link.springer.com/article/10.1007/BF03324750.

17. Bohannon RW. Reference Values for the Timed Up and Go Test. J Geriatr Phys Ther [Internet]. 2006 [cited 2025 Dec 23];29(2):64–8. Available from: https://journals.lww.com/jgpt/abstract/2006/08000/reference_values_for_the_timed_up_and_go_test__a.4.aspx.

18. Maia AC, Rodrigues-de-Paula F, Magalhaes LC, Teixeira RLL. Cross-cultural adaptation and analysis of the psychometric properties of the Balance Evaluation Systems Test and MiniBESTest in the elderly and individuals with Parkinson’s disease: application of the Rasch model. Braz J Phys Ther [Internet]. 2013 [cited 2025 Dec 23];17(3):195–217. Available from: https://doi.org/10.1590/S1413-35552012005000085.

19. Liao WY, Chu YH, Liu FY, Chang KM, Chou LW. Cutoff Point of Mini-Balance Evaluation Systems Test Scores for Elderly Estimated by Center of Pressure Measurements by Linear Regression and Decision Tree Classification. Life [Internet]. 2022 [cited 2025 Dec 23];12(12):2133. Available from: https://doi.org/10.3390/life12122133.

20. Gómez JF, Curcio CL, Alvarado B, Zunzunegui MV, Guralnik J. Validity and reliability of the Short Physical Performance Battery (SPPB): a pilot study on mobility in the Colombian Andes. Colomb Med [Internet]. 2013 [cited 2025 Dec 23];44(3):165–71. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4002038/pdf/1657-9534-cm-44-03-00165.pdf.

21. Silva CFB, Ohara DG, Matos AP, Pinto ACPN, Pegorari MS. Short Physical Performance Battery as a Measure of Physical Performance and Mortality Predictor in Older Adults: A Comprehensive Literature Review. Int J Environ Res Public Health [Internet]. 2021 [cited 2025 Dec 23];18(20):10612. Available from: https://doi.org/10.3390/ijerph182010612.

22. Ferreira S, Raimundo A, Marmeleira J. Test-retest reliability of the functional reach test and the hand grip strength test in older adults using nursing home services. Ir J Med Sci [Internet]. 2021 [cited 2025 Dec 23];190(4):1625–32. Available from: https://link.springer.com/article/10.1007/s11845-020-02492-0.

23. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional Reach: A New Clinical Measure of Balance. J Gerontol [Internet]. 1990 [cited 2025 Dec 23];45(6):M192–7. Available from: https://doi.org/10.1093/geronj/45.6.M192.

24. Balachandran AT, Vigotsky AD, Quiles N, Mokkink LB, Belio MA, Glenn JM. Validity, reliability, and measurement error of a sit-to-stand power test in older adults: A pre-registered study. Exp Gerontol [Internet]. 2021 [cited 2025 Dec 23];145:111202. Available from: https://doi.org/10.1016/j.exger.2020.111202.

25. Bohannon RW, Crouch R. 1-Minute Sit-to-Stand Test. J Cardiopulm Rehabil Prev [Internet]. 2019 [cited 2025 Dec 23]39(1):2–8. Available from: https://journals.lww.com/jcrjournal/abstract/2019/01000/1_minute_sit_to_stand_test__systematic_review_of.2.aspx.

26. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc [Internet]. 2005 [cited 2025 Dec 23]53(4):695–9. Available from: https://doi.org/10.1111/j.1532-5415.2005.53221.x.

27. Daniel B, Agenagnew L, Workicho A, Abera M. Psychometric properties of the montreal cognitive assessment (moca) to detect major neurocognitive disorder among older people in ethiopia: A validation study. Neuropsychiatr Dis Treat [Internet]. 2022 [cited 2025 Dec 23];18:1789–98. Available from: https://doi.org/10.2147/NDT.S377430.

28. Llinàs-Reglà J, Vilalta-Franch J, López-Pousa S, Calvó-Perxas L, Torrents Rodas D, Garre-Olmo J. The Trail Making Test. Assessment [Internet]. 2017 [cited 2025 Dec 23];24(2):183–96. Available from: https://doi.org/10.1177/1073191115602.

29. Periáñez JA, Lubrini G, García-Gutiérrez A, Ríos-Lago M. Construct Validity of the Stroop Color-Word Test: Influence of Speed of Visual Search, Verbal Fluency, Working Memory, Cognitive Flexibility, and Conflict Monitoring. Arch Clin Neuropsychol [Internet]. 2021 [cited 2025 Dec 23];36(1):99–111. Available from: https://doi.org/10.1093/arclin/acaa034.

30. Yun JY, Lee DY, Seo EH, Choo IH, Park SY, Kim SG, et al. Neural Correlates of Stroop Performance in Alzheimer’s Disease: A FDG-PET Study. Dement Geriatr Cogn Dis Extra [Internet]. 2011 [cited 2025 Dec 23];1(1):190–201. Available from: https://doi.org/10.1159/000329517.

31. Woods DL, Kishiyama MM, Yund EW, Herron TJ, Edwards B, Poliva O, et al. Improving digit span assessment of short-term verbal memory. J Clin Exp Neuropsychol [Internet]. 2011 [cited 2025 Dec 23];33(1):101–11. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2978794/pdf/nihms208687.pdf.

