Exergaming and older adult cognition: a cluster randomized clinical trial

Exergaming and cognitive functions in people with mild cognitive impairment and dementia: a meta-analysis

Exergaming is a combination of exercise and gaming. Evidence shows an association between exercise and cognition in older people. However, previous studies showed inconsistent results on the cognitive benefits of exergaming in people with cognitive impairment. Therefore, this study aims to examine the effect of exergaming intervention on cognitive functions in people with MCI or dementia. A systematic literature search was conducted via OVID databases. Randomized controlled trials (RCTs) examined the effect of an exergaming intervention on cognitive functions in people with MCI or dementia were included. Subgroup analyses were conducted according to the type of intervention and training duration. Twenty RCTs with 1152 participants were identified, including 14 trials for MCI and 6 trials for dementia. In people with MCI, 13 studies used virtual-reality (VR)-based exergaming. Those who received VR-based exergaming showed significantly better global cognitive function [SMD (95%CI) = 0.67 (0.23-1.11)], learning and memory [immediate recall test: 0.79 (0.31-1.27); delayed recall test: 0.75 (0.20-1.31)], working memory [5.83 (2.27-9.39)], verbal fluency [0.58 (0.12-1.03)], and faster in executive function than the controls. For people with dementia, all studies used video-based exergaming intervention. Participants with exergaming intervention showed significantly better global cognitive function than the controls [0.38 (0.10-0.67)]. Subgroup analyses showed that longer training duration generated larger effects. The findings suggest that exergaming impacts cognitive functions in people with MCI and dementia. Cognitive benefits are demonstrated for those with a longer training duration. With technological advancement, VR-based exergaming attracts the attention of people with MCI and performs well in improving cognitive functions.

The Effects of Virtual Reality Training on Cognition in Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials

The aim of this systematic review, meta-analysis, and meta-regression was to examine the effects of virtual reality-based training on global cognition and executive function compared with conventional training or information-based treatment in older adults, regardless of cognitive level. A systematic literature search was conducted using four databases. A total of 31 randomized controlled trials were identified. Pooled effect sizes were calculated, the risk of bias was assessed, and evidence was graded. The primary analyses showed a small but statistically significant effect of virtual reality-based training compared with control on global cognition (Hedges' g 0.42, 95% confidence interval [0.17, 0.68], I2 = 70.1%, n = 876, 20 randomized controlled trials, low evidence) and executive function (Hedges' g 0.35, 95% confidence interval [0.06, 0.65], I2 = 68.4%, n = 810, 16 randomized controlled trials, very low evidence). Meta-regression yielded inconclusive results. Virtual reality-based training may be more effective than control in improving cognition in older adults; however, more high-quality studies are needed.

Effects of Multimodal Exercise With Augmented Reality on Cognition in Community-Dwelling Older Adults

OBJECTIVES

This study aims to investigate the effects of an exercise intervention using multimodal exercise with augmented reality and multimodal exercise-only on cognitive function in older adults living in a community dwelling.

DESIGN

Quasi-experimental research study.

SETTING AND PARTICIPANTS

In this control study, 78 participants were divided into 2 experimental groups (with sessions 3 times a week for 12 weeks) and a control group (CG).

METHODS

EG1 participated in a multimodal exercise-only intervention program, EG2 participated in a multimodal exercise program with augmented reality exergames, and CG continued its usual activities. Participants were assessed at baseline and postintervention after 12 weeks.

RESULTS

Comparison between baseline and postintervention at 12 weeks showed significant improvements in executive functions, verbal fluency, choice reaction time, and dual task in EG1, whereas there were improvements in general cognition, executive functions, verbal fluency, discrimination reaction time, and depression in EG2 (P ≤ .05). The clinical effect sizes of the interventions were large for overall cognition, executive functions, and reaction time on single- and dual-task reaction time in EG1 and for overall cognition, executive functions, and verbal fluency in EG2.

CONCLUSION AND IMPLICATIONS

The intervention programs showed significant improvements in several cognitive domains. The multimodal exercise-only showed improvements in more variables than the multimodal exercise with augmented reality, but the augmented reality group showed greater changes between baseline and postintervention.

The Effects of Simultaneous Aerobic Exercise and Video Game Training on Executive Functions and Brain Connectivity in Older Adults

OBJECTIVE

The study was designed to examine the effects of simultaneous combination of aerobic exercise and video game training on executive functions (EFs) and brain functional connectivity in older adults.

DESIGN

A four-armed, quasi-experimental study.

SETTING AND PARTICIPANTS

Community-dwelling adults aged 55 years and older.

METHODS

A total of 97 older adults were divided into one of four groups: aerobic exercise (AE), video game (VG), combined intervention (CI), and passive control (PC). Participants in intervention groups received 32 sessions of training over a 4-month period at a frequency of twice a week. EFs was evaluated using a composite score derived from a battery of neuropsychological tests. The Montreal Cognitive Assessment (MoCA) was employed to evaluate overall cognitive function, while the 6-Minute Walking Test (6MWT) was utilized to gauge physical function. Additionally, the functional connectivity (FC) of the frontal-parietal networks (FPN) was examined as a neural indicator of cognitive processing and connectivity changes.

RESULTS

In terms of EFs, both VG and CI groups demonstrated improvement following the intervention. This improvement was particularly pronounced in the CI group, with a large effect size (Hedge's g = 0.83), while the VG group showed a medium effect size (Hedge's g = 0.56). A significant increase in MoCA scores was also observed in both the VG and CI groups, whereas a significant increase in 6MWT scores was observed in the AE and CI groups. Although there were no group-level changes observed in FC of the FPN, we found that changes in FC was behaviorally relevant as increased FC was associated with greater improvement in EFs.

CONCLUSION

The study offers preliminary evidence that both video game training and combined intervention could enhance EFs in older adults. Simultaneous combined intervention may hold greater potential for facilitating EFs gains. The initial evidence for correlated changes in brain connectivity and EFs provides new insights into understanding the neural basis underlying the training gains.

