External focus strategy improves visuomotor control of gait in older adults

Purpose: Few studies have adopted external focus strategies to mitigate the negative effects of conscious movement processing in older adults. We investigated whether a single-session intervention (SSI) using an external focus could improve gait stability and visual search behaviors during adaptive locomotion in older adults. Methods: We randomly allocated 112 older adults to either an external focus (EXT, n = 56) or a control group (CON, n = 56). Participants performed an obstacle circumvention walking task along an 8-m walkway for five trials at pre-intervention (T0), post-intervention (T1), and retention (T2). The training phase consisted of 20 walking trials with obstacle circumvention. EXT focused on digits displayed on monitors at their path destinations during walking, while CON walked naturally without any specific instructions. Gait kinematics (i.e., gait variabilities and body sway) and visual search data were collected at T0, T1, and T2. Results: Only EXT reduced body sway and variability of spatial and temporal gait parameters, while increasing gait speed when comparing T1 and T2 to T0. EXT also reduced the number of visual fixation and fixation duration percentage on the ground while increasing fixation duration percentage on the destination when comparing T1 and T2 to T0. Conclusions: This study is the first to explore SSI with an external focus in older adults, providing evidence of significant improvements in gait stability and visual search behaviors that facilitate feedforward planning. Practicing with an external focus strategy could be recommended as an adjunctive psychomotor approach in clinical settings to enhance visuomotor performance in older adults.