32. Durmaz B. Validity and Reliability of Geriatric Depression Scale - 15 (Short Form) in Turkish older adults. North Clin Istanb [Internet]. 2018 [cited 2025 Dec 23];5(3):216–20. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6323561/pdf/NCI-5-216.pdf.

33. Brañez-Condorena A, Soriano-Moreno DR, Navarro-Flores A, Solis-Chimoy B, Diaz-Barrera ME, Taype-Rondan A. Accuracy of the Geriatric Depression Scale (GDS)-4 and GDS-5 for the screening of depression among older adults: A systematic review and meta-analysis. PloS One [Internet]. 2021 [cited 2025 Dec 23];16(7):e0253899. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8248624/pdf/pone.0253899.pdf.

34. Theill N, Schumacher V, Adelsberger R, Martin M, Jäncke L. Effects of simultaneously performed cognitive and physical training in older adults. BMC Neurosci [Internet]. 2013 [cited 2025 Dec 23];14(103):1–14. Available from: https://link.springer.com/article/10.1186/1471-2202-14-103.

35. Ansai JH, Andrade LP, Rossi PG, Takahashi ACM, Vale FAC, Rebelatto JR. Gait, dual task and history of falls in elderly with preserved cognition, mild cognitive impairment, and mild Alzheimer’s disease. Braz J Phys Ther [Internet]. 2017 [cited 2025 Dec 23];21(2):144–51. Available from: https://doi.org/10.1016/j.bjpt.2017.03.010.

36. Rezola-Pardo C, Rodriguez-Larrad A, Gomez-Diaz J, Lozano-Real G, Mugica-Errazquin I, Patiño MJ, et al. Comparison Between Multicomponent Exercise and Walking Interventions in Long-Term Nursing Homes: A Randomized Controlled Trial. Meeks S, editor. Gerontologist [Internet]. 2020 [cited 2025 Dec 23];60(7):1364–73. Available from: https://doi.org/10.1093/geront/gnz177.

37. Heinrich KM, Crawford DA, Langford CR, Kehler A, Andrews V. High-Intensity Functional Training Shows Promise for Improving Physical Functioning and Activity in Community-Dwelling Older Adults: A Pilot Study. J Geriatr Phys Ther [Internet]. 2021 [cited 2025 Dec 23];44(1):9–17. Available from: https://journals.lww.com/jgpt/abstract/2021/01000/high_intensity_functional_training_shows_promise.3.aspx.

38. Teza EAR, Stigger F de S, Demarchi A, Salvi LF, Ronconi M, Szortyka JVEH, et al. High-Intensity Functional Exercises Associated or Not With Cognitive Stimulation Improves Cognition and Physical Performance in Older Adults: A Double-Blind Randomized Controlled Trial. J Aging Phys Act [Internet]. 2025 [cited 2025 Dec 23];1–10. Available from: https://doi.org/10.1123/japa.2024-0270.

39. Ali N, Tian H, Thabane L, Ma J, Wu H, Zhong Q, et al. The effects of dual-task training on cognitive and physical functions in older adults with cognitive impairment; A systematic review and meta-analysis. J Prev Alzheimers Dis [Internet]. 2022 [cited 2025 Dec 23];9(2):359–70. Available from: https://doi.org/10.14283/jpad.2022.16.

40. Casemiro FG, Pelegrini L, Fernanda, Resende MC, Aparecida R. Influence of frailty and cognitive decline on dual task performance in older adults: an analytical cross-sectional study. Rev Lat Am Enfermagem [Internet]. 2025 [cited 2025 Oct 8];33:e4485. Available from: https://doi.org/10.1590/1518-8345.7159.4485.

41. Kannan L, Pitts J, Szturm T, Purohit R, Bhatt T. Perturbation-based dual task assessment in older adults with mild cognitive impairment. Front Rehabil Sci [Internet]. 2024 [cited 2025 Dec 23];5:1384582. Available from: https://doi.org/10.3389/fresc.2024.1384582.

42. Gómez-Redondo P, Valenzuela PL, Óscar Martínez-de-Quel, Sánchez-Martín C, Mónica Cerezo-Arroyo, Moreno-Manzanaro D, et al. The role of supervision and motivation during exercise on physical and mental health in older adults: a study protocol for a randomized controlled trial (PRO-Training project). BMC Geriatr [Internet]. 2024 [cited 2025 Dec 23];24(1):274. Available from: https://link.springer.com/article/10.1186/s12877-024-04868-8.

43. Chan KOW, Yuen PP, Fong BYF, Law VTS, Ng FSF, Lee JLC, et al. Synchronous Group-Based Tele-Exercise Versus Community-Based Interventions: Effects on Physical Functioning and Adherence in Older Adults at Risk of Falls: A Randomized Controlled Trial. medRxiv [Internet]. 2024 [cited 2025 Dec 23]:1–29. Available from: https://doi.org/10.1101/2024.06.16.24308943.

Downloads

Published

2026-03-04

How to Cite

El H. Szortyka, J. V., Ronconi, M., T. de Lemos, A., & de S. Stigger, F. (2026). The effects of high intensity functional exercise and simultaneous dual-task training in older adults: a randomized controlled trial study protocol. PAJAR - Pan American Journal of Aging Research, 14(01), e48581. https://doi.org/10.15448/2357-9641.2026.1.48581

Issue

Vol. 14 No. 01 (2026): Single Volume

Section

Original Article

License

Copyright (c) 2026 João Vítor El H. Szortyka, Mariane Ronconi, Adriana T. de Lemos, Felipe de S. Stigger

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.