Changes in cardiovascular health and white matter integrity with aerobic exercise, cognitive and combined training in physically inactive healthy late-middle-aged adults: the "Projecte Moviment" randomized controlled trial

INTRODUCTION

This is a 12-weeks randomized controlled trial examining the effects of aerobic exercise (AE), computerized cognitive training (CCT) and their combination (COMB). We aim to investigate their impact on cardiovascular health and white matter (WM) integrity and how they contribute to the cognitive benefits.

METHODS

109 participants were recruited and 82 (62% female; age = 58.38 ± 5.47) finished the intervention with > 80% adherence. We report changes in cardiovascular risk factors and WM integrity (fractional anisotropy (FA); mean diffusivity (MD)), how they might be related to changes in physical activity, age and sex, and their potential role as mediators in cognitive improvements.

RESULTS

A decrease in BMI (SMD = - 0.32, p = 0.039), waist circumference (SMD = - 0.42, p = 0.003) and diastolic blood pressure (DBP) (SMD = - 0.42, p = 0.006) in the AE group and a decrease in BMI (SMD = - 0.34, p = 0.031) and DBP (SMD = - 0.32, p = 0.034) in the COMB group compared to the waitlist control group was observed. We also found decreased global MD in the CCT group (SMD = - 0.34; p = 0.032) and significant intervention-related changes in FA and MD in the frontal and temporal lobes in the COMB group.

CONCLUSIONS

We found changes in anthropometric measures that suggest initial benefits on cardiovascular health after only 12 weeks of AE and changes in WM microstructure in the CCT and COMB groups. These results add evidence of the clinical relevance of lifestyle interventions and the potential benefits when combining them.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT031123900.

Barriers and facilitators to older adult participation in intergenerational physical activity program: a systematic review

BACKGROUND

The intergenerational physical activity program aims to promote the health, social engagement, and well-being of older adults. It is essential to comprehend the barriers and facilitators that affect their involvement to develop successful intervention strategies. This systematic review critically examines available research to identify the factors that impact the participation of older adults in intergenerational physical activity programs.

METHODS

This study retrieved 13 electronic databases (from January 2000 to March 2023) and used a social-ecological model to classify and analyze the identified facilitators and barriers.

RESULTS

A total of 12 articles were included, which identified 73 facilitators and 37 barriers. These factors were condensed into 7 primary themes and 14 sub-themes in total.

CONCLUSIONS

The factors influencing the participation of older adults in intergenerational physical activities are multifaceted. These factors guide project developers, policymakers, and practitioners in developing and implementing intergenerational physical activity programs to help address global aging issues and promote intergenerational connections.

TRIAL REGISTRY

PROSPERO ID: CRD42023420758.

Effects of Sport Stacking on Cognition in Patients With Mild Alzheimer's Disease and MCI: Preliminary Findings of Randomized Controlled Trial

OBJECTIVE

This mixed-method pilot study aims to investigate the feasibility and preliminary effects of sport stacking on cognitive function in individuals with mild Alzheimer's disease (AD) and those with mild cognitive impairment (MCI).

METHODS

Twenty-four community-dwelling subjects with confirmed mild AD or MCI were evenly randomly assigned to either the 12-week sport stacking intervention group (n = 12) or clinic routine management control group (n = 12). Outcome evaluation included the Auditory Verbal Learning Test (AVLT), Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL), and plasma brain-derived neurotrophic factor (BDNF). A qualitative descriptive study was conducted to explore the overall perception and experience of the sport stacking from the subjects' perspective.

RESULTS

Twenty-two subjects completed the trial. At 12 weeks post-intervention, compared to the control group, the sport stacking group had significantly greater improvements in AVLT immediate recall (P < .001, Cohen d = .66) and an increase in plasma BDNF (P < .001, Cohen d = .64). Subgroup analysis indicated that subjects with MCI had significantly greater increases in AVLT immediate recall (P = .005, Cohen d = .72), ADCS-ADL (P = .130, Cohen d = .42) and plasma BDNF (P = .024, Cohen d = .83). Twelve subjects participating in the post-intervention interviews expressed the benefits (e.g., hand-eye coordination and faster reaction) from sport stacking and their enjoyment of it.

CONCLUSION

To the best of our knowledge, this is the first study indicating that sport stacking is feasible among individuals with MCI and mild AD. The preliminary effect on episodic memory is encouraging, possibly via upregulation of BDNF.

Protocol of the MOVI-ageing randomized controlled trial: a home-based e-Health intervention of cognitively demanding exercise for the improvement of cardiorespiratory fitness and cognitive function in older individuals

Objective

To describe the protocol of the MOVI-ageing randomized controlled trial, a home-based eHealth intervention of cognitive-demanding exercise for older adults, in improving global cognitive function and basic cognitive functions, cardiorespiratory fitness, and muscle fitness.

Methods

This randomized controlled trial will include participants identified in the social centers of Cuenca and Talavera de la Reina who agree to participate and provide informed consent. Adults aged 60-80 years of both genders retired regardless of the reason for retirement, who do not meet frailty criteria according to Fried criteria, and without cognitive impairment will be invited to participate. This study will be developed in two phases: (i) a 12-week randomized efficacy/feasibility trial and (ii) a large-scale implementation randomized trial phase with a 12-week follow-up following similar procedures. In addition, a qualitative study on barriers to and facilitators of the implementation of the physical exercise intervention using eHealth for older people will be conducted. Participants will have access to a platform including videos of cognitively demanding physical exercise. The participants will be remotely and off-line guided through the physical exercise intervention, and the research team will be able to check the degree of compliance with the program and its correct execution. The participants will receive feedback on their compliance with the routines and reinforcement messages.

Implications

The implementations of the findings and their inclusion in guidelines may directly impact in older people's life, and relatives, through the prevention of morbidity and the reduction of years lost to disability. These benefits may be reflected in the reduction of economic expenditure by reducing the demand for social and health care services.

