Exergaming and older adult cognition: a cluster randomized clinical trial

An Immersive Motor Protocol for Frailty Rehabilitation

Frailty is a pre-clinical condition that worsens physical health and quality of life. One of the most frequent symptoms of frailty is an increased risk of falling. In order to reduce this risk, we propose an innovative virtual reality motor rehabilitation program based on an immersive tool. All exercises will take place in the CAVE, a four-screen room with a stationary bike. The protocol will include two types of exercises for the improvement of balance: "Positive Bike" and "Avoid the Rocks." We will choose evaluation scales related to the functional aspects and subjective perception of balance. Our aim is to prove that our innovative motor rehabilitation protocol is as effective as or more effective than classical rehabilitation.

Effects of Traditional vs. iPad-Enhanced Aerobic Exercise on Wayfinding Efficacy and Cognition: A Pilot Randomized Controlled Trial

The purpose of this pilot study was to test the feasibility and efficacy of an iPad-enhanced aerobic exercise intervention designed to enhance wayfinding efficacy and performance and relevant cognitive functioning among middle-aged adults at risk for cognitive impairment. Twenty-seven low active adults (21 females) aged 45 to 62 years (51.22 ± 5.20) participated in a ten-week randomized controlled trial. Participants were randomized to an iPad-enhanced aerobic exercise group (experimental group) or an aerobic exercise-only group (control group) following baseline assessment. Both groups exercised at 50% to 75% of age-predicted heart rate maximum for 30 to 50 min/d, 2 d/wk for 10 weeks. During aerobic exercise, the experimental group engaged in virtual tours delivered via iPad. Baseline and post-intervention assessments of wayfinding self-efficacy, wayfinding task performance, cognitive functioning, electroencephalogram (EEG), and psychosocial questionnaires were administered. The results suggest that ten weeks of iPad-enhanced, moderately intense aerobic exercise had specific effects on wayfinding self-efficacy; however, no statistical differences were found between groups on the behavioral wayfinding task or spatial memory performance at follow-up. Performance scores on an inhibitory attentional-control cognitive assessment revealed significant differences between groups, favoring the experimental group (p < 0.05). Virtual reality-enhanced aerobic exercise may prove to be an effective method for improving cognitive function and increasing confidence to navigate real-world scenarios among individuals at risk of cognitive impairment.

How to Train Your Health: Sports as a Resource to Improve Cognitive Abilities in Cancer Patients

From a cognitive-psychological perspective, physical exercise (PE) and sports are an interesting tool for improving people's cognitive abilities. One field of application for such a tool is decision making (DM) support in chronic patients, cancer patients, and survivors in particular. On the one hand, cancer patients and survivors have to continually take important decisions about their own care (e.g., treatment choice; changes in lifestyle), in collaboration with caregivers and health providers; on the other hand, side effects of treatment may be detrimental to cognitive abilities, such as attention, which make the health DM tasks even more demanding, complex, and emotionally disruptive for patients. Since cancer patients have to engage in healthy activities both for improving their own quality of life and for sustaining the effects of medications, clinical advice to engage in sport and PE is becoming more and more widespread within interventions. However, while sports are usually seen as healthy physical activities, their impact on cognitive abilities is mostly overlooked in the literature. The hypothesis of the present work is that sports could be fully exploited in their potential as focused exercises for cognitive ability training, in the field of cognitive training for chronic patients specifically. Indeed, literature shows that different sports (e.g., individual or team-based) influence and possibly augment cognitive abilities such as focused and divided attention, working memory, and DM under time constraints. Moreover, besides providing training for cognitive abilities, the experience of sports may represent an opportunity to explore, train and sharpen DM abilities directly: we identify five ways in which sport experiences may influence DM processes, and provide indications for future research on the topic.

Game-based interventions for neuropsychological assessment, training and rehabilitation: Which game-elements to use? A systematic review

Game-based interventions (GBI) have been used to promote health-related outcomes, including cognitive functions. Criteria for game-elements (GE) selection are insufficiently characterized in terms of their adequacy to patients' clinical conditions or targeted cognitive outcomes. This study aimed to identify GE applied in GBI for cognitive assessment, training or rehabilitation. A systematic review of literature was conducted. Papers involving video games were included if: (1) presenting empirical and original data; (2) using video games for cognitive intervention; and (3) considering attention, working memory or inhibitory control as outcomes of interest. Ninety-one papers were included. A significant difference between the number of GE reported in the assessed papers and those composing video games was found (p < .001). The two most frequently used GE were: score system (79.2% of the interventions using video games; for assessment, 43.8%; for training, 93.5%; and for rehabilitation, 83.3%) and narrative context (79.2% of interventions; for assessment, 93.8%; for training, 73.9% and for rehabilitation, 66.7%). Usability assessment was significantly associated with six of the seven GE analyzed (p-values between p ≤ 0.001 and p. = 027). The use of GE that act as extrinsic motivation promotors (e.g., numeric feedback system) may jeopardize patients' long-term adherence to interventions, mainly if associated with progressive difficulty-increase of gaming experience. Lack of precise description of GE and absence of a theoretical framework supporting GE selection are important limitations of the available clinical literature.

Effects and Mechanisms of Cognitive, Aerobic Exercise, and Combined Training on Cognition, Health, and Brain Outcomes in Physically Inactive Older Adults: The Projecte Moviment Protocol

INTRODUCTION

Age-related health, brain, and cognitive impairment is a great challenge in current society. Cognitive training, aerobic exercise and their combination have been shown to benefit health, brain, cognition and psychological status in healthy older adults. Inconsistent results across studies may be related to several variables. We need to better identify cognitive changes, individual variables that may predict the effect of these interventions, and changes in structural and functional brain outcomes as well as physiological molecular correlates that may be mediating these effects. Projecte Moviment is a multi-domain randomized trial examining the effect of these interventions applied 5 days per week for 3 months compared to a passive control group. The aim of this paper is to describe the sample, procedures and planned analyses.

METHODS

One hundred and forty healthy physically inactive older adults will be randomly assigned to computerized cognitive training (CCT), aerobic exercise (AE), combined training (COMB), or a control group. The intervention consists of a 3 month home-based program 5 days per week in sessions of 45 min. Data from cognitive, physical, and psychological tests, cardiovascular risk factors, structural and functional brain scans, and blood samples will be obtained before and after the intervention.

RESULTS

Effects of the interventions on cognitive outcomes will be described in intention-to-treat and per protocol analyses. We will also analyze potential genetic, demographic, brain, and physiological molecular correlates that may predict the effects of intervention, as well as the association between cognitive effects and changes in these variables using the per protocol sample.

DISCUSSION

Projecte Moviment is a multi-domain intervention trial based on prior evidence that aims to understand the effects of CCT, AE, and COMB on cognitive and psychological outcomes compared to a passive control group, and to determine related biological correlates and predictors of the intervention effects.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03123900.

Lessons Learned from Gamifying Functional Fitness Training Through Human-Centered Design Methods in Older Adults

Background: The design of meaningful and enjoyable Exergames for fitness training in older adults possesses critical challenges in matching user's needs and motivators with game elements. These challenges are often due to the lack of knowledge of seniors' game preferences and technology literacy as well as a poor involvement of the target population in the design process. Objective: This research aims at describing a detailed and scrutinized use case of applying human-centered design methodologies in the gamification of fitness training routines and illustrates how to incorporate seniors' feedback in the game design pipeline. Materials and Methods: We focus on how to use the insights from human-centered inquiries to improve in-game elements, such as mechanics or esthetics, and how to iterate the game design process based on playtesting sessions in the field. Results: We present a set of four Exergames created to train the critical functional fitness areas of older adults. We show how through rapid prototyping methods and multidisciplinary research, Exergames can be rigorously designed and developed to match individual physical capabilities. Moreover, we propose a set of guidelines for the design of context-aware Exergames based on the lessons learned. Conclusion: We highlight the process followed; it depicts 19 weeks of various activities delivering particular and actionable items that can be used as a checklist for future games for health design projects.

