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Manser P, Herold F, de Bruin ED. Components of effective exergame-based training to improve cognitive functioning in middle-aged to older adults - A systematic review and meta-analysis. Ageing Res Rev 2024; 99:102385. [PMID: 38914262 DOI: 10.1016/j.arr.2024.102385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/19/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Exergame-based training is currently considered a more promising training approach than conventional physical and/or cognitive training. OBJECTIVES This study aimed to provide quantitative evidence on dose-response relationships of specific exercise and training variables (training components) of exergame-based training on cognitive functioning in middle-aged to older adults (MOA). METHODS We conducted a systematic review with meta-analysis including randomized controlled trials comparing the effects of exergame-based training to inactive control interventions on cognitive performance in MOA. RESULTS The systematic literature search identified 22,928 records of which 31 studies were included. The effectiveness of exergame-based training was significantly moderated by the following training components: body position for global cognitive functioning, the type of motor-cognitive training, training location, and training administration for complex attention, and exercise intensity for executive functions. CONCLUSION The effectiveness of exergame-based training was moderated by several training components that have in common that they enhance the ecological validity of the training (e.g., stepping movements in a standing position). Therefore, it seems paramount that future research focuses on developing innovative novel exergame-based training concepts that incorporate these (and other) training components to enhance their ecological validity and transferability to clinical practice. We provide specific evidence-based recommendations for the application of our research findings in research and practical settings and identified and discussed several areas of interest for future research. PROSPERO REGISTRATION NUMBER CRD42023418593; prospectively registered, date of registration: 1 May 2023.
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Affiliation(s)
- Patrick Manser
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany
| | - Eling D de Bruin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Herold F, Theobald P, Gronwald T, Kaushal N, Zou L, de Bruin ED, Bherer L, Müller NG. The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions. JMIR Aging 2024; 7:e56433. [PMID: 39083334 PMCID: PMC11325123 DOI: 10.2196/56433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 08/02/2024] Open
Abstract
A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.
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Affiliation(s)
- Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Paula Theobald
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Hamburg, Germany
| | - Navin Kaushal
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN, United States
| | - Liye Zou
- Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen, China
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St Gallen, Switzerland
| | - Louis Bherer
- Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Université de Montreal, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal, Montreal, QC, Canada
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
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Engelsma T, Heijmink S, Hendriksen HMA, Visser LNC, Lemstra AW, Jaspers MWM, Peute LWP. Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study. JMIR Hum Factors 2024; 11:e54032. [PMID: 39083790 PMCID: PMC11325128 DOI: 10.2196/54032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/15/2024] [Accepted: 03/06/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. OBJECTIVE This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. METHODS First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. RESULTS The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57%) with SCD, 1 (14%) with MCI, and 2 (29%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user's expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. CONCLUSIONS By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population.
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Affiliation(s)
- Thomas Engelsma
- eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Simone Heijmink
- eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - Heleen M A Hendriksen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Leonie N C Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Monique W M Jaspers
- eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
| | - Linda W P Peute
- eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
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Ye Y, Lei M, Chen L, Song R, Zhao F, Zhang L. Efficacy of technology-based cognitive and exercise interventions for mild cognitive impairment: A systematic review, network meta-analysis, and meta-regression of randomized controlled trials. Ageing Res Rev 2024; 100:102438. [PMID: 39069094 DOI: 10.1016/j.arr.2024.102438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Technology has been increasingly integrated into controlling the decline of cognitive function. It is unclear whether technology-based cognitive and exercise interventions (T-CEIs) could generate synergistic benefits and what components would optimize this effect. This study aimed to compare the effectiveness of various T-CEIs on cognitive function in individuals with mild cognitive impairment (MCI). METHODS In this study, we searched MEDLINE, Web of Science, Scopus, Embase, and APA PsycInfo from inception to November 4, 2023. We included randomized controlled trials that evaluated the effects of T-CEIs on cognitive function for individuals with MCI. The primary outcome was global cognition. The outcomes were summarized in narrative synthesis and combined using meta-analysis. Pairwise meta-analysis and network meta-analysis were sequentially performed to investigate the effects of each category of interventions and their comparative intervention effectiveness, respectively. Meta-regression was performed to examine the influence of study design and participants' characteristics on the intervention effectiveness. This systematic review protocol was registered in PROSPERO (CRD 42023486359). RESULTS Twenty-eight studies with 1633 participants were included. The results of pairwise meta-analyses indicated that T-CEIs were superior to active/passive controls in improving global cognition, cognitive shifting, processing speed, working memory, delayed recall, and category fluency (p < 0.05). The results of network meta-analyses indicated that the optimal components in improving global cognition (SUCRA 77.0 %, SMD 0.85, 95 % CI -0.17 to 1.87) and cognitive shifting (SUCRA 92.4 %, SMD 1.57, 95 % CI 0.88-2.25) were cognitive stimulation (CS) combined with mind-body exercise (MBE), while cognitive training combined with MBE was the most beneficial in developing processing speed (SUCRA 88.5 %, SMD 0.68, 95 % CI 0.14-1.22). Meta-regression further suggested that the effects of the tested interventions were independent of the various factors related to study design and participants' characteristics. CONCLUSIONS T-CEIs are effective in improving global cognition and core subdomains of cognition in individuals with MCI. This review highlights the superior effects of technology-based CS combined with MBE in improving global cognition.
