The Effect of Walking Training with Auditory Cueing on Co-Contraction of Lower Limb Muscles in Healthy Elderly

Document Type : Research Paper


1 MSc of Exercise Physiology, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran

2 Associate Professor of Exercise Physiology, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran

3 Assistant Professor of Motor Behavior, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran

4 Assistant Professor of Sport Biomechanics, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran


The elderly often exhibit high levels of co-contraction in lower extremity muscles which may appear to compensate for deteriorations of organs and better motor control. Normal gait depends on both the neuromuscular system and cognitive health and motion automation. Thus, subjects’ attention can be attracted to outer environment by challenging executive resources through rhythmic auditory cueing and thus daily activity such as gait can change to automatic mode. 30 qualified elderly men (age range of 60 to 75 years old) were voluntarily selected and were divided into two control groups (detraining group and walking without auditory cueing) and one experimental group (walking with auditory cueing). The pattern of lower limb muscles activity including soleus, tibialis anterior, vastus medialis, vastus lateralis and biceps femoris during 90s walking at preferred speed was investigated in pretest and posttest to evaluate muscle co-contraction. This program was performed for 6 weeks, 3 sessions per week and 20 minutes each session. Data were analyzed using ANCOVA and nonparametric Bootstrap test at the significance level of 0.05. The results showed an increase in co-contraction in the synergic muscles but a reduction in agonist–antagonist muscles after 18 sessions of program, but these findings were not statistically significant (P˃0.05). These results indicated that auditory cueing during gait could not influence muscle co-contraction in early aging which is probably due to the lack of evident cognitive changes.