Exercise and cognitive function in patients with end-stage kidney disease

In this review we summarize the research pertaining to the role of exercise in preventing cognitive decline in patients with end-stage kidney disease (ESKD). Impairment in cognitive function, especially in executive function, is common in patients with ESKD, and may worsen with maintenance dialysis as a result of retention of uremic toxins, recurrent cerebral ischemia, and high burden of inactivity. Cognitive impairment may lead to long-term adverse consequences, including dementia and death. Home-based and intradialytic exercise training (ET) are among the nonpharmacologic interventions identified to preserve cognitive function in ESKD. Additionally, cognitive training (CT) is an effective approach recently identified in this population. While short-term benefits of ET and CT on cognitive function were consistently observed in patients undergoing dialysis, more studies are needed to replicate these findings in diverse populations including kidney transplant recipients with long-term follow-up to better understand the health and quality of life consequences of these promising interventions. ET as well as CT are feasible interventions that may preserve or even improve cognitive function for patients with ESKD. Whether these interventions translate to improvements in quality of life and long-term health outcomes, including dementia prevention and better survival, are yet to be determined.

Effects of Exergaming in People with Dementia: Results of a Systematic Literature Review

Background:

Physical exercise benefits functioning, health, and well-being. However, people living with dementia in particular hardly engage in exercise. Exergaming (exercise and gaming) is an innovative, fun, and relatively safe way of exercising in a virtual reality or gaming environment. It may help people living with dementia overcome barriers they can experience regarding regular exercise activities.

Objective:

This systematic literature review aims to provide an overview of the cost-effectiveness of exergaming and its effects on physical, cognitive, emotional, and social functioning, as well as the quality of life in people living with dementia.

Methods:

PubMed, Embase, Cinahl, PsycINFO, the Cochrane Library, and the Web of Science Core Collection were searched. Selection of studies was carried out by at least two independent researchers.

Results:

Three studies were found to be eligible and were included in this review. Two of these showed some statistically significant effects of exergaming on physical, cognitive, and emotional functioning in people living with dementia, although based on a very small sample. No articles were found about the cost-effectiveness of exergaming.

Conclusions:

Only a few controlled studies have been conducted into the effectiveness of exergaming, and these show very little significant benefits. More well-designed studies are necessary to examine the effects of exergaming.

Acute Effects of Aerobic Exercise and Active Videogames on Cognitive Flexibility, Reaction Time, and Perceived Exertion in Older Adults

Objective: The aim of this study was to analyze the acute effects of aerobic exercise (AE), active videogames (AVG), and AE+AVG on cognitive flexibility, choice reaction time (CRT), and postexercise rate of perceived exertion (RPE) in a sample composed of 49 older adults, 11 men and 38 women (age M = 67.7 ± 4.7 years). Materials and Methods: An incomplete intrasubject factorial design was followed. Participants were randomly divided into three experimental groups, and each one performed two of three different sessions (A, B, or C). In session A, participants rode on a cycle ergometer for 30 minutes (AE). In session B, they rode on a cycle ergometer for 30 minutes while playing an AVG (AE+AVG). In session C, they only played an AVG. Data were analyzed with a repeated-measures general linear model. Results: Intrasubject pre-post-analysis showed that the three sessions improved CRT, although motor reaction time did not improve significantly with AE. On the contrary, intrasubjects' postanalysis showed better results of AVG compared with AE (lower % of nonperseverative errors) and AE+AVG (less failures to maintain set, although the number of correct responses decreased). AE+AVG showed benefits in RPE compared with AE. Conclusions: The practice of AE and/or AVG acutely improves CRT in older adults, but only AVG improved some variables of cognitive flexibility. Moreover, postexercise RPE was higher after AE in comparison with other conditions (AVG, AE+AVG).

A Systematic Review on the Cognitive Benefits and Neurophysiological Correlates of Exergaming in Healthy Older Adults

Human aging is associated with structural and functional brain deteriorations and a corresponding cognitive decline. Exergaming (i.e., physically active video-gaming) has been supposed to attenuate age-related brain deteriorations and may even improve cognitive functions in healthy older adults. Effects of exergaming, however, vary largely across studies. Moreover, the underlying neurophysiological mechanisms by which exergaming may affect cognitive and brain function are still poorly understood. Therefore, we systematically reviewed the effects of exergame interventions on cognitive outcomes and neurophysiological correlates in healthy older adults (>60 years). After screening 2709 studies (Cochrane Library, PsycINFO, Pubmed, Scopus), we found 15 eligible studies, four of which comprised neurophysiological measures. Most studies reported within group improvements in exergamers and favorable interaction effects compared to passive controls. Fewer studies found superior effects of exergaming over physically active control groups and, if so, solely for executive functions. Regarding individual cognitive domains, results showed no consistence. Positive effects on neurophysiological outcomes were present in all respective studies. In summary, exergaming seems to be equally or slightly more effective than other physical interventions on cognitive functions in healthy older adults. Tailored interventions using well-considered exergames and intervention designs, however, may result in more distinct effects on cognitive functions.

Cognitive demand of eccentric versus concentric cycling and its effects on post-exercise attention and vigilance

PURPOSE

This study tested the hypotheses that eccentric cycling (ECC) would be more cognitively demanding than concentric cycling (CONC), and attention and vigilance would improve more after ECC than CONC.

METHODS

Thirty young adults performed CONC and two bouts of ECC (ECC1 and ECC2) for 20 min at a similar workload (227.5 ± 51.5 W) with 1-week apart. Cognitive load during exercise was assessed by the average error from the target torque over 1200 (60 rpm × 20 min) revolutions, choice reaction time (CRT), the NASA-task load index (NASA-TLX), and prefrontal cortex oxygenation and deoxygenation (HHb) by near-infrared spectroscopy. Attention and vigilance were assessed by a sustained attention to response task (SART) before, immediately, and at every 15 min for 60 min after exercise or sitting (control).

RESULTS

Heart rate was lower during ECC1 (115.5 ± 20.3 bpm) and ECC2 (116.7 ± 21.0 bpm) than CONC (156.9 ± 19.4 bpm). The torque error was greater for ECC1 (26.1 ± 9.0%) and ECC2 (19.4 ± 9.0%) than CONC (10.8 ± 3.7%). CRT (CONC: 602.8 ± 69.0, ECC1: 711.1 ± 113.0, ECC2: 693.6 ± 122.6 ms) and mental demand in NASA-TLX (46.8 ± 25.8, 80.0 ± 15.3, 60.3 ± 17.6) were greater for ECC1 and ECC2 than CONC. Decreases in HHb were greater for ECC1 (- 0.41 ± 0.37 µM) and ECC2 (- 0.40 ± 0.40 µM) than CONC (0.10 ± 0.40 µM) and control (- 0.21 ± 0.28 µM). Attention and vigilance decreased 2-8% after 20-min sitting, but improved 2-10% immediately after ECC2, and did not decline from the baseline for 30 min after ECC1 or 60 min after CONC and ECC2.

CONCLUSION

Cognitive load was greater during ECC than CONC, but post-exercise attention and vigilance changes were not largely different between ECC and CONC.

Exercise Videogames, Physical Activity, and Health: Wii Heart Fitness: A Randomized Clinical Trial

INTRODUCTION

Adults who engage in regular physical activity have lower rates of morbidity and mortality than those who do not. Exercise videogames may offer an attractive, sustainable alternative or supplement to traditional modes of exercise. This study compared exercise videogames with standard exercise modalities for improving uptake and maintenance of moderate to vigorous physical activity, and health risk indices.