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Affiliation(s)
- Yifan Ye
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Ming Lei
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liangying Chen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Song
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fengjiao Zhao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lifeng Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
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Lazarou I, Krooupa AM, Nikolopoulos S, Apostolidis L, Sarris N, Papadopoulos S, Kompatsiaris I. Cancer Patients' Perspectives and Requirements of Digital Health Technologies: A Scoping Literature Review. Cancers (Basel) 2024; 16:2293. [PMID: 39001356 PMCID: PMC11240750 DOI: 10.3390/cancers16132293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Digital health technologies have the potential to alleviate the increasing cancer burden. Incorporating patients' perspectives on digital health tools has been identified as a critical determinant for their successful uptake in cancer care. The main objective of this scoping review was to provide an overview of the existing evidence on cancer patients' perspectives and requirements for patient-facing digital health technologies. Three databases (CINAHL, MEDLINE, Science Direct) were searched and 128 studies were identified as eligible for inclusion. Web-based software/platforms, mobile or smartphone devices/applications, and remote sensing/wearable technologies employed for the delivery of interventions and patient monitoring were the most frequently employed technologies in cancer care. The abilities of digital tools to enable care management, user-friendliness, and facilitate patient-clinician interactions were the technological requirements predominantly considered as important by cancer patients. The findings from this review provide evidence that could inform future research on technology-associated parameters influencing cancer patients' decisions regarding the uptake and adoption of patient-facing digital health technologies.
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Affiliation(s)
- Ioulietta Lazarou
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Anna-Maria Krooupa
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Spiros Nikolopoulos
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Lazaros Apostolidis
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Nikos Sarris
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Symeon Papadopoulos
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Ioannis Kompatsiaris
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
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Klöppel S, Brill E, Frisoni GB, Aarsland D, Klusmann-Weißkopf V. Value-based motivational strategies combined with technology to encourage a lifestyle that helps to prevent dementia. THE LANCET. HEALTHY LONGEVITY 2024; 5:e443-e446. [PMID: 38824958 DOI: 10.1016/s2666-7568(24)00069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 06/04/2024] Open
Abstract
Lifestyles aimed at reducing dementia risk typically combine physical and cognitive training, nutritional adaptations, and, potentially, an augmentation in social interactions. Interventions at the population level are essential but should be complemented by individual efforts. For efficacy, lasting changes to an individual's lifestyle are needed, necessitating robust motivation and volition. Acting in accordance with one's values is assumed to be rewarding, leading to improved motivation and volition, and produces stable behaviour-outcome relationships. To this end, future preventive endeavours might first evaluate an individual's extant lifestyle, preferences, and values, including considerations of age-related changes to ensure these values remain a motivational source. Digital technology can support lifestyle goals and be targeted to support an individual's values. A digital platform could implement situation-specific, sensing-based feedback to alert users to a target situation (eg, opportunity for exercise) coupled with (smartphone-based) feedback on the extent of accomplished behavioural change to support individually set goals and facilitate their adjustment depending on whether these goals are achieved. This use of the motivational impetus of values, coupled with interpersonal techniques, such as motivational interviewing and SMART goal setting, in combination with sensor technology and just-in-time adaptive interventions, is assumed to hold high potential for dementia prevention.
