Effects of an 8-week pickleball intervention on dual-task gait performance and inter-joint coordination in pre-frail older adults

BACKGROUND: Pre-frailty is a reversible state in older adults that increases fall risk. Open-skill, sport-based exercise may improve neuromotor control performance required for safe ambulation under attention-demanding (dual-task) conditions. We examined whether an eight-week supervised pickleball program improved dual-task walking performance and lower-limb inter-joint coordination in pre-frail older adults. METHODS: In this randomized controlled trial, 61 community-dwelling pre-frail older adults (median age 67) were assigned to a supervised pickleball group (n = 29; twice weekly) or a control group (n = 32). Instrumented gait assessment during single-task, motoric dual-task (MDT), and cognitive dual-task (CDT) walking was conducted at baseline and post-intervention. We extracted cadence and stride length to calculate their dual-task costs, stepping strategy ratios, and hip-knee-ankle coordination patterns and variability via vector coding. Data were analysed using mixed-model ANCOVAs (Group-by-Time) adjusted for age, sex, body mass index, and fall history. RESULTS: No significant Group-by-Time interactions were found for spatiotemporal parameters or stepping strategy (p ≥ 0.100). The pickleball group showed improved inter-joint coordination: significant interactions for hip-ankle in-phase pattern (MDT: F = 8.405, p = 0.004, ηp² = 0.069; CDT: F = 5.407, p = 0.022, ηp² = 0.045); and increased knee-ankle anti-phase pattern (F = 3.991, p = 0.048, ηp² = 0.034) and hip-knee coordination variability under CDT (F = 4.997, p = 0.027, ηp² = 0.042). CONCLUSIONS: An eight-week pickleball program improved the adaptability of lower-limb coordination during dual-task walking in pre-frail older adults, without changes in stepping strategy. These findings indicate that cognitively engaging, open-skill sport training can improve motor pattern adaptability, which is important for fall prevention.