STUDY DESIGN

A three-arm clinical RCT including 12 weeks of supervised laboratory-based moderate to vigorous physical activity followed by 6 months follow-up.

SETTING/PARTICIPANTS

This study was conducted at a university affiliated hospital research lab. Healthy, sedentary adults were eligible.

INTERVENTIONS

This study compared a 12-week program of supervised exercise videogames versus standard exercise (e.g., treadmill) versus control. Data were collected from January 2012 to September 2017 and analyzed in 2018.

MAIN OUTCOME MEASURES

The primary outcome was weekly minutes of moderate to vigorous physical activity at end of treatment, assessed at 3 and 6 months post-intervention by using self-report and accelerometer data. Health risk indices (e.g., HbA1c, lipids) were also assessed.

RESULTS

Participants (N=283) had an average age of 46.2 ±13.5 years; 79% were female. At end of treatment, those in the exercise videogame arm engaged in 30 minutes/week more moderate to vigorous physical activity compared with standard exercise and 85 more minutes/week than controls (all p<0.05). Exercise videogame participants had greater reductions in cholesterol, HbA1c, and body fat versus other groups. Reductions in cholesterol were twice as large in exercise videogame versus standard participants.

CONCLUSIONS

Exercise videogames produced greater uptake and maintenance of moderate to vigorous physical activity compared with standard exercise and improvements in multiple health risk indices. Exercise videogames may promote sustainable physical activity with significant health benefits.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT03298919.

Is There a Preferred Mode of Exercise for Cognition Enhancement in Older Age?-A Narrative Review

The aim of this review is to examine the moderating effect of the mode of exercise on the exercise-cognition relationship. Is one mode of exercise more efficient in enhancing cognition than the other? For example, is aerobic exercise preferable over balance training? Based on official guidelines for old age, exercise modes include aerobic activity, strength (resistance) training, flexibility, balance, and coordination. In relation to cognition, these exercise modes are further divided into two categories: physical training—aerobic and strength, and motor training—balance, coordination, and flexibility. The physical training activities are repetitive and automatic in nature, and require high metabolic energy and relatively low neuromuscular effort. The motor activities involve high neuromuscular demands and relatively low metabolic demands. In addition, there are specific movement skills that require more neuromuscular effort (e.g., Tai Chi), and sometimes also greater metabolic demands (e.g., tennis). Selected studies examining the effect of various modes of exercise on cognition contend that both training categories affect neuroplasticity, and consequently cognitive functioning. However, there are two main differences between them: (1) Physical training affects cognition via improvement in cardiovascular fitness, whereas motor training affects cognition directly; (2) Physical training affects neuroplasticity and cognition in a global manner, while motor training is task-specific in increasing brain neuroplasticity and in affecting cognition. Examining the underpinnings of these pathways reveals that there is a difference in the underlying forces behind the two training categories. In the physical training category, it is the intensity of training that enhances neuroplasticity and consequently improves cognition, while in the motor activities it is the task complexity that increases neuroplasticity, which improves cognition. Dual-task training, which includes cognitive demands in addition to physical or motor activity, has proven more effective in improving cognitive functioning than a single task. The implications are that if all training components traditionally recommended by official bodies—physical as well as motor training—are efficient in enhancing cognition, then we merely have to emphasize the inclusion of all exercise modes in our routine exercise regimen for physical as well as cognitive health in advanced age.

Virtual Reality-Based Exercise with Exergames as Medicine in Different Contexts: A Short Review

There is enough evidence that, nowadays, the sedentary lifestyle is one of the major health problems worldwide, linked to many chronic diseases, including mental comorbidities, systemic hypertension, metabolic dysregulation, and cancer. Although health societies recommend engagement to physical activities, there is an overwhelming number of people remaining sedentary, even knowing the health benefits of regular exercises. One of the main factors that justifies this scenario is the lack of motivation, which is a barrier to people intended to start new habits for health. Considering this previous information, new alternatives for exercises may help people engage in a healthier lifestyle. Technology has contributed to this with devices that allow movements based on virtual reality approaches, including the exergames. These are games available even in commercial devices, as video-games, that allow people to work with different physical components. Furthermore, exergames add cognitive gain through its dual-task characteristic. Moreover, due to the combination of these benefits, they are feasible to acquire, and easy to use. Exergames are not only a potential strategy to reduce sedentary lifestyle but also a good method to improve health gains and rehabilitation in different populations and pathological conditions: older adults, stroke survivors, and Parkinson's disease. In this review, we aim to demonstrate some conditions that literature supports the intervention with exergames due to its physical and cognitive benefits. Furthermore, at the end of this review, we also explore the neurobiological mechanisms behind virtual-reality based exercises.

Collaborative Immersive Virtual Environments for Education in Geography

Immersive virtual reality (iVR) devices are rapidly becoming an important part of our lives and forming a new way for people to interact with computers and each other. The impact and consequences of this innovative technology have not yet been satisfactory explored. This empirical study investigated the cognitive and social aspects of collaboration in a shared, immersive virtual reality. A unique application for implementing a collaborative immersive virtual environment (CIVE) was developed by our interdisciplinary team as a software solution for educational purposes, with two scenarios for learning about hypsography, i.e., explanations of contour line principles. Both scenarios allow switching between a usual 2D contour map and a 3D model of the corresponding terrain to increase the intelligibility and clarity of the educational content. Gamification principles were also applied to both scenarios to augment user engagement during the completion of tasks. A qualitative research approach was adopted to obtain a deep insight into the lived experience of users in a CIVE. It was thus possible to form a deep understanding of very new subject matter. Twelve pairs of participants were observed during their CIVE experience and then interviewed either in a semistructured interview or a focus group. Data from these three research techniques were analyzed using interpretative phenomenological analysis, which is research method for studying individual experience. Four superordinate themes—with detailed descriptions of experiences shared by numerous participants—emerged as results from the analysis; we called these (1) Appreciation for having a collaborator, (2) The Surprising “Fun with Maps”, (3) Communication as a challenge, and (4) Cognition in two realities. The findings of the study indicate the importance of the social dimension during education in a virtual environment and the effectiveness of dynamic and interactive 3D visualization.

Let's Play Cards: Multi-Component Cognitive Training With Social Engagement Enhances Executive Control in Older Adults

Cognitive training and social engagement are two of the routes that potentially improve cognitive functions in older adults. The former targets specific functions so that an intervention can trigger the plasticity and efficiency of the underpinning neural systems, and the latter also provides an environment supportive of social and emotional needs. We investigated whether an integration of the two routes could enhance cognitive functions related to executive control, because no prior research has adopted a theory-driven approach to design a group-based cognitive training program for executive control. Forty-six healthy and active older adults living in community settings were randomly assigned to a group-based training program or a group-based active control program. Twenty-three volunteers in a community center were recruited for the waitlist control group. A battery of card games was designed for the cognitive training program based on three theoretical models of executive functions. A set of commercial board games were run in the active control program. Using untrained tests as the outcome measures, we found significant improvement on executive control in the cognitive training group compared with the active and waitlist control groups while the two control groups did not differ in performance. The cognitive training group did not outperform the two groups on a test of reasoning or on a test of delayed episodic memory. The results support the idea that cognitive training with social interaction can improve performance on untrained tests that share overlapping cognitive processes. Despite the inability to adapt to each person’s performance, integrating the two routes is beneficial for improving cognitive functions in older adults.

