{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:25:33Z","timestamp":1790342733216,"version":"4.1.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009128","name":"Research for Patient Benefit Programme","doi-asserted-by":"publisher","award":["NIHR205389"],"award-info":[{"award-number":["NIHR205389"]}],"id":[{"id":"10.13039\/501100009128","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Falls among older adults pose a significant public health challenge, as they lead to severe outcomes such as fractures and loss of independence. Research has shown that training cognitive function and balance simultaneously, termed Dual-Task (DT) training, improves mobility and reduces fall risks in older adults. This study aims to evaluate the feasibility and acceptability of a blended supervised and self-directed technology-based DT training programme for older adults who have high risk of falling. This is a single-arm, non-randomised feasibility study employing quantitative and qualitative methods. Fifty healthy adults aged 65 years or above will be recruited from the NHS primary and secondary care pathways and from the community. Participants will undergo supervised cognitive and balance DT training for 12 weeks, followed by self-directed DT training for an additional 12 weeks. The cognitive training will be delivered using a commercial mobile application (app) available from the AppStore or Google Play. The balance training will involve static (Marching on the spot, Tandem Stand, Hip Abduction &amp; Extension, Squats, Tiptoe Stand, and Pendulum\/Sideways Sway) and dynamic (Figure of Eight Walk, Walking Forwards and Backwards, Lunges, Functional Reach, Toe Tapping, Upper Limb Strength Exercises, and Side-Steps\/Simple Grapevine) exercises focused on improving balance, postural stability and strength. Feasibility outcomes will be recruitment, adherence, usage of the app, and attrition. Outcomes measure data, that will be collected at baseline and at 24 weeks, includes the Timed- Up and Go (TUG) test (likely primary outcome in any future trial), along with self-reported questionnaires assessing cognition, fear of falling, quality of life, healthcare service usage, and the self-reported number of falls. Focus group interviews will be conducted with thirty participants and thirty healthcare professionals for in-depth exploration of the feasibility and acceptability of the DT training programme.<\/jats:p>","DOI":"10.1371\/journal.pone.0314829","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:28:45Z","timestamp":1742862525000},"page":"e0314829","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Supervised and self-directed technology-based dual-task exercise training programme for older adults at risk of falling \u2013 Protocol for a feasibility study"],"prefix":"10.1371","volume":"20","author":[{"given":"Prerna","family":"Mathur","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1811-3946","authenticated-orcid":true,"given":"Magdalena","family":"Chechlacz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afroditi","family":"Stathi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Goodyear","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Krauss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Ives","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2498-8407","authenticated-orcid":true,"given":"Laura","family":"Magill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Kinghorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4200-5243","authenticated-orcid":true,"given":"Shin-Yi","family":"Chiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"pone.0314829.ref001","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/1471-2318-14-107","article-title":"The effect of interactive cognitive-motor training in reducing fall risk in older people: a systematic review","volume":"14","author":"D Schoene","year":"2014","journal-title":"BMC Geriatr"},{"key":"pone.0314829.ref002","year":"2021"},{"issue":"2","key":"pone.0314829.ref003","doi-asserted-by":"crossref","first-page":"31","DOI":"10.22540\/JFSF-05-031","article-title":"Dual-task exercises in older adults: a structured review of current literature","volume":"5","author":"LA Varela-V\u00e1squez","year":"2020","journal-title":"J Frailty Sarcopenia Falls"},{"key":"pone.0314829.ref004","year":"2022"},{"key":"pone.0314829.ref005","doi-asserted-by":"crossref","first-page":"101452","DOI":"10.1016\/j.arr.2021.101452","article-title":"Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis","volume":"71","author":"T Chantanachai","year":"2021","journal-title":"Ageing Res Rev"},{"issue":"4","key":"pone.0314829.ref006","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jamda.2016.10.008","article-title":"Falls, cognitive impairment, and gait performance: results from the GOOD initiative","volume":"18","author":"G Allali","year":"2017","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0314829.ref007","article-title":"Cognition and mobility with aging","author":"KZH Li","year":"2018","journal-title":"Oxford Research Encyclopedia of Psychology"},{"issue":"6","key":"pone.0314829.ref008","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1097\/JGP.0b013e3181ef7a2e","article-title":"Cognitive function is associated with the development of mobility impairments in community-dwelling elders","volume":"19","author":"AS Buchman","year":"2011","journal-title":"Am J Geriatr Psychiatry"},{"key":"pone.0314829.ref009","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.gaitpost.2016.08.028","article-title":"A systematic review and meta-analysis of cross-sectional studies examining the relationship between mobility and cognition in healthy older adults","volume":"50","author":"N Demnitz","year":"2016","journal-title":"Gait Posture"},{"key":"pone.0314829.ref010","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.gaitpost.2018.06.116","article-title":"Cognition and mobility show a global association in