Ethics

The Clinical Research Ethics Committee of the 'Virgen de la Luz' Hospital in Cuenca approved the study protocol (registration number: 2022/PI3222). In addition, this protocol was previously registered in Clinicaltrials.gov (Number: NCT05928078).

The Effect of Wii Training on Neurocognitive Function in Athletes with Functional Ankle Instability: Matched Randomized Clinical Trial

Background

Many studies have investigated ankle sprain injury and it has been reported that in 80% of cases, ankle sprains lead to functional ankle instability (FAI). The conventional exercises for FAI rehabilitation neglect the associated neurocognitive dysfunction.

Objective

This study aims to evaluate the effect of Wii Fit Plus as a virtual reality training on neurocognitive function in athletes with FAI compared to athletes without FAI.

Material and Methods

In this matched randomized clinical trial study, 25 athletes with unilateral FAI and 25 athletes without FAI were assigned to two groups randomly: 1) the intervention group, subjects performed the Wii training including balance and strengthening games three times a week for 12 sessions and 2) subjects in the control group received no intervention. Before and after the training, the neurocognitive function was assessed through the computerized-reaction time test based on the detection or identification of 'X' mark on a computer monitor. Between-groups and within-group comparisons were done by the independent T-test and paired T-test, respectively.

Results

A significant difference was observed in mean differences of neurocognitive function between athletes with and without FAI. Comprising before and after training was significant in the intervention group.

Conclusion

Based on the results, the information-processing speed of athletes with FAI increased after the training, utilized for rehabilitation protocols.

Classifying the non-metabolic demands of different physical activity types: The Physical Activity Demand (PAD) typology

Different physical activity types vary in metabolic demand (intensity), but also in non-metabolic physical demand (balance, co-ordination, speed and flexibility), cognitive demand (attention, memory and decision making), and social demand (social interaction). Activity types with different combinations of demands may have different effects on health outcomes but this cannot be formally tested until such demands can be reliably quantified. The present Delphi expert consensus study aimed to objectively quantify the cognitive, physical and social demands of different core physical activity types and use these scores to create a formal Physical Activity Demand (PAD) typology. International experts (n = 40; experts in cognitive science, psychology, sports science and physiology; 7 different nationalities; 18 male/22 female; M = 13.75 years of disciplinary experience) systematically rated the intrinsic cognitive, physical and social demands of 61 common activity types over 2-rounds of a modified Delphi (expert consensus) study. Consensus (>70% agreement) was reached after 2 rounds on the demands of 59/61 activity types. Cognitive, physical and social demand scores were combined to create an overall non-metabolic demand rating for each activity type, and two-step cluster-analysis was used to identify groups of activities with comparable demand profiles. Three distinct clusters of activities were identified representing activity types with low (n = 12 activities; e.g. domestic cleaning), moderate (n = 23 activities; e.g. tai-chi) and high (n = 24 activities; e.g. football) total non-metabolic demands. These activity types were then organised into a formal typology. This typology can now be used to test hypotheses about if and why physical activity types with different combinations of cognitive, physical and social demands affect health outcomes in different ways.

Event-related brain potentials reveal enhancing and compensatory mechanisms during dual neurocognitive and cycling tasks

BACKGROUND

Various neurocognitive tests have shown that cycling enhances cognitive performance compared to resting. Event-related potentials (ERPs) elicited by an oddball or flanker task have clarified the impact of dual-task cycling on perception and attention. In this study, we investigate the effect of cycling on cognitive recruitment during tasks that involve not only stimulus identification but also semantic processing and memory retention.

METHODS

We recruited 24 healthy young adults (12 males, 12 females; mean age = 22.71, SD = 1.97 years) to perform three neurocognitive tasks (namely color-word matching, arithmetic calculation, and spatial working memory) at rest and while cycling, employing a within-subject design with rest/cycling counterbalancing.

RESULTS

The reaction time on the spatial working memory task was faster while cycling than at rest at a level approaching statistical significance. The commission error percentage on the color-word matching task was significantly lower at rest than while cycling. Dual-task cycling while responding to neurocognitive tests elicited the following results: (a) a greater ERP P1 amplitude, delayed P3a latency, less negative N4, and less positivity in the late slow wave (LSW) during color-word matching; (b) a greater P1 amplitude during memory encoding and smaller posterior negativity during memory retention on the spatial working memory task; and (c) a smaller P3 amplitude, followed by a more negative N4 and less LSW positivity during arithmetic calculation.

CONCLUSION

The encoding of color-word and spatial information while cycling may have resulted in compensatory visual processing and attention allocation to cope with the additional cycling task load. The dual-task cycling and cognitive performance reduced the demands of semantic processing for color-word matching and the cognitive load associated with temporarily suspending spatial information. While dual-tasking may have required enhanced semantic processing to initiate mental arithmetic, a compensatory decrement was noted during arithmetic calculation. These significant neurocognitive findings demonstrate the effect of cycling on semantic-demand and memory retention-demand tasks.

The Effects of Adolescents' Participation in Video Games on Cognitive Function and Motor Control Skills

There is still a lack of understanding of the productive areas of video game participation. Therefore, in order to observe positive effects and changes in game participation, this study examines the effects of game participation on the cognitive function and motor skills from 130 adolescents. To evaluate the participants' test performance, a cognitive function and motor control skill test program consisting of 10 tests were used (Trail Making, Corsi block, Tower of London, shooting game tasks, etc.). Differences in test performances between groups were verified using one-way ANOVA and an independent t-test. The results were as follows: first, there was no difference between groups according to the frequency of game participation in every test performance. Second, the results of this study showed statistically significant differences between groups according to the play time of game participation in several test performances (Key-mapping: p = 0.40; score of Grid Shot: p = 0.01, 0.07; score of Sphere Track: p = 0.12, 0.21; accuracy of Sphere Track: p = 0.12, 0.16). Also, all the effects' size results were confirmed as medium (Cohen's f > 0.20 and <0.40). Third, high school students only showed statistically significant higher results in a Multi-tasking test performance than middle school students, and the results of the effect size were confirmed to be middle and large (Multi-tasking1: p = 0.00, Cohen's d = 0.830; Multi-tasking2: p = 0.05, Cohen's d = 0.501). The results of this study imply the need to regard game participation as a behavior that can contribute to adolescents' cognitive psychological health.

