Effects of dual-task training on gait and balance in post-stroke individuals: a systematic review with meta-analysis

Procópio, Ally Summer Santiago; Portilho, Deivid Barbosa; Avelino, Patrick Roberto; Menezes, Kênia Kiefer Parreiras de

doi:10.1590/1809-2950/e24005024en

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 32 • 2025 • https://doi.org/10.1590/1809-2950/e24005024en linkcopy

Effects of dual-task training on gait and balance in post-stroke individuals: a systematic review with meta-analysis

Efectos del entrenamiento de doble tarea sobre la marcha y el equilibrio de los individuos después del accidente cerebrovascular: una revisión sistemática con metaanálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This article aims to investigate the effects of dual-task training in the gait and balance of post-stroke individuals via a systematic review with meta-analysis of clinical trials with adequate methodological quality. Searches in the electronic databases PubMed, Lilacs, SciELO, PEDro, up to September 2024, by two independent researchers. We included randomized clinical trials, with dual-task training in post-stroke individuals, with an average PEDro scale score of six or higher. The outcome measures of interest were any related to gait and/or balance, which could be assessed using tests or questionnaires. Study methodological quality was assessed using the PEDro scale. Eight studies were included. Overall, dual-task training showed to be effective in improving gait speed by 0.11 m/s (95%CI 0.02–0.21; I²=11%; p=0.02), cadence by 7.30 steps/minute (95%CI 2.46–12.14; I²=0%; p=0.003), and balance (SMD 0.45; 95%CI 0.08–0.81; I²=36%; p=0.02). No significant results were found for stride length (SD 1.72; 95%CI −9.15–12.59; I²=22%; p=0.76) and mobility (95%CI −5.64–1.88; I²=0%; p=0.33). This systematic review showed, via meta-analysis, that dual-task training can significantly improve gait speed, cadence, and balance in post-stroke individuals. However, we recommend new clinical trials, with higher methodological quality, especially studying the effects on mobility and balance.

Keywords
Stroke; Dual Task; Gait; Balance; Systematic Review; Meta-analysis

Study	Participants	Intervention		Outcome measures*
		Comparison	Parameters
Ahmed et al ⁸	N=74	Experimental Group vs. Standard Interventions	Experimental Group: Side and diagonal trunk exercises with dual task.	Timed up and go (s)
	Age (years) = 61.71 (±7.99)		Control Group: More trunk movements in the sagittal plane (Sagittal Movements > Lateral and diagonal).	10-meter walk test (m/s)
	Chronic and Acute			Berg balance scale (0-56)
	Average speed = 16.59 (±3.33)			Berg balance scale (0-56)
Baek et al. ¹⁶	N=34	Experimental Group vs. Treadmill Walk	Each intervention was performed for 1 hour, twice a week for 6 weeks for both groups.	OptoGait (Speed – m/s; stride length – cm; and cadence – steps/min.)
	Age (years) = 56.53 (±9.52)		Experimental Group: Treadmill training in conjunction with cognitive tasks, with mental tracking, verbal fluency, etc. Followed by simple exercises.
	Chronic		Control Group: Treadmill gait training, no additional tasks (dual task), and performs the same cognitive tasks of the EG off the treadmill.
	Average speed = 0.38 (±0.16)
Cho et al. ¹⁷	N=22	Experimental Group vs. Treadmill Walk	All subjects performed the standard intervention program containing physical exercise and occupational therapy	GAITRite system (Speed – m/s; stride length – cm; and cadence – steps/min.)
	Age (years) = 59.32 (±10.62)		Experimental Group: Standard intervention + treadmill walk, subjects performed cognitive tasks (memory, arithmetic and verbal tasks) for 4 weeks, 30 min/day, five days a week.
	Chronic		Control Group = Standard intervention + treadmill walk.
	Average speed = 41.32 (±11.09)		Control Group = Standard intervention + treadmill walk.
Kim et al. ¹⁸	N=30	Experimental Group vs. Treadmill Walk	All subjects had 20 sessions, five times a week, for 4 weeks.	GAITRite system (Speed – m/s; stride length – cm; and cadence – steps/min.)
	Age (years) = 54.38 (±10.33)		Experimental Group = Treadmill gait + cognitive tasks.	10-meter walk test (m/s)
	Chronic		Control Group = Conventional treadmill walk.
	Average speed = 43.63 (±11.23)		Control Group = Conventional treadmill walk.
Meester et al. ¹⁹	N=50	Experimental Group vs. Treadmill Walk	There were 20 biweekly sessions for 10 weeks, with 30 minutes in aerobic training intensity (55-85% of max HR).	2-minute walk test (m)
	Age (years) = 61.55 (±15.19)		Experimental Group = Dual-task treadmill training = distractions with cognitive and verbal tasks, for 10 minutes in each task.
	Chronic		Control Group = Treadmill walk with as few distractions as possible.
	Average speed = 55.36 (±24.05)
Pang et al. ⁷	N=84	Experimental Group vs. Single-Task Group vs. Control Group	Experimental Group = Dual-task training (exercises with mobility/balance and cognitive tasks) for 30 min + 30 min of flexibility exercises.	Activities-specific balance confidence (ABC) scale
	Age (years) = 61.2 (±6.4)		Control Group = Same mobility and balance training as the EG, but without cognitive tasks for 30 min. Subsequently, the same cognitive activities as the EG, however, sitting.
	Chronic		Control Group = Only flexibility exercises for all limbs and strengthening for upper limbs.
	Average speed = 21.66
Plummer et al. ²⁰	N=36	Experimental Group vs. Standard Interventions	Experimental Group = 12 sessions of 30 min, three times a week for 4 weeks. Weight discharge, standing balance, natural speech, arithmetic, etc.	10-meter walk test (m/s)
	Age (years) = 57 (±15.45)		Control Group = Same training as the EG, but without simultaneous cognitive tasks. Participants were instructed as to not speaking during gait and balance training.	Timed up and go (s)
	Chronic			Activities-specific balance confidence (ABC) scale.
	Average speed = 7.42 (±6.60)			Activities-specific balance confidence (ABC) scale.
Yang et al. ¹⁵	N=25	Experimental Group vs. Control Group	Experimental Group = Ball exercises for 30 min, three times a week, for 4 weeks. Participants should walk with one or two balls in their hands; bounce the ball with one or two hands while walking, etc.	GAITRite system (Speed – m/s; stride length – cm; and cadence – steps/min.)
	Age (years) = 59.31 (±11.90)		Control Group = No intervention.
	Chronic
	Average speed = 63.39 (±12.36)

Criteria	Ahmed et al. ⁸	Yang et al. ¹⁵	Baek et al. ¹⁶	Cho et al. ¹⁷	Kim et al. ¹⁸	Meester et al. ¹⁹	Pang et al. ⁷	Plummer et al. ²⁰
Randomization	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Blinding of the distribution of participants	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes
Initial similarity between groups	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Blinding of participants	No	No	No	No	Yes	No	No	No
Blinding of therapists	No	No	No	No	No	No	No	No
Blinding of evaluators	Yes	Yes	Yes	No	No	Yes	Yes	Yes
Adequate Follow-up	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes
Primary outcome measures “Intention to treat”	Yes	No	No	Yes	Yes	No	Yes	Yes
Intergroup comparison of primary outcome	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Accuracy and variability measures for at least one outcome	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Total	8	7	7	7	7	6	8	8

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[1] *Although the studies may have studied the effects on other outcome measures, only those of interest were reported.