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Affiliation(s)
- Stefan Klöppel
- University Psychiatric Services Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern Switzerland.
| | - Esther Brill
- University Psychiatric Services Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern Switzerland
| | - Giovanni B Frisoni
- Memory Center, University of Geneva and University Hospitals, Geneva, Switzerland
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Nasrun MWS, Kusumaningrum P, Malik K, Kusumaningsih W, Harimurti K, Prawiroharjo P, Mardhiyah FS, Matanta RH, Lalenoh LAP, Kiasati SK. Technological acceptance and features needed in mobile health apps development for people living with dementia and their caregivers in Indonesia. Inform Health Soc Care 2024; 49:99-115. [PMID: 38578948 DOI: 10.1080/17538157.2024.2328029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
In Indonesia, the number of People Living with Dementia (PLWD) is predicted to be rising continuously. PLWD need help operating cell phones for their daily needs. Numerous mobile health applications have been innovated to deliver better dementia care. The objective of this study is to identify the technological acceptance and features needed by PLWD and caregivers in Indonesia. This study started with questionnaire development through focused-group discussion with experts, caregivers and PLWD. It was followed by item development involving experts in geriatrics (psychiatry, internal medicine, medical rehabilitation and neurology) to prepare an online questionnaire. We considered using jargon and words that are familiar to users. The data collected was analyzed for the technological acceptance model (TAM) using Structural Equation Model (SEM). This study showed that perceived usefulness and ease of use of the technology have positively correlated to the actual use. This study reflects the need for social connectedness and information for PLWD. For caregivers, the main feature needed is information related to dementia symptoms and treatment. The understanding gained from this study can be used to improve strategies related to developing mobile health technology for PLWD and caregivers.
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Affiliation(s)
- Martina Wiwie Setiawan Nasrun
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Neuroscience and Brain Development Research Cluster IMERI FKUI, Jakarta, Indonesia
| | - Profitasari Kusumaningrum
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Khamelia Malik
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Neuroscience and Brain Development Research Cluster IMERI FKUI, Jakarta, Indonesia
| | - Widjajalaksmi Kusumaningsih
- Neuroscience and Brain Development Research Cluster IMERI FKUI, Jakarta, Indonesia
- Department of Medical Rehabilitation, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Department of Internal Medicine, Division of Geriatrics, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Pukovisa Prawiroharjo
- Department of Neurology, Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | | | | - Saarah Khansa Kiasati
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Seinsche J, de Bruin ED, Hinrichs T, Giannouli E. Effects of home-based interventions using exergames on physical and cognitive functions in community-dwelling older adults: a PRISMA-P-compliant protocol for a systematic review. Front Public Health 2024; 11:1291120. [PMID: 38274539 PMCID: PMC10808653 DOI: 10.3389/fpubh.2023.1291120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Physical activity and exercise are crucial to counteract physical and cognitive decline in old age. Home-based exergame training can be a solution to overcome physical inactivity. This systematic review aims to provide a comprehensive overview of home-based exergame interventions and evaluate their effectiveness in improving cognitive and physical functions through physical activity enhancement in older adults. Methods and analysis We are conducting a systematic literature search including studies examining (1) community-dwelling older adults aged 60 years and older without any specific disease, (2) exergame-based exercise programs that take place at least partially in a home setting, and (3) intervention-related physical and/or cognitive outcomes. We will include randomized controlled trials and any other type of pre-post study published in English. There are no restrictions in terms of control group type and publication date. A search string was created and used in PubMed, Web of Science, Embase, Scopus and CINAHL. In addition, a hand search is carried out. This involves checking the references of the included studies and searching Google Scholar for further studies. The included studies will be summarized and, if homogeneity is sufficient, a random-effects meta-analysis will be performed. We will assess the risk of bias using RoB 2.0 and ROBINS-I. Conclusion The findings of this systematic review will help to define the most suitable exergame programs to counteract cognitive and physical decline in older adults. Additionally, they will inform the development of effective home-based exergame systems and point to future pathways of digital rehabilitation in older adults. Registration Prospero (ID: CRD42023374234).