The effects of an acute bout of ergometer cycling on young adults' executive function: A systematic review and meta-analysis

Purpose

The extent to which acute exercise improves executive function (EF) remains indeterminate. The purpose of this systematic review and meta-analysis was to determine the effect of acute ergometer cycling exercise on executive function (EF), including the potential moderating effects of exercise intensity and duration, EF task type, and EF task onset.

Methods

We searched seven electronic research databases using cycling- and cognition-related terms. All 17 studies included were published in the last 10 years and comprised healthy participants aged 18-35 years who completed tasks assessing a variety of EFs before and after cycling exercise lasting 10-60 min. We analyzed 293 effect sizes obtained from 494 individuals (mean age = 22.07 ± 2.46 yrs). Additional analyses were performed, using averaged effect sizes for each separate study to examine the omnibus effect across studies.

Results

There was a positive effect of acute ergometer cycling exercise on response time (RT) in 16 of 17 studies reviewed and a positive effect for response accuracy (RA) in 8 of 14 studies; three studies did not report RA data. Hedges' g effect sizes [95% CI] for RT ranged from 0.06 [-0.45, 0.56] to 1.50 [0.58, 2.43] and for RA from -1.94 [-2.61, -1.28] to 1.03 [0.88, 1.19].Bouts of cycling completed at moderate intensities appear to have the greatest effect on RT (Hedges' g = 1.03 [0.88, 1.19]) but no significant effect on RA; bouts with durations of 21-30 min appear to offer the greatest benefits for both RT (Hedges' g = 0.77 [0.41, 1.13]) and RA (Hedges' g = 0.92 [0.31, 1.52]). Effect sizes were greatest for RT in inhibitory control tasks (Hedges' g = 0.91 [0.80, 1.03]) and for RT when EF tasks were completed immediately post-exercise (Hedges' g = 1.11 [0.88, 1.33]).

Findings were similar in the omnibus analyses

moderate-intensity bouts had the greatest effect on RT, SMD = 0.79 (95% CI [0.49, 1.08]), z = 5.20, p < 0.0001, as did cycling durations of 21-30 min, SMD = 0.87 (95% CI [0.58, 1.15], z = 5.95, p < 0.0001. The greatest benefits were derived for inhibitory control tasks, SMD = 0.70 (95% CI [0.43, 0.98]), z = 5.07, p < 0.04, and when the EF task was completed immediately post-exercise, SMD = 0.96 (95% CI [0.51, 1.41]), z = 4.19, p < 0.001. There were no overall effects on RA.

Conclusion

Our findings indicate that acute bouts of cycling exercise may be a viable means to enhance RTs in immediately subsequent EF task performance, but moderating and interactive effects of several exercise parameters must also be considered.

The Impact of Intradialytic Cognitive and Physical Training Program on the Physical and Cognitive Abilities in End-Stage Kidney Disease Patients: A Randomized Clinical Controlled Trial

BACKGROUND

Hemodialysis (HD) patients have lower cognitive functioning and reduced physical fitness than age-matched healthy individuals. Clinicians typically do not recognize the declining cognitive performance in these patients; therefore, cognitive impairment is greatly underestimated and not appropriately treated. This study aimed to evaluate the impact on cognitive function of combining cognitive training with physical exercise and physical performance in HD patients.

METHODS

Using a randomized, single-blinded control design, forty-four HD patients were recruited and randomly assigned to either an intradialytic physical exercise and cognitive training program (EXP group; n = 22; 54% male; 65.7 ± 9.7 years; 77.1 ± 21.9 kg; body mass index 26.8 ± 6.0) or a standard care control group (CON group; n = 21; 77% male; 67.2 ± 12.5 years; 74.2 ± 14.3 kg; body mass index 25.9 ± 3.8). The EXP group performed intradialytic cycling and cognitive training three days per week for 12 weeks. Study outcomes were assessed by the Symbol Digit Modalities Test (SDMT), Montreal Cognitive Assessment (MoCA), 10-repetition sit-to-stand test (10-STS), handgrip strength test (HGS), and stork balance test.

RESULTS

The results showed a significant time*group interaction effect for SDMT (p < 0.001; η2 = 0.267) and MoCA (p < 0.001; η2 = 0.266). Moreover, no significant interaction was observed for 10-STS, HGS, and stork balance test (p > 0.05).

CONCLUSIONS

Our findings suggest that incorporating intradialytic cognitive and physical exercise training could help to improve the functional status of HD patients. The innovative, nonpharmacological, bimodal intervention is cost-effective, safe, and easy to implement during the intradialytic period and offers a potential impact on patients' quality of life and well-being.

Paving the way to better understand the effects of prolonged spaceflight on operational performance and its neural bases

Space exploration objectives will soon move from low Earth orbit to distant destinations like Moon and Mars. The present work provides an up-to-date roadmap that identifies critical research gaps related to human behavior and performance in altered gravity and space. The roadmap summarizes (1) key neurobehavioral challenges associated with spaceflight, (2) the need to consider sex as a biological variable, (3) the use of integrative omics technologies to elucidate mechanisms underlying changes in the brain and behavior, and (4) the importance of understanding the neural representation of gravity throughout the brain and its multisensory processing. We then highlight the need for a variety of target-specific countermeasures, and a personalized administration schedule as two critical strategies for mitigating potentially adverse effects of spaceflight on the central nervous system and performance. We conclude with a summary of key priorities for the roadmaps of current and future space programs and stress the importance of new collaborative strategies across agencies and researchers for fostering an integrative cross- and transdisciplinary approach from cells, molecules to neural circuits and cognitive performance. Finally, we highlight that space research in neurocognitive science goes beyond monitoring and mitigating risks in astronauts but could also have significant benefits for the population on Earth.