middle- and late-adulthood: Analyses from the Canadian Longitudinal Study on Aging","volume":"64","author":"N Demnitz","year":"2018","journal-title":"Gait Posture"},{"issue":"1","key":"pone.0314829.ref011","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.physio.2015.04.011","article-title":"Dual-task testing to predict falls in community-dwelling older adults: a systematic review","volume":"102","author":"SW Muir-Hunter","year":"2016","journal-title":"Physiotherapy"},{"issue":"6","key":"pone.0314829.ref012","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.neucli.2020.10.008","article-title":"Can dual-task paradigms predict Falls better than single task? - A systematic literature review","volume":"50","author":"M Bayot","year":"2020","journal-title":"Neurophysiol Clin"},{"issue":"2","key":"pone.0314829.ref013","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/ageing\/afu175","article-title":"Cognitive motor interference for preventing falls in older adults: a systematic review and meta-analysis of randomised controlled trials","volume":"44","author":"X Wang","year":"2015","journal-title":"Age Ageing"},{"key":"pone.0314829.ref014","doi-asserted-by":"crossref","first-page":"289","DOI":"10.3389\/fpubh.2016.00289","article-title":"Behavior change with fitness technology in sedentary adults: a review of the evidence for increasing physical activity","volume":"4","author":"AN Sullivan","year":"2017","journal-title":"Front Public Health"},{"key":"pone.0314829.ref015","doi-asserted-by":"crossref","first-page":"111434","DOI":"10.1016\/j.exger.2021.111434","article-title":"A novel cognitive-motor exercise program delivered via a tablet to improve mobility in older people with cognitive impairment - StandingTall Cognition and Mobility","volume":"152","author":"ML Callisaya","year":"2021","journal-title":"Exp Gerontol"},{"issue":"12","key":"pone.0314829.ref016","doi-asserted-by":"crossref","first-page":"e039054","DOI":"10.1136\/bmjopen-2020-039054","article-title":"Feasibility and acceptability study on the use of a smartphone application to facilitate balance training in the ageing population","volume":"10","author":"E Papi","year":"2020","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0314829.ref017","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1519\/JPT.0000000000000095","article-title":"Adherence to technology-based exercise programs in older adults: a systematic review","volume":"41","author":"T Valenzuela","year":"2018","journal-title":"J Geriatr Phys Ther"},{"issue":"4","key":"pone.0314829.ref018","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1159\/000517918","article-title":"Personalized exercise programs based upon remote assessment of motor fitness: a pilot study among healthy people aged 65 years and older","volume":"68","author":"Y Netz","year":"2022","journal-title":"Gerontology"},{"issue":"1 Suppl","key":"pone.0314829.ref019","first-page":"62S-9S","article-title":"A randomized trial to measure the impact of a community-based cognitive training intervention on balance and gait in cognitively intact Black older adults","volume":"41","author":"RL Smith-Ray","year":"2014","journal-title":"Health Educ Behav"},{"issue":"1","key":"pone.0314829.ref020","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.2196\/mhealth.8619","article-title":"Prevalence of health app use among older adults in Germany: national survey","volume":"6","author":"P Rasche","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"issue":"1","key":"pone.0314829.ref021","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1186\/s12877-020-01880-6","article-title":"Map the apps: a rapid review of digital approaches to support the engagement of older adults in strength and balance exercises","volume":"20","author":"L McGarrigle","year":"2020","journal-title":"BMC Geriatr"},{"issue":"1","key":"pone.0314829.ref022","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1186\/s12889-021-11623-w","article-title":"Barriers and facilitators to the use of e-health by older adults: a scoping review","volume":"21","author":"J Wilson","year":"2021","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0314829.ref023","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1093\/ageing\/afy164","article-title":"Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults: systematic review and meta-analysis","volume":"48","author":"KJ Hughes","year":"2019","journal-title":"Age Ageing"},{"issue":"5","key":"pone.0314829.ref024","first-page":"347","article-title":"Effects of exergame-based dual-task training on executive function and dual-task performance in community-dwelling older people: a randomized-controlled trial","volume":"10","author":"R-Y Wang","year":"2021","journal-title":"Games Health J"},{"key":"pone.0314829.ref025","author":"PEAK-Brain Training App"},{"key":"pone.0314829.ref026","unstructured":"Ltd. SL. Peak (Version 5.34.9) [Mobile Application Software]; 2024."},{"issue":"3","key":"pone.0314829.ref027","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.jclinepi.2011.07.011","article-title":"The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency","volume":"65","author":"J Sim","year":"2012","journal-title":"J Clin Epidemiol"},{"key":"pone.0314829.ref028","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/1745-6215-15-264","article-title":"Sample size requirements to estimate key design parameters from external pilot randomised controlled trials: a simulation study","volume":"15","author":"MD Teare","year":"2014","journal-title":"Trials"},{"issue":"2","key":"pone.0314829.ref029","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j..2002.384.doc.x","article-title":"Design and analysis of pilot studies: recommendations for good practice","volume":"10","author":"GA Lancaster","year":"2004","journal-title":"J Eval Clin Pract"},{"issue":"12","key":"pone.0314829.ref030","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1093\/gerona\/63.12.1325","article-title":"Guest