Effects of the six-month training on cognitive, physical performance, and daily physical activity in older adults

INTERVENTION: Participants follow a six months guided training intervention. Training sessions take place twice weekly for one hour each session. Subjects are randomized into three groups with different training programs. The participants of all three training groups will practice a basic training program consisting of strength and balance exercises. Strength exercises are performed using own body weight, small barbells, weight‐wests, and resistive rubber‐bands. The intensity of these exercises is increased progressively and performed with high movement velocity (power training). Participants are accustomed slowly to the exercises and are continuously monitored by the instructors. 1. Intervention group one (video‐game dancing): This group executes virtual‐reality video‐game dance training in addition to the strength and balance exercises. For the dance training, participants follow the step instructions (arrows) presented on a computer screen. Movements have to be carried out with the rhythm of the music. Participants are standing on a pressure‐sensitive platform, which records right and false movements. For security reasons, participants hold on to ropes that are attached to the ceiling. 2. Intervention group two (dual‐task walking): This group also performs strength and balance exercises as a basic training program. Additionally, this group executes dual‐task training with walking on a treadmill while doing memory exercises presented on a computer screen. 3. Intervention group three (control group, treadmill walking): This group acts as a control group and does treadmill walking without any cognitive tasks, in addition to the basic strength and balance training. CONDITION: Geriatrics related conditions of independent living and community dwelling in old adults ; Not Applicable PRIMARY OUTCOME: 1. Study part A (cognition and gait): ; 1.1 Test battery for cognitive function; 1.2 Test for attention and concentration: age concentration test (AKT); 1.3 Processing speed: digit‐symbols‐test [revised Hamburg‐Wechsler Intelligence Test for Adults (HAWIE‐R)]; 1.4 Memory: reproduce story [Wechsler Memory Scale‐Revised (WMS‐R)]; 1.4.1 Memory: pair associate learning (IGD); 1.4.2 Working memory: executive control (IGD); 1.4.3 Short time memory: digit span forward/backward (WMS‐R); 1.5 Fluid intelligence: Raven's matrices test; 1.6 Attention: Trailmaking A and B test; 2. Study part B (aerobic performance and executive function):; 2.1. Heart‐rate‐variability, Six‐minute walking test: Participants walk as far as possible within six minutes. Participants walk back and forth on a 30‐meter track. Measures: walking distance; heart rate variability at rest, during the walk, and at recovery; heart rate recovery during five minutes after the walk; 2.2. Executive function: Tests 1.2, 1.4.2, and 1.6 (see above); 3. Study part C (prevention of falls and one year follow up):; 3.1. Falls: With a fall‐diary, the frequency and severity of falls is assessed during the six months training phase and one year thereafter. ; 3.2. Fear of falling: The Falls Efficacy Scale International (FES‐I) questionnaire is used as a measure of 'concern' about falling, to determine the transfer effects of training to activities of daily living. This scale assesses both easy and difficult physical activities and social activities with a scale of: 1 = not at all concerned, 2 = somewhat concerned, 3 = fairly concerned, 4 = very concerned. ; ; All measures are assessed pre‐intervention, after three months, and after six months (post‐intervention). Falls measures and some selected other measures are again assessed one‐year post‐intervention. INCLUSION CRITERIA: 1. Age over 70 years 2. Signed informed consent statement 3. Ability to walk at least 20 meters with or without walking aids 4. Independent living or community dwelling SECONDARY OUTCOME: 1. Study part A (cognition and gait): ; 1.1. Gait parameters are assessed with the GAITRite system (CIR Systems, USA). The GAITRite system provides temporal (time) and spatial (distance) gait parameters via an electronic walkway connected to the serial port of a personal computer. The GAITRite walkway contains sensor pads encapsulated in a roll‐up carpet with an active area of 7.3m long. As the subject walks through the walkway, the sensors capture each footfall as a function of time and transfer the information to a personal computer. ; 2. Study part B (aerobic performance and executive function):; 2.1. With the Short Physical Performance Battery (SPPB) the lower extremity functioning will be assessed. This test battery consists of a balance test, a 3‐meter gait test, and a 5‐chair‐rise test. The sum of the three components comprises the final SPPB score with a possible range from 0 to 12 (12 indicating the highest degree of lower extremity functioning). The SPPB was developed by the U.S.A. National Institute of Aging. ; 2.2. Body fat percentage and muscle mass is measured by means of bioelectrical impedance analysis (BIA). The leg‐to‐leg BIA system provides a simple and highly reproducible assessment for the body composition for groups. ; 3. Study part C (prevention of falls and one year follow up):; 3.1. Daily physical activity is recorded using accelerometers (StepWatch, Orthocare Innovations, USA). These will be worn during one week. The StepWatch accelerometer can be used as a valid device to assess physical activity in community‐dwelling older adults. ; 3.2. Using the geriatric depression scale (GDS) symptoms of depression are recorded. The German version of the GDS has a good validity and reliability.