Brain Health Indicators Following Acute Neuro-Exergaming: Biomarker and Cognition in Mild Cognitive Impairment (MCI) after Pedal-n-Play (iPACES)

Facing an unrelenting rise in dementia cases worldwide, researchers are exploring non-pharmacological ways to ameliorate cognitive decline in later life. Twenty older adults completed assessments before and after a single bout of interactive physical and cognitive exercise, by playing a neuro-exergame that required pedaling and steering to control progress in a tablet-based video game tailored to impact executive function (the interactive Physical and Cognitive Exercise System; iPACES v2). This study explored the cognitive and biomarker outcomes for participants with mild cognitive impairment (MCI) and normative older adults after 20 min of pedal-to-play exercise. Neuropsychological and salivary assessments were performed pre- and post-exercise to assess the impact. Repeated-measures ANOVAs revealed significant interaction effects, with MCI participants experiencing greater changes in executive function and alpha-amylase levels than normative older adults; within-group changes were also significant. This study provides further data regarding cognitive effects and potential mechanisms of action for exercise as an intervention for MCI.

Effects of exergaming in older individuals with mild cognitive impairment and dementia: A systematic review and meta-analysis

BACKGROUND

Non-pharmaceutical interventions have been implemented for people with dementia or mild cognitive impairment (MCI). Researchers have used exergaming in dementia to alleviate cognitive decline in patients with dementia.

AIMS

We assessed the effects of exergaming interventions on MCI and dementia.

METHODS

We conducted a systematic review and meta-analysis (PROSPERO [CRD42022347399]). PubMed, Cochrane Library, Web of Science, CINAHL, and Embase electronic databases were searched for randomized controlled trials (RCTs). The impact of exergaming on cognitive function, physical performance, and quality of life in patients with MCI and dementia was investigated.

RESULTS

Ten RCTs met the eligibility criteria and were included in our systematic review. The results of the meta-analysis demonstrated a statistically significant difference in the Mini-mental State Examination, Montreal Cognitive Assessment, Trail Making Test, Chinese version of the Verbal Learning Test, Berg Balance Scale, Short Physical Performance Battery, and Physical Activity Scale for the Elderly in people with dementia and MCI who participated in exergaming. However, there were no significant improvements in the Activities of Daily Living, Instrumental Activity of Daily Living or Quality of Life.

CONCLUSION

Although there were significant differences in cognitive and physical functions, these results should be interpreted with caution because of heterogeneity. The additional benefits of exergaming remain to be confirmed in future studies.

Older Adults and Three-Dimensional Exergaming: Motivators and Barriers to Participation and Retention

Background: Cognitive and physical activity are important for daily functioning. However, limited research exists on the motivators and barriers associated with older adults participating and adhering to exergame studies that promote physical and cognitive activity. Our objective was to examine older adults' motivators and barriers to joining and completing a three-dimensional exergame study. Methods: Fourteen older adults who participated in the exergame study contributed to one of three focus group discussions. Inductive and deductive methods were used to analyze the qualitative data. Results: Motivators for joining were generativity, peer referrals, self-improvement, and curiosity. Accomplishment, immersion, and exercise were motivators for retention. Participants also cited the structured schedule and adaptive difficulty features as motivators for retention. Barriers to participation included frustration due to lack of level advancement and fatigue/pain during gameplay. Some (n = 3) reported camera tracking issues as a barrier. Unanticipated gender-based trends arose when examining perceptions of the study team's role and motivators for retention. Conclusion: These findings will inform future research strategies for participant recruitment, enrollment, and retention, in addition to providing insights into the design of motivating, enjoyable, and sustainable exergames for older adults.

Factors for optimizing intervention programs for cognition in older adults: the value of exergames

This review presents factors that could optimize the effectiveness of an intervention program on cognitive health in older adults. Combined, multi-dimensional and interactive programs appear to be relevant. On one hand, for the characteristics to be implemented in the physical dimension of a program, multimodal interventions stimulating the aerobic pathway and muscle strengthening during the solicitation of gross motor activities, seem to be interesting. On the other hand, regarding the cognitive dimension of a program, complex and variable cognitive stimuli appear to hold the greatest promise for generating cognitive benefits and the broadest transfers to untrained tasks. The field of video games also brings interesting enrichment through the gamification of situations and the feeling of immersion. However, some gray areas remain to be clarified, notably the ideal response dose, the balance between physical and cognitive solicitation and the programs’ customization.

Effects of exergame and bicycle exercise intervention on blood pressure and executive function in older adults with hypertension: A three-group randomized controlled study

Management of hypertension and prevention of cognitive decline are challenging public health problems. However, the effects of exergame intervention on blood pressure (BP) remain to be explored, and whether exergame intervention is an effective alternative to traditional physical exercise intervention for older adults with hypertension remains to be demonstrated. This study aimed to explore the effectiveness of moderate-intensity exergame intervention and bicycle exercise training on BP and executive function in older hypertensive patients. A total of 128 participants were randomly assigned to the exergame intervention group (n = 41), bicycle exercise intervention group (n = 44), and control group (n = 43). The intervention groups exercised for 60 min, 3 times per week, for 16 weeks, while the control group maintained their normal lifestyle. The results revealed that there were no significant differences between two intervention groups and control group in systolic BP and diastolic BP changes (ps > 0.05). Both intervention groups demonstrated significant improvements in working memory when compared with control group (exergame intervention group: -461.9 ms, p = 0.025; bicycle exercise intervention group: -470.1 ms, p = 0.021). There were no significant differences in systolic BP, diastolic BP, or working memory between the two intervention groups after 16 weeks of training (ps > 0.05). No difference in inhibition or cognitive flexibility was observed between the intervention and control groups (ps > 0.05). The current results showed that moderate-intensity exergame intervention did not produce significant benefits in reducing BP, but yielded similar beneficial effects in working memory to that of bicycle exercise intervention. More studies are needed on whether exergame intervention has the potential to be a promising supplemental therapeutic tool for older adults with hypertension.

