The effect of single and dual task balance exercises on balance in degenerative lumbar spinal stenosis: a randomized controlled trial

Key points

1. 01Both exercise programs significantly improved Berg Balance Scale scores, TUG times, Tinetti scores, single leg stance, and activity-specific balance confidence (all p < 0.001).
2. 02Dual-task training produced significantly greater improvement in 10-meter walk test speed under both single-task and dual-task conditions (p = 0.002 and p = 0.003 respectively).
3. 03The single-task group showed no significant change in 10-meter walk test times after treatment (p > 0.05).
4. 04Dual-task training used progressive cognitive second tasks such as counting backward by three, verbal fluency, and arithmetic problem-solving added to standard balance exercises.
5. 05No adverse events were recorded in either group during the 4-week, 3-sessions-per-week program.

How it was conducted

Design

Randomized controlled trial

Participants

43 adults aged 65 or older with clinically and radiologically confirmed lumbar spinal stenosis

Groups

Group 1 (n=21): single-task balance training only; Group 2 (n=22): same balance training with progressive cognitive dual tasks added

Duration

4 weeks, 3 days per week, 45 minutes per session

Primary outcomes

Berg Balance Scale (BBS), Timed Up and Go (TUG), 10-meter walk test (single and dual task), Tinetti balance and gait test, single leg stance test, Activities-Specific Balance Confidence (ABC) scale

Statistical approach

Mann-Whitney U Test for between-group differences; Wilcoxon Paired-Sample Test for within-group changes

What they found

• BBS improved significantly in both groups (Group 1: 42.28 to 49.98, p < 0.001; Group 2: 43.48 to 50.16, p < 0.001); between-group comparison favored dual-task group (p = 0.031).
• TUG single-task improved in both groups (Group 1: 12.4 to 8.3 s, p < 0.001; Group 2: 12.7 to 7.4 s, p < 0.001); no significant between-group difference (p = 0.234).
• TUG dual-task improved in both groups (Group 1: 14.5 to 11.4 s, p < 0.001; Group 2: 14.3 to 12.4 s, p < 0.001); between-group comparison favored dual-task group (p = 0.045).
• 10-meter walk test single-task: no significant change in Group 1 (12.74 to 12.02 s, p = 0.456); significant improvement in Group 2 (12.19 to 8.34 s, p < 0.001); between-group difference p = 0.002.
• 10-meter walk test dual-task: no significant change in Group 1 (14.16 to 13.23 s, p = 0.345); significant improvement in Group 2 (13.91 to 7.21 s, p < 0.001); between-group difference p = 0.003.
• Tinetti total score improved significantly in both groups (Group 1: 28.15 to 33.23, p < 0.001; Group 2: 29.08 to 34.57, p < 0.001); no significant between-group difference (p = 0.089).
• Single leg stance improved in both groups (Group 1: 8.65 to 15.56 s, p < 0.001; Group 2: 9.12 to 14.45 s, p < 0.001); no significant between-group difference (p = 0.123).
• ABC scale improved in both groups (Group 1: 68.53 to 78.56, p < 0.001; Group 2: 69.45 to 80.76, p < 0.001); no significant between-group difference (p = 0.097).

Limitations

• Short follow-up of only 4 weeks with no post-treatment follow-up period, so long-term effects are unknown.
• No control group receiving no treatment, making it impossible to separate exercise effects from natural recovery or placebo effects.
• Cognitive outcomes were not measured, limiting conclusions about the cognitive benefits of dual-task training.
• Balance assessment equipment (force platforms) was not used, relying solely on clinical tests that may miss subtle neuromuscular changes.

Why it matters

For patients

Older adults with spinal stenosis can expect meaningful improvements in their balance and walking from a 4-week supervised exercise program, and adding mental challenges such as counting or word games to the exercises may help walking speed more than balance exercises alone.

For clinicians

Dual-task balance training should be considered over standard single-task balance training for patients with lumbar spinal stenosis when improving functional walking speed is a treatment goal, particularly for fall prevention in real-world multitasking situations.

For readers

This small single-centre RCT provides the first direct comparison of single- versus dual-task balance training in lumbar spinal stenosis, supporting the feasibility of dual-task programs; larger trials with longer follow-up and no-treatment controls are needed to confirm these findings.