Dual-task training and cognitive performance in individuals with coronary artery disease and/or heart failure: a systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Coronary artery disease and/or heart failure (n=228). Intervention: Motor-cognitive dual-task training (DTT) vs. Usual care, isolated exercise/motor task only, booklet-guided training, or historical non-training comparison group. Primary outcome: Cognitive performance (including memory, selective attention, conflict resolution, and postoperative cognitive dysfunction).

Q: What does this research mean for the field?

Motor-cognitive dual-task training shows potential to improve cognitive performance, including memory, selective attention, and conflict resolution, in individuals with coronary artery disease or heart failure, though overall certainty of evidence is low. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Talita Cezareti; Wallace Machado Magalhães de Souza; Andréa Camaz Deslandes; Tereza Cristina Felippe Guimarães; Daniel Arthur Barata Kasal; Luiz Fernando Rodrigues; Mauro Felippe Felix Mediano

doi:10.3389/fcvm.2025.1462385

March 6, 2025Frontiers in Cardiovascular MedicineOpen Access

Dual-task training and cognitive performance in individuals with coronary artery disease and/or heart failure: a systematic review

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Key result

Motor-cognitive dual-task training shows positive trends for improving cognitive performance in CAD and HF.

n=228

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Why the study?

Dual-task training emerged as a promising strategy to improve cognition in cardiovascular diseases, prompting a description of literature on motor-cognitive dual-task training and cognitive performance in coronary artery disease and/or heart failure.

Does motor-cognitive dual-task training improve cognitive performance in individuals with coronary artery disease and/or heart failure?

Key Points

To evaluate the literature on the relationship between motor-cognitive dual-task training and cognitive performance in individuals with coronary artery disease and/or heart failure.
Systematic search conducted across MEDLINE/Pubmed, SciELO, Lilacs, PEDro, and EMBASE databases, evaluating intervention and observational studies.
Methodological quality was assessed using PEDro and ROBII for intervention studies and the Newcastle-Ottawa Scale for observational studies, with certainty of evidence rated via the GRADE approach.
Five studies (N=228 total) from the United States, Portugal, and Russia met eligibility criteria, comprising three randomized trials, one quasi-experimental study, and one prospective cohort study.
The overall certainty of evidence for cognitive performance was rated as low under the GRADE approach due to risk of bias and indirectness across heterogeneous protocols.
Two studies reported reductions in early postoperative cognitive dysfunction after myocardial revascularization (39% in dual-task training vs. 64% in control, p=0.08; and 54.4% vs. 69.3%, p=0.04).
Individual studies demonstrated improvements in selective attention, conflict resolution, and verbal memory, while one small trial showed only a small improvement trend in fluid cognition.

Study Design

Type

Systematic Review (n=228)

Blinding

Two independent blinded researchers conducted data extraction

Multicenter

Yes

Structured PICO

Does motor-cognitive dual-task training improve cognitive performance in individuals with coronary artery disease and/or heart failure?

P

Population

228 individuals with coronary artery disease and/or heart failure across 5 studies (3 RCTs, 1 quasi-experimental, 1 prospective cohort) conducted in the United States, Portugal, and Russia, with intervention durations ranging from 1 to 24 weeks.

I

Intervention

Motor-cognitive dual-task training (DTT), conducted either simultaneously (n=3 studies, e.g., Kinect virtual reality during cardiac rehabilitation exercises, or postural balance platform training paired with verbal/arithmetic cognitive tasks) or sequentially (n=2 studies, e.g., walking/aerobic exercise paired with computerized Brain Fitness or audio-based BrainHQ cognitive training). Frequency ranged from 3 to 7 sessions per week, 15 to 60 minutes per session, at 60%-70% maximum heart rate intensity, over 1 to 24 weeks.

C

Comparator

Varied across included studies: usual care (stretching, flexibility, education), isolated exercise/motor task only (walking, booklet-guided home exercise, or postural training alone), or non-training cohort comparison.