The benefits of regular aerobic exercise training on cerebrovascular function and cognition in older adults

We compared the differences in cerebrovascular and cognitive function between 13 aerobic exercise trained, older adults and 13 age-, height- and sex-matched sedentary, untrained controls. We determined whether other measures accounted for differences in cerebrovascular and cognitive function between these groups and examined the associations between these functions. Participants undertook anthropometric, mood, cardiovascular, exercise performance, strength, cerebrovascular, and cognitive measurements, and a blood collection. Transcranial Doppler ultrasonography determined cerebrovascular responsiveness (CVR) to hypercapnia and cognitive stimuli. The trained group had a higher CVR to hypercapnia (80.3 ± 7.2 vs 35.1 ± 6.7%, P < 0.001), CVR to cognitive stimuli (30.1 ± 2.9 vs 17.8 ± 1.4%, P = 0.001) and total composite cognitive score (117 ± 2 vs 98 ± 4, P < 0.001) than the controls. These parameters no longer remained statistically different between the groups following adjustments for covariates. There were positive correlations between the total composite cognitive score and CVR to hypercapnia (r = 0.474, P = 0.014) and CVR to cognitive stimuli (r = 0.685, P < 0.001). We observed a relationship between cerebrovascular and cognitive function in older adults and an interaction between regular lifelong aerobic exercise training and cardiometabolic factors that may directly influence these functions.

SMARTfit Dual-Task Exercise Improves Cognition and Physical Function in Older Adults With Mild Cognitive Impairment: Results of a Community-Based Pilot Study

Mild cognitive impairment is an intermediate state between the cognitive decline often experienced in normal aging and dementia that affects 15% of Americans over 65 years of age. Our communities have an opportunity to support the development and adoption of evidence-based programs to help older adults preserve cognition and physical function. In partnership with a local urban YMCA in an underserved, predominantly minority neighborhood, we tested the appeal and therapeutic benefits of SMARTfit training among older adults with mild cognitive impairment. The participants reported a positive training experience. After 12 weeks of dual-task training, Trail-Making Test and Stroop Color-Word Interference Test scores improved, as did scores on the Short Physical Performance Battery. Results of our SMARTfit dual-task training intervention are encouraging. Larger randomized controlled trials must further investigate the development, implementation, and therapeutic impacts of SMARTfit dual-task training on cognitive and physical function in aging.

Differences in Brain Activity and Body Movements Between Virtual Reality and Offline Exercise: Randomized Crossover Trial

BACKGROUND

Virtual reality (VR) has been suggested to be effective at enhancing physical exercises because of its immersive characteristics. However, few studies have quantitatively assessed the range of motion and brain activity during VR exercises.

OBJECTIVE

We hypothesized that 3D immersive VR could stimulate body movement and brain activity more effectively than standard exercises and that the increased range of motions during 3D immersive VR exercises would be associated with orbitofrontal activation.

METHODS

A randomized crossover trial was conducted to compare exercises with and without VR. A total of 24 healthy males performed the same motions when exercising with and without 3D immersive VR, and the recorded videos were used for motion analysis. Hemodynamic changes in the prefrontal cortex were assessed using functional near-infrared spectroscopy.

RESULTS

There were significant differences in the total angle (z=-2.31; P=.02), length (z=-2.78; P=.005), calorie consumption (z=-3.04; P=.002), and change in accumulated oxygenated hemoglobin within the right orbitofrontal cortex (F^1,94=9.36; P=.003) between the VR and offline trials. Hemodynamic changes in the right orbitofrontal cortex were positively correlated with the total angle (r=0.45; P=.001) and length (r=0.38; P=.007) in the VR exercise; however, there was no significant correlation in the offline trial.

CONCLUSIONS

The results of this study suggest that 3D immersive VR exercise effectively increases the range of motion in healthy individuals in relation to orbitofrontal activation.

TRIAL REGISTRATION

Clinical Research Information Service KCT0008021; https://cris.nih.go.kr/cris/search/detailSearch.do/23671.

Using Digital Technology to Design a Simple Interactive System for Nostalgic Gaming to Promote the Health of Slightly Disabled Elderly People

An interactive digital gaming system with simple tangible interfaces is proposed for use by slightly disabled elderly people to promote their health and enjoyment of playful aging. The system simulates a rice threshing machine with nostalgic and entertaining functions expected to bring better life quality to older adults. Initially, pieces of literature were reviewed to derive relevant design principles. A prototype system was constructed accordingly and refined according to the invited older users' comments. The refined system was performed subsequently by slightly disabled elderly people, followed by a questionnaire survey conducted to collect their opinions. The opinion data were analyzed statistically by SPSS and AMOS to be reliable and valid. In addition, interviews were conducted with the users and experts were invited to collect comments on the system's usability, which were then evaluated to reveal several findings about the system's effectiveness: (1) digital products related to life experiences are more acceptable to slightly disabled elderly people, promoting their willingness to play games to achieve active aging; (2) simple system interfaces requiring no complicated limb functions are appropriate for the slightly disabled elderly people; and (3) digital gaming has the effects of training slightly disabled elderly peoples' cognitive and motor abilities as well as strengthening their body and mind.

Dance to Prosper: Benefits of Chinese Square Dance in QOL and the Moderating Roles of Aging Stereotypes

BACKGROUND

By examining the effect of Chinese square dance duration through a positive activity model and discussing the impact of aging stereotype internalization, this study examined the relationships between dance duration, attitudes toward own aging (ATOA), aging stereotypes, and quality of life.

METHODS

403 Chinese square dance participants were recruited to complete a 7-day diary survey in a cross-sectional design. Participants reported on their ATOA, aging stereotypes, perceived quality of life, and everyday dance participation during the week. Data were analyzed using latent variable structural equation modeling.