editorial: linking thinking, walking, and falling","volume":"63","author":"NB Alexander","year":"2008","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0314829.ref031","first-page":"64","article-title":"Neuropsychological mechanisms of falls in older adults","volume":"6","author":"Y Liu","year":"2014","journal-title":"Front Aging Neurosci"},{"issue":"1","key":"pone.0314829.ref032","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/epirev\/mxs004","article-title":"The dynamic relationship between physical function and cognition in longitudinal aging cohorts","volume":"35","author":"SAP Clouston","year":"2013","journal-title":"Epidemiol Rev"},{"issue":"11","key":"pone.0314829.ref033","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s11910-023-01305-y","article-title":"The association between cognitive domains and postural balance among healthy older adults: a systematic review of literature and meta-analysis","volume":"23","author":"N Divandari","year":"2023","journal-title":"Curr Neurol Neurosci Rep"},{"issue":"4","key":"pone.0314829.ref034","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1093\/geront\/gnt075","article-title":"Multiple levels of influence on older adults\u2019 attendance and adherence to community exercise classes","volume":"54","author":"H Hawley-Hague","year":"2014","journal-title":"Gerontologist"},{"issue":"3","key":"pone.0314829.ref035","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1123\/japa.14.3.344","article-title":"Social-cognitive determinants of physical activity attendance in older adults","volume":"14","author":"F Lucidi","year":"2006","journal-title":"J Aging Phys Act"},{"issue":"Suppl 2","key":"pone.0314829.ref036","doi-asserted-by":"crossref","first-page":"ii3","DOI":"10.1093\/heapol\/czw082","article-title":"District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia","volume":"31","author":"BI Avan","year":"2016","journal-title":"Health Policy Plan"},{"issue":"9","key":"pone.0314829.ref037","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1093\/ptj\/80.9.896","article-title":"Predicting the probability for falls in community-dwelling older adults using the timed up & go test","volume":"80","author":"A Shumway-Cook","year":"2000","journal-title":"Physical Therapy"},{"key":"pone.0314829.ref038","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.2147\/CIA.S86001","article-title":"Assessment of the risk of falling with the use of timed up and go test in the elderly with lower extremity osteoarthritis","volume":"10","author":"E Zasadzka","year":"2015","journal-title":"Clin Interv Aging"},{"issue":"6","key":"pone.0314829.ref039","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.jalz.2011.02.007","article-title":"The measurement of everyday cognition: development and validation of a short form of the everyday cognition scales","volume":"7","author":"S Tomaszewski Farias","year":"2011","journal-title":"Alzheimers Dement"},{"issue":"3","key":"pone.0314829.ref040","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/WAD.0000000000000450","article-title":"The measurement of everyday cognition (ECog): revisions and updates","volume":"35","author":"ST Farias","year":"2021","journal-title":"Alzheimer Dis Assoc Disord"},{"issue":"2","key":"pone.0314829.ref041","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1093\/ageing\/afp225","article-title":"The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study","volume":"39","author":"K Delbaere","year":"2010","journal-title":"Age Ageing"},{"issue":"10","key":"pone.0314829.ref042","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"M Herdman","year":"2011","journal-title":"Qual Life Res"},{"issue":"1","key":"pone.0314829.ref043","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1186\/s12913-023-10011-x","article-title":"Development of a brief, generic, modular resource-use measure (ModRUM): piloting with patients","volume":"23","author":"K Garfield","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0314829.ref044","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1186\/s12889-021-11398-0","article-title":"Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study","volume":"21","author":"VA Goodyear","year":"2021","journal-title":"BMC Public Health"},{"issue":"4","key":"pone.0314829.ref045","doi-asserted-by":"crossref","first-page":"e316","DOI":"10.1016\/S2468-2667(22)00004-4","article-title":"Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: the REACT (Retirement in Action) randomised controlled trial","volume":"7","author":"A Stathi","year":"2022","journal-title":"Lancet Public Health"},{"key":"pone.0314829.ref046","volume-title":"IBM SPSS Statistics for Windows. 29.0.2.0 ed","year":"2023"},{"issue":"13","key":"pone.0314829.ref047","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1056\/NEJM199409293311301","article-title":"A multifactorial intervention to reduce the risk of falling among elderly people living in the community","volume":"331","author":"ME Tinetti","year":"1994","journal-title":"N Engl J Med"},{"issue":"Suppl 2","key":"pone.0314829.ref048","first-page":"S193","article-title":"Translating research into clinical practice. Abstracts of the Seventh International Symposium on Osteoporosis. April 18-22, 2007. Washington, DC, USA","volume":"18","author":"MW Anne Shumway-Cook","year":"2007","journal-title":"Osteoporos Int"},{"key":"pone.0314829.ref049","year":"2022"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0314829","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:30:46Z","timestamp":1742862646000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0314829"}},"subtitle":[],"editor":[{"given":"Marianne","family":"Clemence","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,24]]},"references-count":49,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0314829","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.11.19.24317600","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,24]]}}}