The feasibility, acceptability and outcomes of exergaming among individuals with cancer: a systematic review

Background

Individuals with cancer have reduced quality of life, functionality, range of motion, strength, and an increase in pain and fatigue. Exergaming appears to be an effective rehabilitation tool for Parkinson’s disease, multiple sclerosis and post-stroke patients to improve functionality, balance and quality of life; however, the usefulness of exergaming in individuals with cancer is unknown. The aim of this systematic review is to describe exergaming interventions delivered to adults with a current or previous cancer diagnosis and to report the feasibility, acceptability and outcomes of such interventions.

Methods

Studies reporting on exergaming interventions delivered to individuals with a current or previous cancer diagnosis were included. 12 electronic databases were searched. Eight articles (seven interventions) were identified. Data were extracted and assessed for quality by two reviewers.

Results

Three interventions were delivered at hospital, two at home, one at a clinical laboratory, and one did not report. Two interventions were delivered by a physiotherapist, two by an occupational therapist, and one by a nurse, research staff and an exercise physiologist. The Nintendo Wii was used in four of seven studies, whilst the remaining three used the IREX system, BrightArm Duo Rehabilitation System or a custom made exergame. Studies showed that most participants enjoyed the exergaming intervention, and would recommend their use, with some preferring exergaming over standard care interventions. Adherence rates and enjoyment appear greater during exergaming than standard care. Exergaming interventions appear to support improvements balance, function, physical activity levels, strength, fatigue, emotions, cognition and pain.

Conclusion

Exergaming interventions delivered to individuals with cancer show great heterogeneity; differing in duration, frequency and gaming platform. The disease stage and severity of those included, and the outcome measures assessed also vary widely making it difficult to conclude its effectiveness at this time. However, adherence rates and enjoyment appear greater during exergaming compared to standard care, supporting the feasibility and acceptability of this type of intervention delivery for adults with cancer.

Cognitive Training Game Versus Action Videogame: Effects on Cognitive Functions in Older Adults

OBJECTIVE

The purpose of the study was to compare a cognitive training game, Kawashima Brain Training (KBT), and an action videogame, Super Mario Bros (SMB), in their effects on cognitive function in older adults.

MATERIALS AND METHODS

Thirty-six older adults were randomly assigned to the KBT group, the SMB group, or the no-training no-contact control group. All participants completed several cognitive tests [matrix reasoning, Stroop, Trail Making Test, digit symbol substitution test (DSST), Corsi clock, spatial relation, and number comparison]. Then, participants in the game groups were instructed to play the videogame (KBT or SMB) for 1 hour, thrice per week, during 2 months, for a total training time of 24 hours. When the twenty-four 1-hour game sessions were complete, the three groups again completed the cognitive tests.

RESULTS

Analysis of variances on each of the cognitive measures and Tukey's post hoc tests showed that the matrix reasoning change score was significantly greater in both game groups than in the control group. The Stroop test change was significantly greater in the KBT group than in control and SMB groups. The DSST, Corsi block test, spatial relations test, and number comparison test showed significantly greater change in the SMB group than in the control group with KBT intermediate.

CONCLUSION

The scope of benefits of SMB training seems broader than those from the KBT program. The intrinsic characteristics of SMB and KBT games may well be partly responsible for these differences.

Aging and Alzheimer's disease: Comparison and associations from molecular to system level

Alzheimer's disease is the most prevalent cause of dementia, which is defined by the combined presence of amyloid and tau, but researchers are gradually moving away from the simple assumption of linear causality proposed by the original amyloid hypothesis. Aging is the main risk factor for Alzheimer's disease that cannot be explained by amyloid hypothesis. To evaluate how aging and Alzheimer's disease are intrinsically interwoven with each other, we review and summarize evidence from molecular, cellular, and system level. In particular, we focus on study designs, treatments, or interventions in Alzheimer's disease that could also be insightful in aging and vice versa.

Effect of Acute Exercise Mode on Serum Brain-Derived Neurotrophic Factor (BDNF) and Task Switching Performance

Previous studies have consistently reported a positive effect of acute exercise on cognition, particularly on executive function. However, most studies have focused on aerobic and resistant forms of exercise. The purpose of this study was to compare the effect of ‘open-skill’ with ‘closed-skill’ exercise (defined in terms of the predictability of the performing environment) on brain-derived neurotrophic factor (BDNF) production and task switching performance. Twenty young adult males participated in both closed (running) and open (badminton) skill exercise sessions in a counterbalanced order on separate days. The exercise sessions consisted of 5 min of warm up exercises followed by 30 min of running or badminton. The exercise intensity was set at 60% (±5%) of the heart rate reserve level (HRR) with HR being monitored by a wireless heart rate monitor. Blood samples were taken and participation in a task-switching paradigm occurred before and after each exercise session. Results showed no differences in serum BDNF or task-switching performance at the pre-test stage, however, badminton exercise resulted in significantly higher serum BDNF levels (a proxy for levels of BDNF in the brain) and near significant smaller global switching costs relative to running. This study has provided preliminary evidence in support the relative benefits of open-skills exercises on BDNF and executive function.

The interactive Physical and Cognitive Exercise System (iPACES™): effects of a 3-month in-home pilot clinical trial for mild cognitive impairment and caregivers

Background

Alzheimer’s and related dementias are on the rise, and older adults and their families are seeking accessible and effective ways to stave off or ameliorate mild cognitive impairment (MCI).

Aim

This pilot clinical trial (ClinicalTrials.gov Identifier: 03069391) examined neuropsychological and neurobiological outcomes of interactive physical and mental exercise.

Participants and methods

Older adults (MCI and caregivers) were enrolled in a 3-month, in-home trial of a portable neuro-exergame (the interactive Physical and Cognitive Exercise System [iPACES™]), in which they pedaled and steered along a virtual bike path to complete a list of errands (Memory Lane™). Neuropsychological function and salivary biomarkers were measured at pre-, mid-, and posttrial. Ten older adults complied with the recommended use of iPACES (complete dose; ≥2×/wk, 67% of the 15 who also had pre- and postevaluation data). Statistical analyses compared change over time and also change among those with a complete dose vs inadequate dose. Correlations between change in neuropsychological and biomarker measures were also examined.

Results

Executive function and verbal memory increased after 3 months (p = 0.01; no significant change was found with an inadequate dose). Change in salivary biomarkers was moderately associated with increasing cognition (cortisol, r = 0.68; IGF-1, r = 0.37).

Conclusion

Further research is needed, but these pilot data provide preliminary indications to suggest neuro-exergaming can impact cognitive function, perhaps via neurobiological mechanisms, and as such may provide an effective and practical way to promote healthy aging.

Motor-cognitive effects of a computerized game-based training method in people with dementia: a randomized controlled trial

OBJECTIVES

To examine the effects of a computerized, game-based training on motor-cognitive performances, the transfer of training effects on untrained tasks, and the sustainability of training gains in people with dementia.

METHOD

Ninety-nine individuals with a mean age of 82.9 (5.8) and dementia participated in a 10-week randomized controlled trial with three-month follow-up. The intervention group (IG) received a motor-cognitive training on (Physiomat®) including concurrent dual-tasks of balance control with cognitive demands (Physiomat®-Trail Making Tasks (PTMTs)). The control group (CG) performed non-specific, low-intensity exercises. Duration and accuracy at different complexity levels of trained and untrained PTMTs and the number of successfully performed tasks (PTMT score) were assessed.

RESULTS

Physiomat® training significantly improved the duration and accuracy at almost all complexity levels of trained (P ≤ 0.001-0.047, η_p² = 0.065-0.589) and untrained PTMTs (P < 0.001-0.005, η_p² = 0.073-0.459). Significant effects were also found for the PTMT score of trained (P < 0.001, η_p² = 0.211) and untrained PTMTs (P < 0.001, η_p² = 0.184). Training gains were partly sustained at follow-up.

CONCLUSION

Physiomat® is feasible and has the potential to sustainably improve motor-cognitive performances in people with dementia.

The Enhanced Interactive Physical and Cognitive Exercise System (iPACESTM v2.0): Pilot Clinical Trial of an In-Home iPad-Based Neuro-Exergame for Mild Cognitive Impairment (MCI)

Given increasing longevity worldwide, older adults and caregivers are seeking ways to curb cognitive decline especially for those with mild cognitive impairment (MCI, now mild neurocognitive disorder, mNCD, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V). This quasi-experimental, within-subjects pilot clinical trial was designed to replicate and extend the study of cognitive benefits for MCI by improving upon our prior interactive Physical and Cognitive Exercise Study (iPACESTM v1.0) by increasing the usability of the neuro-exergame and exploring possible underlying neurobiological mechanisms. Older adults were enrolled in a three-month, in-home trial of a portable neuro-exergame (iPACES™ v2.0) where participants pedaled and steered along a virtual bike path (Memory Lane™). Neuropsychological function was assessed at baseline after component familiarization intervals (e.g., two weeks of exercise-only, game-only, etc.) and after three months of interactive neuro-exergame intervention. Fourteen participants were enrolled in the study and seven completed the final evaluation. Intent-to-treat analyses were conducted with imputed missing data (total n = 14). Significant improvement in executive function (Stroop) was found (d = 0.68, p = 0.02) only. Changes in salivary biomarkers (cortisol and insulin-like growth factor 1; IGF-1) were significantly associated with improved cognition. Further research is needed, but pilot data suggest that a portable in-home neuro-exergame may be an additional, practical tool to fight back against cognitive decline and dementia.

Falls prevention through physical and cognitive training (falls PACT) in older adults with mild cognitive impairment: a randomized controlled trial protocol

Background

The presence of mild cognitive impairment (MCI) in older adults increases their fall risk. While physical exercise is effective in reducing falls rate and risk of falls, and cognitive training in improving cognitive functioning in healthy older adults, their effectiveness in preventing falls and reducing risks of falls in MCI when administered simultaneously is not yet established. Therefore, this study aims to determine the effectiveness of combined physical and cognitive training in preventing falls and decreasing risks of falls among community-dwelling older persons with MCI.

Methods/design

This is a single-blind, multicentre, randomized controlled trial. At least ninety-three community-dwelling older adults with MCI aged 60 or above will be recruited. They will be randomly allocated into four groups: Physical Training alone (PT), Cognitive Training alone (CT), combined Physical And Cognitive Training (PACT) and Waitlist Group (WG). The PT group will perform exercises (flexibility, endurance, strengthening, and balance training) for 60–90 min three times per week for 12 weeks. The CT group will be involved in a paper-based training focusing on orientation, memory, attention and executive functioning for 60–90 min per session, once a week for 12 weeks. The PACT group will undergo cognitive training incorporated in physical exercise for 60–90 min three times per week for 12 weeks. The WG will receive the intervention, combined physical and cognitive training, at a later date. Assessors blinded to participant allocation will conduct pre-intervention, post-intervention, and 6-month follow-up assessments. The primary outcome measure will be falls rate. The secondary outcome measures will be Physiologic Profile Assessment and Falls Risk for Older Persons in the Community, and assessments that evaluate cognitive, physical and psychological factors related to falls.

Discussion

Considering the possible physical, social, financial and psychological consequences of a fall, we hope to provide insights on the effectiveness of combining physical and cognitive training on falls and fall-related factors for older adults with MCI. It is projected that the combined interventions will lead to significantly lower falls rate and reduced risk of falls compared to using single or no intervention.

Trial registration

ClinicalTrials.gov NCT03167840. Registered on May 30, 2017.

Affective and Attentional States When Running in a Virtual Reality Environment

Engaging in physical exercise in a virtual reality (VR) environment has been reported to improve physical effort and affective states. However, these conclusions might be influenced by experimental design factors, such as comparing VR environments against a non-VR environment without actively controlling for the presence of visual input in non-VR conditions. The present study addressed this issue to examine affective and attentional states in a virtual running task. Participants (n = 40), completed a 21 min run on a treadmill at 70% of Vmax. One group of participants ran in a computer-generated VR environment that included other virtual runners while another group ran while viewing neutral images. Participants in both conditions showed a pattern of reduced positive affect and increased tension during the run with a return to high positive affect after the run. In the VR condition, higher levels of immersive tendencies and attention/absorption in the virtual environment were associated with more positive affect after the run. In addition, participants in the VR condition focused attention more on external task-relevant stimuli and less to internal states than participants in the neutral images condition. However, the neutral images condition produced less negative affect and more enjoyment after the run than the VR condition. The finding suggest that the effects of exercising in a VR environment will depend on individual difference factors (e.g., attention/absorption in the virtual world) but it may not always be better than distracting attention away from exercise-related cues.

Characteristics, Usability, and Users Experience of a System Combining Cognitive and Physical Therapy in a Virtual Environment: Positive Bike

We present the architecture and usability evaluation of virtual reality system-"Positive Bike"-designed for improving cognitive and motor conditions in frail elderly patients. The system consists of a cycle-ergometer integrated in an immersive virtual reality system (CAVE) which allows combining motor and cognitive exercises according to a "dual-task" paradigm. We tested the usability and user's experience of the prototype in a pilot evaluation study that involved five elderly patients. The prototype was tested in one-session training to understand the limitations and areas for improvement of our system. The evaluation consisted in (i) usability assessment using the system usability scale; (ii) evaluation of user's engagement using the flow state scale; and (iii) expert evaluation involving interviews with domain experts. Results showed a good usability, both for system usability scale and the semi-structured interview. The level of flow (i.e., enjoyment with the task at hand) measured using the short flow state scale, was also high. Analysis of semi-structured interview carried out with domain experts provided further indications to improve the system. Overall, these findings show that, despite some limitations, the system is usable and provides an enjoyable user's experience.

Acceptance of different design exergames in elders

For promoting the successful aging of elderly residents of Chang Gung Silver Village in Taiwan, five interactive exergames were developed to promote the well-being of the elderly. The exergames included both physical games and cognitive games, and were implemented using various computer-based technologies in the Chang Gung Silver Village. The exergames were trialed by 39 elderly residents (15 male, 24 female; mean age 79.5 ± 17.5 years) of Chang Gung Silver Village. Following the trials, the participants were requested to complete a Technology Acceptance Model 2 (TAM2) questionnaire. The results showed that the perceived playfulness and perceived usefulness of the exergames were significantly related to the users’ usage behavior and intention to use for both the physical games and the cognitive games. However, a relationship between the output quality of the game and the usage behavior was apparent only in the case of the cognitive exergames. Finally, the impact of social influence on the intention to use and the usage behavior was more pronounced for the physical exergames. Overall, the results revealed that the acceptance of exergames by the elderly depends not so much on the awareness of fun in using the game, but the perceived usefulness of the related physical and cognitive abilities.