RESULTS

Increased dance participation improved quality of life, and the mediation by ATOA was determined. Positive and negative aging stereotypes separately moderated the mediating process. In general, people who had relatively stronger negative stereotypes benefited more from dancing duration, while people with stronger positive stereotypes felt no such dose effect.

CONCLUSIONS

The results suggest that an attitudinal pathway explains the positive activity dose effect, and people with more negative aging stereotypes are encouraged to practice Chinese square dance to benefit from certain effects.

Randomised controlled trials for the prevention of cognitive decline or dementia: A systematic review

Dementia prevention research has progressed rapidly in recent years, with publication of several large lifestyle intervention trials, and renewed interest in pharmacological interventions, notably for individuals with Alzheimer's disease biomarkers, warranting an updated review of results and methodology. We identified 112 completed trials testing the efficacy of single-domain pharmacological (n = 33, 29%), nutritional (n = 27, 24%), physical activity (n = 18, 16%) and cognitive stimulation (n = 13, 12%), or multidomain (n = 22, 20%) interventions on incident dementia, or a relevant intermediate marker (e.g. cognitive function, biomarkers or dementia risk scores) in people without dementia. The earliest trials tested pharmacological interventions or nutritional supplements, but lifestyle interventions predominated in the last decade. In total, 21 (19%) trials demonstrated a clear beneficial effect on the pre-specified primary outcome (or all co-primary outcomes), but only two (10%) were large-scale (testing blood pressure lowering (Syst-Eur) or multidomain (FINGER) interventions on incident dementia and cognitive change in cognitive function, respectively). Of the 116 ongoing trials, 40% (n = 46) are testing multidomain interventions. Recent methodological shifts concern target populations, primary outcome measures, and intervention design, but study design remains constant (parallel group randomised controlled trial). Future trials may consider using adaptive trials or interventions, and more targeted approaches, since certain interventions may be more effective in certain subgroups of the population, and at specific times in the life-course. Efforts should also be made to increase the representativeness and diversity of prevention trial populations.

Effects of preventive interventions on neuroimaging biomarkers in subjects at-risk to develop Alzheimer's disease: A systematic review

Alzheimer's Disease (AD) is a multifactorial and complex neurodegenerative disorder. Some modifiable risk factors have been associated with an increased risk of appearance of the disease and/or cognitive decline. Preventive clinical trials aiming at reducing one or combined risk factors have been implemented and their potential effects assessed on cognitive trajectories and on AD biomarkers. However, the effect of interventions on surrogate markers, in particular imaging biomarkers, remains poorly understood. We conducted a review of the literature and analyzed 43 interventional studies that included physical exercise, nutrition, cognitive training or multidomain interventions, and assessed various brain imaging biomarkers, to determine the effects of preventive interventions on imaging biomarkers for subjects at-risk to develop AD. Deciphering the global and regional brain effect of each and combined interventions will help to better understand the interplay relationship between multimodal interventions, cognition, surrogate brain markers, and to better design primary and secondary outcomes for future preventive clinical trials. Those studies were pondered using generally-admitted quality criteria to reveal that interventions may affect the brain of patients with cognitive impairment rather than those without cognitive impairment thus indicating that particular care should be taken when selecting individuals for interventions. Additionally, a majority of the studies concurred on the effect of the interventions and particularly onto the frontal brain areas.

Acute effects of virtual reality treadmill training on gait and cognition in older adults: A randomized controlled trial

INTRODUCTION

Everyday walking often involves walking with divided attention (i.e., dual-tasking). Exercise interventions for older adults should mimic these simultaneous physical and cognitive demands. This proof-of-concept study had a two-fold purpose: 1) identify acute cognitive and gait benefits of a single session of virtual reality treadmill training (VRTT), relative to conventional treadmill training (CTT), and 2) identify differences between those who reduced dual-task costs (i.e., responders) on gait or cognition and those who did not, after the session.

METHODS

Sixty older adults were randomized to complete a single 30-minute session of VRTT (n = 30, 71.2±6.5 years, 22 females) or CTT (n = 30, 72.0±7.7 years, 21 females). Pre- and post-exercise session, participants performed single-task walking, single-task cognitive, and dual-task walking trials while gait and cognition were recorded. Gait variables were gait speed and gait speed variability. Cognition variables were response reaction time, response accuracy, and cognitive throughput. Dual-task effects (DTE) on gait and cognition variables were also calculated.

RESULTS

Post-exercise, there were no group differences (all p>0.05). During single- and dual-task trials, both groups walked faster (single-task: F(1, 58) = 9.560, p = 0.003; dual-task: F(1, 58) = 19.228, p<0.001), responded more quickly (single-task: F(1, 58) = 5.054, p = 0.028; dual-task: F(1, 58) = 8.543, p = 0.005), and reduced cognitive throughput (single-task: F(1, 58) = 6.425, p = 0.014; dual-task: F(1, 58) = 28.152, p<0.001). Both groups also exhibited reduced DTE on gait speed (F(1, 58) = 8.066, p = 0.006), response accuracy (F(1, 58) = 4.123, p = 0.047), and cognitive throughput (F(1, 58) = 6.807, p = 0.012). Gait responders and non-responders did not differ (all p>0.05), but cognitive responders completed fewer years of education (t(58) = 2.114, p = 0.039) and better information processing speed (t(58) = -2.265, p = 0.027) than cognitive non-responders.

CONCLUSIONS

The results indicate that both VRTT and CTT may acutely improve gait and cognition. Therefore, older adults will likely benefit from participating in either type of exercise. The study also provides evidence that baseline cognition can impact training effects on DTE on cognition.

