Dual-belt Treadmill Training with Open-skill Stepping Tasks in Day-care Rehabilitation Users: Effects on Balance and Cognition

Introduction: Day-care rehabilitation users are at high risk of falls, and pragmatic interventions deliverable within routine services are needed. Dual-belt treadmill training can provide task-specific balance challenges while maintaining a feasible dose. We examined whether adding dual-belt treadmill balance training to routine rehabilitation is associated with improvements in dynamic balance/mobility and cognition in very old adults.

Method: This single-group pre–post study included 47 day-care rehabilitation users (age 81.4±6.7 years). Participants continued routine rehabilitation (strength and aerobic training) and additionally performed dual-belt treadmill balance training once weekly for 20 minutes over 3 months (~12 sessions). The dual-belt training used an open-skill task in which random numbers were displayed on a monitor and participants moved forward/backward and side-to-side between lanes to press the corresponding target button at one of four corners, aiming to elicit both voluntary and reactive multi-directional stepping. Outcomes were assessed pre and post: Community Balance and Mobility Scale (CB&M), Trail Making Test Part A (TMT-A), Falls Efficacy Scale (FES), and Montreal Cognitive Assessment (MoCA). Paired t-tests were used for CB&M and FES; Wilcoxon signed-rank tests for TMT-A and MoCA. Effect sizes were reported as Cohen’s dz (CB&M) and rank-biserial r (MoCA). Exploratory analyses examined baseline dependency and associations between change in balance/mobility (ΔCB&M) and changes in other outcomes.

Results: CB&M improved from 41.9±16.1 to 47.2±16.1 (p<0.001; Cohen’s dz=0.69). MoCA improved from 22.0±4.5 to 23.0±5.0 (p=0.027; rank-biserial r=0.38). TMT-A and FES showed no significant pre–post changes. Greater MoCA gain occurred in those with lower baseline MoCA (r=-0.50, p<0.001). Improvements in balance/mobility were associated with cognitive change (ΔMoCA vs ΔCB&M: r=0.40, p=0.006) and with FES change (r=-0.33, p=0.024).

Conclusion: A 3-month, once-weekly dual-belt treadmill balance training added to routine day-care rehabilitation was associated with meaningful improvement in dynamic balance/mobility and a small improvement in global cognition. Future controlled studies should confirm causality and clarify which individuals benefit most.