O

Outcome

Cognitive performance (CP) across multiple domains (global cognition, verbal and working memory, executive function, selective and distributed attention, processing speed, conflict resolution, and incidence of postoperative cognitive dysfunction), assessed via MoCA, RBANS, WAIS-IV, Trail Making Test, Stroop Test, NIH Toolbox Adult Fluid Cognition Battery, and Burdon correction test.surrogate

This systematic review provides preliminary, low-certainty evidence that combining motor and cognitive training (dual-task training) is safe and may improve memory, attention, and postoperative cognitive recovery in patients with coronary artery disease or heart failure.

Limitations

Significant heterogeneity in participant characteristics, sample sizes, types of DTT interventions, and cognitive outcome measures prevented meta-analysis
Small number of included studies (n=5) and small total sample size (n=228) limiting statistical power
High risk of bias across randomized trials assessed using the ROBII scale and low overall certainty of evidence by GRADE
Use of AI tools (ChatGPT and Google Translate) to translate two Russian-language studies
Exclusion of grey literature which may have omitted relevant studies
Significant heterogeneity in participant characteristics, sample sizes, DTT protocols, and cognitive outcome measures precluded a meta-analysis
Small number of included studies (5 studies) and small total sample size (228 patients)
High risk of bias in randomized trials according to ROBII assessment and low overall GRADE certainty of evidence
Reliance on AI translation tools (ChatGPT and Google Translate) for two Russian-language articles
Exclusion of grey literature

Implication

May support dual-task training for cognition in CAD/HF; leaves open efficacy confirmation pending larger, higher-certainty trials.

Abstract

Introduction Dual-task training (DTT) emerged as a promising intervention strategy to improve cognition in individuals with cardiovascular diseases (CVDs). The aim of this study is to describe the literature on the relationship between motor-cognitive DTT and cognitive performance (CP) in individuals with coronary artery disease (CAD) and/or heart failure (HF). Method This systematic review includes intervention and observational studies that assessed motor-cognitive DTT on CP in individuals with CAD and/or HF. Searches were performed in the MEDLINE/Pubmed, Scielo, Lilacs, PEDro, and EMBASE databases. Methodological quality was assessed using the PEDro and ROBII scales for intervention studies and the Newcastle-Ottawa Scale for observational studies. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach . Results A total of 2,098 articles were retrieved, and 21 articles were selected for full reading. Among these, 16 were excluded according to pre-specified exclusion criteria, resulting in five studies conducted between 2018 and 2022, conducted in three countries (United States, Portugal, and Russia). The studies included 228 individuals, comprising one study with HF participants, one including women with CAD, two including individuals that underwent myocardial revascularization, and one with patients with CAD enrolled in a phase 2 of cardiac rehabilitation program. Each study used different combinations of motor and cognitive tasks, conducted sequentially ( n = 2 studies) or simultaneously ( n = 3 studies), with one study using virtual training. The overall certainty of evidence for CP was low according to GRADE approach. Reduction in postoperative cognitive dysfunction after myocardial revascularization was observed in two studies. Moreover, the results indicate that DTT may have a positive impact on memory, selective attention, and conflict resolution capacity. Conclusion The studies reviewed indicate motor-cognitive DTT as a potential approach to improve CP in individuals with CAD and/or HF. Systematic Review Registration www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202341516 , identifier (CRD 4202341516).

Discussion

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Cite This Study

Cezareti et al. (2025) conducted a systematic review in Coronary artery disease and/or heart failure (n=228). Motor-cognitive dual-task training (DTT) vs. Usual care, isolated exercise/motor task only, booklet-guided training, or historical non-training comparison group was evaluated on Cognitive performance (including memory, selective attention, conflict resolution, and postoperative cognitive dysfunction). Motor-cognitive dual-task training showed a positive trend for improving cognitive performance in 4 of 5 studies (N=228) of patients with CAD or HF, though overall certainty of evidence was low.

synapsesocial.com/papers/6a75c25a9c92392688b24da7 https://doi.org/10.3389/fcvm.2025.1462385

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Dual-task training and cognitive performance in individuals with coronary artery disease and/or heart failure: a systematic review

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Dual-task training and cognitive performance in individuals with coronary artery disease and/or heart failure: a systematic review

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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