The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis

BACKGROUND

Aerobic exercise (AE) may slow age-related cognitive decline. However, such cognition-sparing effects are not uniform across cognitive domains and studies. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation and is also emerging as a potential alternative to pharmaceutical therapies. Like AE, the effectiveness of tDCS is also inconsistent for reducing cognitive impairment in ageing. The unexplored possibility exists that pairing AE and tDCS could produce synergistic effects and reciprocally augment cognition-improving effects in older individuals with and without cognitive impairments. Previous research found such synergistic effects on cognition when cognitive training is paired with tDCS in older individuals with and without mild cognitive impairment (MCI) or dementia.

AIM

The purpose of this systematic review with meta-analysis was to explore if pairing AE with tDCS could augment singular effects of AE and tDCS on global cognition (GC), working memory (WM) and executive function (EF) in older individuals with or without MCI and dementia.

METHODS

Using a PRISMA-based systematic review, we compiled studies that examined the effects of AE alone, tDCS alone, and AE and tDCS combined on cognitive function in older individuals with and without mild cognitive impairment (MCI) or dementia. Using a PICOS approach, we systematically searched PubMed, Scopus and Web of Science searches up to December 2021, we focused on 'MoCA', 'MMSE', 'Mini-Cog' (measures) and 'cognition', 'cognitive function', 'cognitive', 'cognitive performance', 'executive function', 'executive process', 'attention', 'memory', 'memory performance' (outcome terms). We included only randomized controlled trials (RTC) in humans if available in English full text over the past 20 years, with participants' age over 60. We assessed the methodological quality of the included studies (RTC) by the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Overall, 68 studies were included in the meta-analyses. AE (ES = 0.56 [95% CI: 0.28-0.83], p = 0.01) and tDCS (ES = 0.69 [95% CI: 0.12-1.26], p = 0.02) improved GC in all three groups of older adults combined (healthy, MCI, demented). In healthy population, AE improved GC (ES = 0.46 [95% CI: 0.22-0.69], p = 0.01) and EF (ES = 0.27 [95% CI: 0.05-0.49], p = 0.02). AE improved GC in older adults with MCI (ES = 0.76 [95% CI: 0.21-1.32], p = 0.01). tDCS improved GC (ES = 0.69 [90% CI: 0.12-1.26], p = 0.02), all three cognitive function (GC, WM and EF) combined in older adults with dementia (ES = 1.12 [95% CI: 0.04-2.19], p = 0.04) and improved cognitive function in older adults overall (ES = 0.69 [95% CI: 0.20-1,18], p = 0.01).

CONCLUSION

Our systematic review with meta-analysis provided evidence that beyond the cardiovascular and fitness benefits of AE, pairing AE with tDCS may have the potential to slow symptom progression of cognitive decline in MCI and dementia. Future studies will examine the hypothesis of this present review that a potentiating effect would incrementally improve cognition with increasing severity of cognitive impairment.

Cognitive Benefits of Physical Exercise, Physical-Cognitive Training, and Technology-Based Intervention in Obese Individuals with and without Postmenopausal Condition: A Narrative Review

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.

The effect of exergaming on cognition and brain activity in older adults: A motor- related cortical potential study

Exergames have positive effects on various cognitive domains. However, to the best of our knowledge, not only have few studies investigated the exergame-induced brain changes, but also in most of them, preparatory brain activity has not been considered. Preparatory brain activity is a particularly relevant aspect for investigating the interaction between cognitive and sensorimotor functions in the brain. Accordingly, the aim of this study was to investigate the effects of an exergame protocol versus traditional motor-cognitive dual-task training on the cognition and proactive components of movement-related cortical potential. A total of 52 older adults were randomly assigned to the intervention (exergame training) and the control group (motor-cognitive dual-task training). The outcome measurements were neurophysiological data (i.e., the amplitude of the late contingent negative variation [CNV], and alpha/beta event-related desynchronization [ERD]), and neuropsychological data (rate-correct score [RCS] in go/no go task and trail-making test [TMT]). The results revealed that both groups had a decreased late CNV, and alpha/ beta ERD in post-training compared to pre-training in Cz and C3 channels. Moreover, both groups had an increased RCS and a decreased TMT-A in post-training compared to pre-training. However, for TMT-B, the results indicated a significant interaction in favor of the exergame group. These findings indicate that in older adults, both interventions may result in increasing inhibitory control, information processing speed, and preparatory brain activity. However, for cognitive flexibility, exergame has an additional effect relative to the control group.

Physical activities and risk of neurodegenerative diseases: A two-sample Mendelian randomization study

Objectives

Physical activity (PA) is considered beneficial in slowing the progression and improving the neurodegenerative disease prognosis. However, the association between PA and neurodegenerative diseases remains unknown. In this study, we conducted a two-sample Mendelian randomization (MR) analysis to estimate the causal association between PA phenotypes and neurodegenerative diseases.

Materials and methods

Genetic variants robustly associated with PA phenotypes, used as instrumental variables, were extracted from public genome-wide association study (GWAS) summary statistics. Neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD), and Alzheimer’s disease (AD), were considered outcomes. GWAS information was also obtained from the most recent large population study of individuals with European ancestry. Multiple MR methods, pleiotropy tests and sensitivity analyses were performed to obtain a robust and valid estimation.

Results

We found a positive association between moderate-to-vigorous physical activities and ALS based on the inverse variance weighted MR analysis method (OR: 2.507, 95% CI: 1.218–5.160, p = 0.013). The pleiotropy test and sensitivity analysis confirmed the robustness and validity of these MR results. No causal effects of PA phenotypes were found on PD and AD.

Conclusion

Our study indicates a causal effect of PA on the risk of neurodegenerative diseases. Genetically predicted increases in self-reported moderate-to-vigorous PA participation could increase the risk of ALS in individuals of European ancestry. Precise and individualized prescriptions of physical activity should be provided to the elderly population.

An examination of the relationship among plasma brain derived neurotropic factor, peripheral vascular function, and body composition with cognition in midlife African Americans/Black individuals

African American/Black individuals have been excluded from several lines of prominent neuroscience research, despite exhibiting disproportionately higher risk factors associated with the onset and magnitude of neurodegeneration. