Restoring anticipatory control through cognitive–motor dual-task training improves emotional and executive function in frail older adults

Background: Aging-related frailty is increasingly recognized as a multidimensional condition involving impairments in cognitive, emotional, and motor domains. Traditional interventions often fail to capture the complexity of real-world functioning, highlighting the need for more ecologically valid approaches. Objectives: This study investigated the effects of a structured Cognitive-Motor Dual-Task Training (CMDT) protocol, incorporating alternating bilateral stimulation (BAS), on emotional regulation, executive function, and anticipatory neural mechanisms in frail and pre-frail older adults. Methods: Thirty participants aged ≥ 65 years were enrolled in a randomized controlled trial and assigned to either a CMDT group or a motor-only control group. The intervention lasted 8 weeks (two sessions per week). Assessments were conducted at baseline, mid-intervention, and post-intervention, and included measures of anxiety (STAI-Y), depression (BDI-II), executive performance (reaction times, variability, and accuracy), functional mobility (BBS, TUG, 10mWT), and high-density EEG during a Go/No-go task to extract anticipatory event-related potentials (prefrontal negativity, pN; Bereitschaftspotential, BP). Results: The CMDT group showed significant reductions in anxiety and depressive symptoms, along with improved executive performance compared to the control group. At the neural level, CMDT enhanced anticipatory activity, reflected by increased pN and BP amplitudes. Mediation analyses revealed that changes in prefrontal anticipatory activity (pN) significantly mediated the relationship between CMDT and emotional improvements, with a full mediation pattern observed for self-reported depressive symptoms and a partial mediation pattern for anxiety. Conclusion: These findings indicate that CMDT enhances anticipatory control mechanisms linking brain function to behavior, supporting both emotional regulation and executive efficiency in frail older adults. By embedding cognitive demands within motor actions, this approach provides a low-cost and scalable intervention with increased ecological relevance, offering a promising strategy for addressing multidimensional vulnerability in aging.