1. Gallahue D. Understanding motor development: infants, children, adolescents‏: Mcgraw-hill; 2006.
2.  Maclean L, Brown L, Gerontologist AA-T. The effect of rhythmic musical training on healthy older adults’ gait and cognitive function‌. Aging clinical and experimental research. 2018;30)1):89-92.‌
3.  Henschke JU, Ohl FW, Budinger E. Crossmodal connections of primary sensory cortices largely vanish during normal aging. Front Aging Neurosci. 2018;10:52.‌
4. Savica R, Wennberg A, … CH-J of. Comparison of gait parameters for predicting cognitive decline. the Mayo Clinic Study of Aging‌. Journal of Alzheimer's Disease. 2017;55(2):559-567.
5. Aboutorabi A, Arazpour M, Bahramizadeh M, Hutchins SW, Fadayevatan R. The effect of aging on gait parameters in able-bodied older subjects: a literature review. Aging Clinical and Experimental Research. 2016;28(3):393-405.
6. Joana Caetano MD, Lord SR, Allen N, Brodie M, A. Large scale physiological monitoring View project Wearable intelligent cueing and feedback for gait in Parkinson’s disease View project Stepping reaction time and gait adaptability are significantly impaired in people with Parkinson’s disease: Implication. Park Relat Disord. 2017;47:32-38
7. Lo J, Lo O, Olson E, Habtemariam D, posture II-G&, 2017‌  undefined. Functional implications of muscle co-contraction during gait in advanced age‌. Elsevier Health Sciences. 2017;53:110-114.‌
8. Iwamoto Y, Takahashi M, Shinkoda K. Differences of muscle co-contraction of the ankle joint between young and elderly adults during dynamic postural control at different speeds. J Physiol Anthropol. 2017;36(1):32
9. Sun W, Liang J, Yang Y. Investigating Aging-Related Changes in the Coordination of Agonist and Antagonist Muscles Using Fuzzy Entropy and Mutual Information. 2016;18(6):229.‌
10. Strazza A, Mengarelli A, Fioretti S et al. Surface-EMG analysis for the quantification of thigh muscle dynamic co-contractions during normal gait. Gait & posture. 2017;51:228-233.‌
11. Craig CE, Goble DJ, Doumas M. Proprioceptive acuity predicts muscle co-contraction of the tibialis anterior and gastrocnemius medialis in older adults’ dynamic postural control. Neuroscience. 2016;322:251-261.
12. Terrier P. Fractal Fluctuations in Human Walking: Comparison Between Auditory and Visually Guided Stepping. Ann Biomed Eng. 2016;44(9):2785-2793.‌
13.  Jung Yang D, Kyu Park S, Han Uhm Y. The correlation between muscle activity of the quadriceps and balance and gait in stroke patients. Journal of physical therapy science. 2016;28(8):2289-2292.‌
14.  Nombela C, Hughes L, Owen A. Into the groove: can rhythm influence Parkinson’s disease?‌. Elsevier Health Sciences. 2013;37(10):2564-2570.
15. Thaut M. Rhythm, music, and the brain: Scientific foundations and clinical applications‌. Routledge. 2013
16. Bigliassi M, Karageorghis C, … GH-P of S. The Way You Make Me Feel: Psychological and cerebral responses to music during real-life physical activity‌. Psychology of Sport and Exercise. 2019;41:211-217.‌
17. Ghai S. Effects of real-time (sonification) and rhythmic auditory stimuli on recovering arm function post stroke: A systematic review and meta-analysis. Frontiers in Neurology. 2018.
18. Ghai S. Effects of rhythmic auditory cueing in gait rehabilitation for multiple sclerosis: a mini systematic review and meta-analysis‌. Scientific reports. 2018;8(1):506.‌
19. Ghai S. Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis‌. Scientific reports. 2017;12:557.
20. Clements-Cortes A, Bartel L, … HA-M and. The potential of rhythmic sensory stimulation treatments for persons with Alzheimer’s disease‌. Music and Medicine. 2017;9(3):167-173.
21. Rochester L, Hetherington V. The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson’s disease‌. Archives of physical medicine and rehabilitation. 2005;86(5):999-1006.‌
22. Sejdić E, Fu Y, Pak A, Fairley JA, Chau T. The effects of rhythmic sensory cues on the temporal dynamics of human gait. PLoS One. 2012;7(8):e43104.‌
23. Schreiber C, Remacle A, Chantraine F. Influence of a rhythmic auditory stimulation on asymptomatic gait‌.  Gait & posture. 2016;50:17-22.‌
24. Yogev-Seligmann G, Sprecher E, Kodesh E. The Effect of External and Internal Focus of Attention on Gait Variability in Older Adults. Journal of motor behavior. 2017;49(2):179-184.
25. Ducharme S, Sands C, Moore C. Changes to gait speed and the walk ratio with rhythmic auditory cuing‌. Gait & posture. 2018;66:255-259.‌
26. Hamburg J, Therapy AC-J of M. The effects of a movement with music program on measures of balance and gait speed in healthy older adults‌. Journal of Music Therapy. 2003;40(3):212-226.‌
27. Wittwer J, Webster K. Music and metronome cues produce different effects on gait spatiotemporal measures but not gait variability in healthy older adults‌. Gait & posture. 2013;3(2):219-222.
28. Yu L, Zhang Q, Hu C, Huang Q, Ye M, Li D. Effects of different frequencies of rhythmic auditory cueing on the stride length, cadence, and gait speed in healthy young females. Journal of physical therapy science. 2015;27(2):485-487.‌
29. Westlake K, therapy EC-P. Sensory-specific balance training in older adults: effect on proprioceptive reintegration and cognitive demands‌. Physical therapy. 2007;87(10):1274-1283.‌
30. Tian Q, Bair W, Resnick S, Bilgel M. β-amyloid deposition is associated with gait variability in usual aging‌. gait & posture. 2018;61:346-352.‌
31. Ghai S. Effect of rhythmic auditory cueing on aging gait: a systematic review and meta-analysis‌. 2018;9(5):901.‌
32. Bailey CA, Corona F, Murgia M, Pili R, Pau M, Côté JN. Electromyographical gait characteristics in Parkinson’S disease: Effects of combined physical therapy and rhythmic auditory stimulation. Front Neurol. 2018;9:211
33. Praxedes J, Leporace G, Pinto S, Pereira G, Silva A, Alberto Batista L. Co-contraction of tibialis anterior and soleus muscles during exercises with different conditions of instability.Journal of Sport Sciences. 2011.
34. Palmieri-Smith RM, McLean SG, Ashton-Miller JA, Wojtys EM. Association of quadriceps and hamstrings cocontraction patterns with knee joint loading. Journal of athletic training. 2009;44(3):256-263.
35. Zacaron KAM, Dias JMD, Alencar MA, Almeida LL de, Alberto Mourão-Júnior C, Dias RC. Electromyographic normalization of vastus lateralis and biceps femoris co-contraction during gait of elderly females. Fisioterapia em Movimento.  2016; 29(4) : 787- 794. 36. Clark JE, Phillips SJ. A Longitudinal Study of Intralimb Coordination in the First Year of Independent Walking: A Dynamical Systems Analysis. Child development. 1993; 64(4) : 1143-1157.
37. Winstein CJ, Pohl PS, Lewthwaite R. Effects of physical guidance and knowledge of results on motor learning: Support for the guidance hypothesis. Research quarterly for exercise and sport 1994: 65(4): 316-323.