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Affiliation(s)
- Julia Seinsche
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Eling D. de Bruin
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Eleftheria Giannouli
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Herold F, Theobald P, Gronwald T, Kaushal N, Zou L, de Bruin ED, Bherer L, Müller NG. Alexa, let's train now! - A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:30-46. [PMID: 36736727 PMCID: PMC10818117 DOI: 10.1016/j.jshs.2023.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging. Consequently, the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions. In this context, digital and home-based physical training interventions might be a promising alternative to center-based intervention programs. Thus, this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance. METHODS In this pre-registered systematic review (PROSPERO; ID: CRD42022320031), 5 electronic databases (PubMed, Web of Science, PsycInfo, SPORTDiscus, and Cochrane Library) were searched by 2 independent researchers (FH and PT) to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults. The systematic literature search yielded 8258 records (extra 17 records from other sources), of which 27 controlled trials were considered relevant. Two reviewers (FH and PT) independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX scale). RESULTS Of the 27 reviewed studies, 15 reported positive effects on cognitive and motor-cognitive outcomes (i.e., performance improvements in measures of executive functions, working memory, and choice stepping reaction test), and a considerable heterogeneity concerning study-related, population-related, and intervention-related characteristics was noticed. A more detailed analysis suggests that, in particular, interventions using online classes and technology-based exercise devices (i.e., step-based exergames) can improve cognitive performance in healthy older adults. Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence (≤85%) and monitoring of the level of regular physical activity in the control group. CONCLUSION The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall, though there is limited evidence that specific types of digital and home-based physical training interventions (e.g., online classes and step-based exergames) can be an effective strategy for improving cognitive performance in older adults. However, due to the limited number of available studies, future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.
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Affiliation(s)
- Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China.
| | - Paula Theobald
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg 20457, Germany
| | - Navin Kaushal
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Liye Zou
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich 8093, Switzerland; Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm 17177, Sweden; Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen 9001, Switzerland
| | - Louis Bherer
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada; Department of Medicine, Universite de Montreal, Montreal, QC H3T 1J4, Canada; Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal, Montreal, QC H3W 1W5, Canada
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China
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10
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Furtado GE, Reis ASLDS, Braga-Pereira R, Caldo-Silva A, Teques P, Sampaio AR, dos Santos CAF, Bachi ALL, Campos F, Borges GF, Brito-Costa S. Impact of Exercise Interventions on Sustained Brain Health Outcomes in Frail Older Individuals: A Comprehensive Review of Systematic Reviews. Healthcare (Basel) 2023; 11:3160. [PMID: 38132050 PMCID: PMC10742503 DOI: 10.3390/healthcare11243160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Several systematic review studies highlight exercise's positive impact on brain health outcomes for frail individuals. This study adopts a Comprehensive Review of reviews (CRs) approach to amalgamate data from existing reviews, focusing on exercise's influence on brain health outcomes in older frail and pre-frail adults. The methodology involves a thorough search of Portuguese, Spanish, and English-indexed databases (i.e., Ebsco Health, Scielo, ERIC, LILACS, Medline, Web of Science, SportDiscus) from 1990 to 2022, with the AMSTAR-2 tool assessing evidence robustness. The search terms "physical exercise", "elderly frail", and "systematic review" were employed. Results: Out of 12 systematically reviewed studies, four presented high-quality (with metanalyses), while eight exhibit critically low quality. Positive trends emerge in specific cognitive and neuromotor aspects, yet challenges persist in psychosocial domains, complex cognitive tasks, and ADL outcomes. This study yields reasonable and promising evidence regarding exercise's influence on quality of life and depression in frail older individuals. However, the impact on biochemical markers remains inconclusive, emphasizing the need for standardized methodologies. Conclusions: The findings highlight the importance of acknowledging methodological nuances for clinicians and policymakers when translating these results into impactful interventions for aging populations. This emphasizes the necessity for a comprehensive and customized approach to exercise interventions aimed at fostering the sustainability of overall well-being in older individuals, aligning with United Nations Sustainable Development Goal 3.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal;
- Research Centre for Natural Resources Environment and Society (CERNAS), Polytechnic Institute of Coimbra, Bencanta, 3045-601 Coimbra, Portugal
| | - Anne Sulivan Lopes da Silva Reis
- Postgraduate Program in Physical Education, University of Southwest Bahia and the State University of Santa Cruz (PPGEF/UESB/UESC), Ilhéus 45650-000, Brazil;
| | - Ricardo Braga-Pereira
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
| | - Adriana Caldo-Silva
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, 3040-248 Coimbra, Portugal;
| | - Pedro Teques
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
- CIPER, Interdisciplinary Center for the Study of Human Performance, 1499-002 Lisbon, Portugal
| | - António Rodrigues Sampaio
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
| | - Carlos André Freitas dos Santos
- Discipline of Geriatrics and Gerontology, Department of Medicine, Paulista School of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo 04020-050, Brazil;
- Postgraduate Program in Translational Medicine, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo 04023-062, Brazil
| | - André Luís Lacerda Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | - Francisco Campos
- Coimbra Education School, Polytechnic of Coimbra, 3045-043 Coimbra, Portugal;
| | - Grasiely Faccin Borges
- Center for Public Policies and Social Technologies, Federal University of Southern Bahia, Praça José Bastos, s/n, Centro, Itabuna 45600-923, Brazil;
| | - Sónia Brito-Costa
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal;
- Research Group in Social and Human Sciences (NICSH), Coimbra Education School, Polytechnic of Coimbra, 3045-043 Coimbra, Portugal
- Human Potential Development Center (CDPH), Polytechnic of Coimbra, 3030-329 Coimbra, Portugal
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11
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Manser P, Poikonen H, de Bruin ED. Feasibility, usability, and acceptance of "Brain-IT"-A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trial. Front Aging Neurosci 2023; 15:1163388. [PMID: 37810620 PMCID: PMC10557950 DOI: 10.3389/fnagi.2023.1163388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Exergames provide a promising new approach to implement simultaneous motor-cognitive training, which may support preventing the decline in cognitive functioning in older adults who have a mild neurocognitive disorder (mNCD). Objectives To evaluate feasibility, system usability, and acceptance of "Brain-IT", a newly developed training concept combining exergame-based motor-cognitive training and heart rate variability (HRV) guided resonance breathing for the secondary prevention of mNCD. Methods A pilot randomized controlled trial (RCT) with an allocation ratio of 2:1 (i.e., intervention:control) was conducted. The control group proceeded with usual care. The intervention group performed a 12-week training according to the "Brain-IT" training concept implemented with the "Senso Flex" (Dividat AG) exergaming system in addition to usual care. Feasibility and usability outcomes were analyzed using descriptive statistics. User acceptance was analyzed qualitatively and using Friedman analysis of variance (ANOVA), as well as Wilcoxon signed-rank tests. Results Eighteen participants (77.3 ± 9.8 years; 44.4% females) were included. On average, we recruited 2.2 participants per month, and 35.3% of the individuals contacted were included. The intervention group had an attrition rate of 20% and mean adherence and compliance rates of 85.0 and 84.1%, respectively. The mean system usability score, measured with the system usability scale, was 71.7. High levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness, were observed. Preliminary data on the effects of the "Brain-IT" training are promising. Conclusion The feasibility and usability of the "Brain-IT" training are acceptable. However, frequent occurrences of technical problems and difficulties in using the exergame training system were identified as barriers to performing the "Brain-IT" training. To optimize feasibility, either improvements or alternative solutions are required in the hardware and software of the exergame used to implement the "Brain-IT" training. The "Brain-IT" training itself was well-accepted by older adults who have mNCD. Therefore, the effectiveness of the "Brain-IT" training concept should be investigated in future studies. Trial registration clinicaltrials.gov/ct2/show/NCT04996654.