Exergames Inherently Contain Cognitive Elements as Indicated by Cortical Processing

Exergames are increasingly used to train both physical and cognitive functioning, but direct evidence whether and how exergames affect cortical activity is lacking. Although portable electroencephalography (EEG) can be used while exergaming, it is unknown whether brain activity will be obscured by movement artifacts. The aims of this study were to assess whether electrophysiological measurements during exergaming are feasible and if so, whether cortical activity changes with additional cognitive elements. Twenty-four young adults performed self-paced sideways leaning movements, followed by two blocks of exergaming in which participants completed a puzzle by leaning left or right to select the correct piece. At the easy level, only the correct piece was shown, while two pieces were presented at the choice level. Brain activity was recorded using a 64-channel passive EEG system. After filtering, an adaptive mixture independent component analysis identified the spatio-temporal sources of brain activity. Results showed that it is feasible to record brain activity in young adults while playing exergames. Furthermore, five spatially different clusters were identified located frontal, bilateral central, and bilateral parietal. The frontal cluster had significantly higher theta power in the exergaming condition with choice compared to self-paced leaning movements and exergaming without choice, while both central clusters showed a significant increase in absolute alpha-2 power in the exergaming conditions compared to the self-paced movements. This is the first study to show that it is feasible to record brain activity while exergaming. Furthermore, results indicated that even a simple exergame without explicit cognitive demands inherently requires cognitive processing. These results pave the way for studying brain activity during various exergames in different populations to help improve their effective use in rehabilitation settings.

The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial

Prior research has found that cognitive benefits of physical exercise and brain health in older adults may be enhanced when mental exercise is interactive simultaneously, as in exergaming. It is unclear whether the cognitive benefit can be maximized by increasing the degree of mental challenge during exercise. This randomized clinical trial (RCT), the Aerobic and Cognitive Exercise Study (ACES) sought to replicate and extend prior findings of added cognitive benefit from exergaming to those with or at risk for mild cognitive impairment (MCI). ACES compares the effects of 6 months of an exer-tour (virtual reality bike rides) with the effects of a more effortful exer-score (pedaling through a videogame to score points). Fourteen community-dwelling older adults meeting screening criteria for MCI (sMCI) were adherent to their assigned exercise for 6 months. The primary outcome was executive function, while secondary outcomes included memory and everyday cognitive function. Exer-tour and exer-score yielded significant moderate effects on executive function (Stroop A/C; d's = 0.51 and 0.47); there was no significant interaction effect. However, after 3 months the exer-tour revealed a significant and moderate effect, while exer-score showed little impact, as did a game-only condition. Both exer-tour and exer-score conditions also resulted in significant improvements in verbal memory. Effects appear to generalize to self-reported everyday cognitive function. Pilot data, including salivary biomarkers and structural MRI, were gathered at baseline and 6 months; exercise dose was associated with increased BDNF as well as increased gray matter volume in the PFC and ACC. Improvement in memory was associated with an increase in the DLPFC. Improved executive function was associated with increased expression of exosomal miRNA-9. Interactive physical and cognitive exercise (both high and low mental challenge) yielded similarly significant cognitive benefit for adherent sMCI exercisers over 6 months. A larger RCT is needed to confirm these findings. Further innovation and clinical trial data are needed to develop accessible, yet engaging and effective interventions to combat cognitive decline for the growing MCI population.

ClinicalTrials.gov ID: NCT02237560

The Effects of Aerobic Exercise and Gaming on Cognitive Performance

The purpose of our study was to investigate the effects of video gaming, aerobic exercise (biking), and the combination of these two activities on the domains of cognitive performance: selective attention, processing speed, and executive functioning. The study was a randomized clinical trial with 40 subjects (mean age 23.7 ± 1.8 years) randomized to one of four thirty-minute conditions: video gaming, biking, simultaneous gaming and biking, and a control condition. Cognitive performance was measured pre and post condition using the Stroop test and Trails B test. A mixed design was utilized. While video gaming, biking, simultaneous gaming and biking conditions improved selective attention and processing speed (p < 0.05), only the bike condition improved the highest order of cognitive performance, executive function (p < 0.01). There were no changes in cognitive performance for the control condition. Previous studies have shown that if tasks approach the limits of attentional capacity there is an increase in the overall chance for errors, known as the dual-task deficit. Simultaneous biking and gaming may have surpassed attentional capacity limits, ultimately increasing errors during the executive function tests of our cognitive performance battery. The results suggest that the fatiguing effects of a combined physically and mentally challenging task that extends after the exercise cessation may overcome the eventual beneficial cognitive effects derived from the physical exercise.

Exercise Intervention Associated with Cognitive Improvement in Alzheimer's Disease

Alzheimer's disease (AD) is a progressive neurodegenerative disease with the syndrome of cognitive and functional decline. Pharmacotherapy has always been in a dominant position for the treatment of AD. However, in most cases, drug therapy is accompanied with clinical delays when older adults have suffered from cognitive decline in episodic memory, working memory, and executive function. On the other hand, accumulating evidence suggests that exercise intervention may ameliorate the progression of cognitive impairment in aging ones while the standard strategy is lacking based on different levels of cognitive decline especially in mild cognitive impairment (MCI) and AD. MCI is the preclinical stage of AD in which neurodegeneration may be reversed via neuroplasticity. Therefore, taking exercise intervention in the early stage of MCI and healthy aging at the risk of AD could slow down the process of cognitive impairment and provide a promising cost-effective nonpharmacological therapy to dementia.

Recommendations for the Design of Serious Games in Neurodegenerative Diseases

The use of Serious Games (SG) in the health domain is expanding. In the field of Neurodegenerative Diseases (ND) such as Alzheimer’s Disease, SG are currently employed to provide alternative solutions for patients’ treatment, stimulation, and rehabilitation. The design of SG for people with ND implies collaborations between professionals in ND and professionals in SG design. As the field is quite young, professionals specialized in both ND and SG are still rare, and recommendations for the design of SG for people with ND are still missing. This perspective paper aims to provide recommendations in terms of ergonomic choices for the design of SG aiming at stimulating people with ND, starting from the existing SG already tested in this population: “MINWii”, “Kitchen and Cooking”, and “X-Torp”. We propose to rely on nine ergonomic criteria: eight ergonomic criteria inspired by works in the domain of office automation: Compatibility, Guidance, Workload, Adaptability, Consistency, Significance of codes, Explicit control and Error management; and one ergonomic criterion related to videogame: the game rules. Perspectives derived from this proposal are also discussed.

Combining perceptual regulation and exergaming for exercise prescription in low-active adults with and without cognitive impairment

BACKGROUND

Exercise adherence in already low-active older adults with and without mild cognitive impairment (MCI) remains low. Perceptual regulation and exergaming may facilitate future exercise behaviour by improving the affective experience, however evidence that this population can perceptually regulate is lacking. To explore this, we investigated 1) perceptual regulation of exercise intensity during either exergaming or regular ergometer cycling and 2) explored affective responses.

METHODS

Thirty-two low active older adults (73.9 ± 7.3 years, n = 16, 8 females) with or without MCI (70.9 ± 5.5 years, n = 16, 11 females) participated in a sub-maximal fitness assessment to determine ventilatory threshold (VT) and two experimental sessions (counterbalanced: exergaming or regular ergometer cycling). Experimental sessions consisted 21-min of continuous cycling with 7-min at each: RPE 9, 11 and 13. Oxygen consumption (VO2), heart rate (HR), and affect (Feeling Scale) were obtained throughout the exercise.

RESULTS

VO2 (p < 0.01) and HR (p < 0.01) increased linearly with RPE, but were not significantly different between exercise modes or cognitive groups. At RPE 13, participants worked above VT in both modes (exergaming: 115.7 ± 27.3; non-exergaming 114.1 ± 24.3 VO2 (%VT)). Regardless of cognitive group, affect declined significantly as RPE increased (p < 0.01). However on average, affect remained pleasant throughout and did not differ between exercise modes or cognitive groups.

CONCLUSIONS

These results suggest low-active older adults can perceptually regulate exercise intensity, regardless of cognition or mode. At RPE 13, participants regulated above VT, at an intensity that improves cardiorespiratory fitness long-term, and affect remained positive in the majority of participants, which may support long-term physical activity adherence.

International Ballroom Dancing Against Neurodegeneration: A Randomized Controlled Trial in Greek Community-Dwelling Elders With Mild Cognitive impairment

BACKGROUND

Many studies have highlighted the positive effects of dance in people with neurodegenerative diseases.

OBJECTIVES

To explore the effects of International Ballroom Dancing on cognitive function in elders with amnestic mild cognitive impairment (aMCI).

METHODS

One-hundred twenty-nine elderly patients with aMCI diagnosis (mean age 66.8 ± 10.1 years) were randomly assigned into 2 groups: intervention group (IG, n = 66) and control group (CG, n = 63). The IG exercised systematically for 10 months, and both groups were submitted to extensive neuropsychological assessment prior and after the 10-month period.

RESULTS

According to the independent sample t test at the follow-up, significant differences between groups were found in benefit of the IG while the CG showed worse performance in the majority of neuropsychological tests. According to the Student t test, better performance is detected in IG in contrast with CG, which had worse performance almost in all scales.

CONCLUSION

Dance may be an important nonpharmacological approach that can benefit cognitive functions.

Gaming for Health: Systematic Review and Meta-analysis of the Physical and Cognitive Effects of Active Computer Gaming in Older Adults

BACKGROUND

Active computer gaming (ACG) is a method of facilitating physical activity in older people to improve health outcomes.

PURPOSE

The purpose of this study was to update and extend a systematic review of the evidence for ACG to determine its effects on physical and cognitive health in older adults.

DATA SOURCES

MEDLINE, EMBASE, CENTRAL in the Cochrane Library, and PsycINFO databases were searched from the date of the previous review (2011) to May 2016.

STUDY SELECTION

Eligible articles were randomized controlled trials (RCTs) investigating the effect of ACG in adults aged 65 and older.

DATA EXTRACTION

Thirty-five studies were eligible for inclusion. Two review authors independently conducted data extraction, risk-of-bias assessment, and coding of behavior change techniques. Outcomes of interest were analyzed as continuous data and pooled as standardized mean differences (SMD) and 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the quality of the evidence.

DATA SYNTHESIS

Behavior change techniques (N = 106) were coded in the included studies (mean = 3.02). Data were pooled for 5 main outcomes of interest. Significant moderate effects in favor of ACG were observed for balance (SMD = 0.52, 95% CI = 0.24 to 0.79; 17 studies; 743 participants), for functional exercise capacity when intervention delivery was >120 minutes per week (SMD = 0.53, 95% CI = 0.15 to 0.90; 5 studies; 116 participants), and for cognitive function (SMD = -0.48, 95% CI = -0.80 to 0.17; 8 studies; 459 participants). There was no significant effect observed for functional mobility or fear of falling.

LIMITATIONS

The quality of the evidence for all comparisons was graded low or very low.

CONCLUSIONS

At present there is very little confidence that ACG improves physical and cognitive outcomes in older adults.

Influence of Sequential vs. Simultaneous Dual-Task Exercise Training on Cognitive Function in Older Adults

Emerging research indicates that exercise combined with cognitive training may improve cognitive function in older adults. Typically these programs have incorporated sequential training, where exercise and cognitive training are undertaken separately. However, simultaneous or dual-task training, where cognitive and/or motor training are performed simultaneously with exercise, may offer greater benefits. This review summary provides an overview of the effects of combined simultaneous vs. sequential training on cognitive function in older adults. Based on the available evidence, there are inconsistent findings with regard to the cognitive benefits of sequential training in comparison to cognitive or exercise training alone. In contrast, simultaneous training interventions, particularly multimodal exercise programs in combination with secondary tasks regulated by sensory cues, have significantly improved cognition in both healthy older and clinical populations. However, further research is needed to determine the optimal characteristics of a successful simultaneous training program for optimizing cognitive function in older people.

Effect of Different Types of Physical Activity on Activities of Daily Living in Older Adults: Systematic Review and Meta-Analysis

Physical activity is associated with greater independence in old age. However, little is known about the effect of physical activity level and activity type on activities of daily living (ADL). This review systematically analyzed the effects of physical activity level and activity type on ADL in older adults (mean age, 60+). Electronic search methods (up to March 2015) identified 47 relevant, randomized controlled trials. Random effects meta-analyses revealed significant, beneficial effects of physical activity on ADL physical performance (SMD = 0.72, 95% CI [0.45, 1.00];p < .01), with the largest effects found for moderate physical activity levels, and for activity types with high levels of mental (e.g., memory, attention), physical (e.g., coordination, balance) and social (e.g., social interaction) demands. Inconsistent effects were observed on self-reported ADL measures. Interventions that include moderate physical activity levels with high mental, physical, and social demands may produce the greatest benefits on ADL physical performance.

Comparing the effects of an acute bout of physical exercise with an acute bout of interactive mental and physical exercise on electrophysiology and executive functioning in younger and older adults

BACKGROUND

Physical exercise has been shown to improve cognitive and neural functioning in older adults.

AIMS AND METHODS

The current study compared the effects of an acute bout of physical exercise with a bout of interactive mental and physical exercise (i.e., "exergaming") on executive (Stroop) task performance and event-related potential (ERP) amplitudes in younger and older adults.

RESULTS

Results revealed enhanced executive task performance in younger and older adults after exercise, with no differences in performance between exercise conditions. Stroop (RT) performance in older adults improved more than in younger adults from pre- to post-exercise. A significant increase in EEG amplitude from pre- to post-exercise was found at the Cz site from 320 to 700 ms post-stimulus for both younger and older adults, with older adults demonstrating a larger Stroop interference effect. While younger adults exhibited overall greater EEG amplitudes than older adults, they showed no differences between congruent and incongruent trials (i.e., minimal interference). Compared to peers with higher BMI (body mass index), older adults with lower BMI showed a greater reduction in Stroop interference effects from pre- to post-exercise.

DISCUSSION AND CONCLUSIONS

The beneficial effects of an acute bout of physical exercise on cognitive and neural functioning in younger and older adults were confirmed, with no difference between standard exercise and exergaming. Findings suggest that BMI, sometimes used as a proxy for fitness level, may modulate benefits that older adults derive from an acute bout of exercise. Findings have implications for future research that seeks to investigate unique effects of exergaming when compared to standard physical exercise.

Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline1

This 6-month experimental case series study investigated the effects of a dual-task gait training and aerobic exercise intervention on cognition, mobility, and cardiovascular health in community-dwelling older adults without dementia. Participants exercised 40 min/day, 3 days/week for 26 weeks on a Biodex GaitTrainer2 treadmill. Participants were assessed at baseline (V0), interim (V1: 12-weeks), intervention endpoint (V2: 26-weeks), and study endpoint (V3: 52-weeks). The study outcomes included: cognition [executive function (EF), processing speed, verbal fluency, and memory]; mobility: usual & dual-task gait (speed, step length, and stride time variability); and vascular health: ambulatory blood pressure, carotid arterial compliance, and intima-media thickness (cIMT). Fifty-six participants [age: 70(6) years; 61% female] were included in this study. Significant improvements following the exercise program (V2) were observed in cognition: EF (p = 0.002), processing speed (p < 0.001), verbal fluency [digit symbol coding (p < 0.001), phonemic verbal fluency (p < 0.001)], and memory [immediate recall (p < 0.001) and delayed recall (p < 0.001)]; mobility: usual & dual-task gait speed (p = 0.002 and p < 0.001, respectively) and step length (p = 0.001 and p = 0.003, respectively); and vascular health: cIMT (p = 0.002). No changes were seen in the remaining outcomes. In conclusion, 26 weeks of dual-task gait training and aerobic exercise improved performance on a number of cognitive outcomes, while increasing usual & dual-task gait speed and step length in a sample of older adults without dementia.

