Picture yourself having a conversation at the dinner table while cutting your food. For most people, this happens automatically. For someone living with Parkinson’s disease (PD), however, this simple combination of tasks can become difficult and even unsafe, as talking while eating may increase the risk of choking.
Similarly, walking through a crowded space while answering a question may cause steps to slow, stride length to shorten, and balance to feel less secure. These are everyday examples of dual-tasking, performing two tasks at the same time, and they reflect one of the most common challenges experienced by people with PD.1
In Parkinson’s disease, the basal ganglia, a group of brain structures involved in the automatic control of movement, is affected by the progressive loss of dopamine-producing cells. The basal ganglia helps automate familiar motor patterns such as arm swing during walking or shifting weight when turning. When this system is disrupted, movement becomes less automatic and requires greater conscious attention. As a result, dividing attention between a motor task and a cognitive task can impair performance in both. Researchers describe this phenomenon as dual-task interference, which may lead to slower walking, shorter steps, reduced coordination, and a greater risk of freezing or falling.1
Can Dual-Task Training Improve Parkinson’s Disease?
Research examining dual-task training (DTT) in Parkinson’s disease has expanded considerably in recent years, with several systematic reviews and meta-analyses supporting its effectiveness.
A 2024 meta-analysis involving 14 randomised controlled trials and 548 individuals with PD found that dual-task training was superior to single-task training for improving dual-task gait speed, stride length, and cadence. The study also reported improvements in dual-task cost and quality of life, although no additional benefit was observed for balance confidence.2
These findings are consistent with a 2023 systematic review and meta-analysis, which demonstrated significant improvements in gait speed, step and stride length, and dynamic balance following dual-task training when compared with other rehabilitation approaches.3 Another recent study comparing dual-task and single-task training across walking performance, balance, and cognitive function also supported the benefits of DTT for mobility outcomes, while noting that further research is still needed to better understand its effects on cognition.4
Across studies, training programmes typically involved sessions lasting 30 to 60 minutes, performed two to five times per week over four to twelve weeks. Common training tasks included walking while performing verbal fluency exercises, serial subtraction, or auditory reaction-time activities. Collectively, current evidence supports incorporating dual-task training into Parkinson’s disease rehabilitation, as practising combined cognitive and motor demands may improve real-world function.2–6
Dual-Tasking Exercises for Parkinson’s Disease
The following exercises are adapted from dual-task paradigms commonly used in Parkinson’s disease research and may be performed at home or in a clinical setting. Standing exercises should always be performed under supervision, with an assistive device or support if needed. If movement becomes unstable, steps become smaller, or freezing occurs, pause the cognitive task, regain steady movement, and then continue.
Walking and Talking
- Movement: Walk in place at a steady pace. Use an assistive device or support person if required.
- Cognitive task: Name items aloud from a category such as numbers, colours, animals, or fruits while continuing to walk. Change categories after each round without interrupting the rhythm of movement.
- What this tests: This exercise combines rhythmic stepping with verbal fluency and category switching, increasing attentional and executive demands in a way that reflects real-world walking challenges.
Dual Hand Task
Sit upright at a table.
- Movement: Tap a steady rhythm on the table with the right hand while drawing slow, continuous circles with the left hand.
- Cognitive task: Count backwards aloud from 50.
- What this tests: This activity challenges simultaneous motor control of both hands while adding a working memory task, reflecting the interaction between cognitive processing and motor coordination.
Step and Go/No-Go Task
Stand with feet shoulder-width apart.
- Movement: Step slowly from side to side, ensuring the feet are lifted and placed rather than dragged.
- Cognitive task: Have a partner call out cues. When the cue is “Yes,” continue stepping. When the cue is “No,” stop immediately, remain still for two to three seconds, and then restart smoothly.
- What this tests: This exercise is adapted from the Go/No-Go paradigm used in motor control research and challenges response inhibition, stopping ability, and movement re-initiation under cognitive demand, functions commonly affected in Parkinson’s disease.
Final Thoughts on Dual-Tasking and Parkinson’s Disease
Dual-tasking is difficult in Parkinson’s disease, but this difficulty is also what makes training valuable. Growing evidence suggests that practising motor and cognitive tasks together in a safe and structured way can improve walking speed, stride length, and overall mobility in people with PD. 2–4 These improvements extend beyond clinical measures and may help support greater confidence, safety, and independence in everyday life.
Follow us on social media for video demonstrations of these exercises so you can practise along at home. As always, speak with your physiotherapist or neurologist before starting any new exercise programme.
References:
- Fok P, Farrell M, McMeeken J. The effect of dividing attention between walking and auxiliary tasks in people with Parkinson’s disease. Hum Mov Sci. 2012;31(1):236–246. doi:10.1016/j.humov.2011.05.002
- Sarasso E, Parente MP, Agosta F, Filippi M, Corbetta D. Dual-task vs. single-task gait training to improve spatiotemporal gait parameters in people with Parkinson’s disease: a systematic review and meta-analysis. Brain Sci. 2024;14(5):517. doi:10.3390/brainsci14050517
- García-López H, Castillo-Pintor M, Castro-Sánchez AM, Lara-Palomo IC, Obrero-Gaitán E, Cortés-Pérez I. Efficacy of dual-task training in patients with Parkinson’s disease: a systematic review with meta-analysis. Mov Disord Clin Pract. 2023;10(9):1268–1284. doi:10.1002/mdc3.1382
- Lin X, Zhang Y, Zhang X, Chen X, Liu J, Yang L, Pang MYC. Comparing the effects of dual-task training and single-task training on walking, balance and cognitive functions in individuals with Parkinson’s disease: a systematic review. Chin Med J (Engl). 2024;137(13):1535–1543. doi:10.1097/CM9.0000000000002999
- Xiao Y, Yang T, Shang H. The impact of motor-cognitive dual-task training on physical and cognitive functions in Parkinson’s disease. Brain Sci. 2023;13(3):437. doi:10.3390/brainsci13030437
- Tan X, Wang K, Sun W, Li X, Wang W, Tian F. A review of recent advances in cognitive-motor dual-tasking for Parkinson’s disease rehabilitation. Sensors. 2024;24(19):6353. doi:10.3390/s24196353