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Affiliation(s)
- Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Hanna Poikonen
- Learning Sciences and Higher Education, Department of Humanities, Social and Political Sciences, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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12
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Swinnen N, de Bruin ED, Guimarães V, Dumoulin C, De Jong J, Akkerman R, Vandenbulcke M, Stubbs B, Vancampfort D. The feasibility of a stepping exergame prototype for older adults with major neurocognitive disorder residing in a long-term care facility: a mixed methods pilot study. Disabil Rehabil 2023:1-15. [PMID: 36824039 DOI: 10.1080/09638288.2023.2182916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To explore the feasibility of an exergame prototype in residential individuals with major neurocognitive disorder (MNCD). MATERIALS AND METHODS Participants were randomly assigned to a 12-week stepping exergame training or traditional exercise (active control group). Semi-structured interviews were conducted after six and 12 weeks of exergaming. Qualitative data were thematically analysed using NVivo 12. The Short Physical Performance Battery, one minute sit-to-stand test, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, and Dementia Quality of Life were assessed at baseline and post intervention using a Quade's ANCOVA. RESULTS Seven older adults with MNCD in the exergame and 11 in the active control group completed the study [mean age = 83.2 ± 6.5 years; 94.4% female; SPPB score = 7.3 ± 2.4]. Results indicated that the VITAAL exergame prototype was experienced as enjoyable and beneficial. The post-MMSE score was higher (η2=.02, p = 0.01, F = 8.1) following exergaming versus traditional exercise. CONCLUSIONS The findings suggest that the exergame prototype is accepted by individuals with MNCD residing in a long-term care facility when they are able to participate and under the condition that they are extensively guided. The preliminary efficacy results revealed higher post-MMSE scores after exergaming versus traditional exercise. Future trials should confirm or refute these findings. TRIAL REGISTRATION The trial was registered in ClinicalTrials.gov (Identifier: NCT04436315)Implications for rehabilitationThe VITAAL exergame prototype is accepted by individuals with MNCD residing in a long-term care facility who are able to participate.Supervision of exergaming by health professionals is essential for successful implementation.The VITAAL exergame prototype might maintain cognitive levels in major neurocognitive disorder longer than walking combined with standardised squatting and stepping exercises.
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Affiliation(s)
- Nathalie Swinnen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Vânia Guimarães
- Fraunhofer Portugal Research Center for Assistive Information and Communication Solutions, Porto, Portugal
| | - Chantal Dumoulin
- Faculty of Medicine, University of Montreal, Québec, Canada
- Montreal Geriatric University Institute, Québec, Canada
| | | | | | - Mathieu Vandenbulcke
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
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Keawtep P, Wichayanrat W, Boripuntakul S, Chattipakorn SC, Sungkarat S. Cognitive Benefits of Physical Exercise, Physical-Cognitive Training, and Technology-Based Intervention in Obese Individuals with and without Postmenopausal Condition: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013364. [PMID: 36293943 PMCID: PMC9603710 DOI: 10.3390/ijerph192013364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 06/14/2023]
Abstract
Obesity and estrogen deprivation have been identified as significant risk factors for cognitive impairment. Thus, postmenopausal conditions when paired with obesity may amplify the risks of developing dementia. Physical exercise has been recommended as a primary treatment for preventing obesity-related comorbidities and alleviating menopausal symptoms. This narrative review aimed to summarize the effects of exercise on cognition in obese individuals with and without menopausal condition, along with potential physiological mechanisms linking these interventions to cognitive improvement. Research evidence has demonstrated that exercise benefits not only physical but also cognitive and brain health. Among various types of exercise, recent studies have suggested that combined physical-cognitive exercise may exert larger gains in cognitive benefits than physical or cognitive exercise alone. Despite the scarcity of studies investigating the effects of physical and combined physical-cognitive exercise in obese individuals, especially those with menopausal condition, existing evidence has shown promising findings. Applying these exercises through technology-based interventions may be a viable approach to increase accessibility and adherence to the intervention. More evidence from randomized clinical trials with large samples and rigorous methodology is required. Further, investigations of biochemical and physiological outcomes along with behavioral changes will provide insight into underlying mechanisms linking these interventions to cognitive improvement.
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Affiliation(s)
- Puntarik Keawtep
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wanachaporn Wichayanrat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sirinun Boripuntakul
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Research Group of Modern Management and Information Technology, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Siriporn C. Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Research Group of Modern Management and Information Technology, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai 50200, Thailand
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