High-intensity training enhances executive function in children in a randomized, placebo-controlled trial

Background:

Exercise-induced cognitive improvements have traditionally been observed following aerobic exercise interventions; that is, sustained sessions of moderate intensity. Here, we tested the effect of a 6 week high-intensity training (HIT) regimen on measures of cognitive control and working memory in a multicenter, randomized (1:1 allocation), placebo-controlled trial.

Methods:

318 children aged 7-13 years were randomly assigned to a HIT or an active control group matched for enjoyment and motivation. In the primary analysis, we compared improvements on six cognitive tasks representing two cognitive constructs (N = 305). Secondary outcomes included genetic data and physiological measurements.

Results:

The 6-week HIT regimen resulted in improvements on measures of cognitive control [BFM = 3.38, g = 0.31 (0.09, 0.54)] and working memory [BFM = 5233.68, g = 0.54 (0.31, 0.77)], moderated by BDNF genotype, with met66 carriers showing larger gains post-exercise than val66 homozygotes.

Conclusions:

This study suggests a promising alternative to enhance cognition, via short and potent exercise regimens.

Funding:

Funded by Centre for Brain Research.

Clinical trial number:

NCT03255499.

Exercise has beneficial effects on the body and brain. People who perform well on tests of cardiovascular fitness also do well on tests of learning, memory and other cognitive skills. So far, studies have suggested that moderate intensity aerobic exercise that lasts for 30 to 40 minutes produces the greatest improvements in these brain abilities.

Recently, short high-intensity workouts that combine cardiovascular exercise and strength training have become popular. Studies have shown that these brief bouts of strenuous exercise improve physical health, but do these benefits extend to the brain? It would also be helpful to know if the effect that exercise has on the brain depends on an individual’s genetic makeup or physical health. This might help to match people to the type of exercise that will work best for them.

Now, Moreau et al. show that just 10 minutes of high-intensity exercise a day over six weeks can boost the cognitive abilities of children. In the experiments, over 300 children between 7 and 13 years of age were randomly assigned to one of two groups: one that performed the high-intensity exercises, or a ‘control’ group that took part in less active activities – such as quizzes and playing computer games – over the same time period. The children who took part in the high-intensity training showed greater improvements in cognitive skills than the children in the control group. Specifically, the high-intensity exercise boosted working memory and left the children better able to focus on specific tasks, two skills that are important for academic success.

Moreau et al. further found that the high-intensity exercises had the most benefit for the children who needed it most – those with poor cardiovascular health and those with gene variants that are linked to poorer cognitive skills. This suggests that genetic differences do alter the effects of exercise on the brain, but also shows that targeted exercise programs can offer everyone a chance to thrive.

Moreau et al. suggest that exercise need not be time consuming to boost brain health; the key is to pack more intense exercise in shorter time periods. Further work could build on these findings to produce effective exercise routines that could ultimately form part of school curriculums, as well as proving useful to anyone who wishes to improve their cognitive skills.

Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function

Introduction

Cognitive decline is common and increases mortality risk in hemodialysis patients. Intradialytic interventions like cognitive training (CT) and exercise training (ET) may preserve cognitive function.

Methods

We conducted a pilot randomized controlled trial of 20 hemodialysis patients to study the impact of 3 months of intradialytic CT (tablet-based brain games) (n = 7), ET (foot peddlers) (n = 6), or standard of care (SC) (n = 7) on cognitive function. Global cognitive function was measured by the Modified Mini Mental Status Exam (3MS), psychomotor speed was measured by Trail Making Tests A and B (TMTA and TMTB), and executive function was assessed by subtracting (TMTB − TMTA). Lower 3MS scores and slower TMTA and TMTB times reflected worse cognitive function. P values for differences were generated using analysis of variance, and 95% confidence intervals (CIs) and P values were generated from linear regression.

Results

Patients with SC experienced a decrease in psychomotor speed and executive function by 3 months (TMTA: 15 seconds; P = 0.055; TMTB: 47.4 seconds; P = 0.006; TMTB − TMTA; 31.7 seconds; P = 0.052); this decline was not seen among those with CT or ET (all P > 0.05). Compared with SC, the difference in the mean change in 3MS score was −3.29 points (95% CI: −11.70 to 5.12; P = 0.42) for CT and 4.48 points (95% CI: −4.27 to 13.22; P = 0.30) for ET. Compared with SC, the difference in mean change for TMTA was −15.13 seconds (95% CI: −37.64 to 7.39; P = 0.17) for CT and −17.48 seconds (95% CI: −41.18 to 6.22; P = 0.14) for ET, for TMTB, the difference was −46.72 seconds (95% CI: −91.12 to −2.31; P = 0.04) for CT and −56.21 seconds (95% CI: −105.86 to −6.56; P = 0.03) for ET, and for TMTB – TMTA, the difference was −30.88 seconds (95% CI: −76.05 to 14.28; P = 0.16) for CT and −34.93 seconds (95% CI: −85.43 to 15.56; P = 0.16) for ET.

Conclusion

Preliminary findings of our pilot study suggested that cognitive decline in psychomotor speed and executive function is possibly prevented by intradialytic CT and ET. These preliminary pilot findings should be replicated.

Exercise Promotes Neuroplasticity in Both Healthy and Depressed Brains: An fMRI Pilot Study

Memory impairments are a frequently reported cognitive symptom in people suffering from major depressive disorder (MDD) and often persist despite antidepressant therapy. Neuroimaging studies have identified abnormal hippocampal activity during memory processes in MDD. Exercise as an ad-on treatment for MDD is a promising therapeutic strategy shown to improve mood, cognitive function, and neural structure and function. To advance our understanding of how exercise impacts neural function in MDD, we must also understand how exercise impacts healthy individuals without MDD. This pilot study used a subsequent memory paradigm to investigate the effects of an eight-week exercise intervention on hippocampal function in low-active healthy (n = 8) and low-active MDD (n = 8) individuals. Results showed a marked improvement in depression scores for the MDD group (p < 0.0001) and no change in memory performance for either group (p > 0.05). Functional imaging results showed a marginally significant decrease in hippocampal activity in both groups following the exercise intervention. Our whole brain analysis collapsed across groups revealed a similar deactivation pattern across several memory-associated regions. These results suggest that exercise may enhance neural efficiency in low-fit individuals while still resulting in a substantially greater mood effect for those suffering from MDD. This trial is registered with clinical trials.gov NCT03191994.

The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: a randomized controlled trial

[Purpose] This study investigates whether cognition, balance and dual task performance in institutionalized older adults improves by a virtual reality dual task training. [Subjects and Methods] Randomized controlled trial; Twenty institutionalized older adults with mild cognitive impairment (13 female, 7 male; average age, 87.2 ± 5.96 years) were randomized to the intervention (i.e. Virtual reality dual-task training using the BioRescue) or control group (no additional training). The intervention group took part in a 6-week training program while the elderly in the control group maintained their daily activities. Balance was measured with the Instrumented Timed Up-and-Go Test with and without a cognitive task. The Observed Emotion Rating Scale and Intrinsic Motivation Inventory were administered to evaluate the emotions and motivation regarding the exergaming program. [Results] The intervention group improved significantly on the total Timed Up-and-Go duration and the turn-to-sit duration during single-task walking in comparison to the control group who received no additional training. Participants found the virtual reality dual task training pleasant and useful for their concentration, memory and balance. Pleasure and alertness were the two emotions which were mostly seen during the intervention. [Conclusion] The BioRescue is a pleasant and interesting treatment method, well suited for institutionalized older adults in need of lifelong physical therapy.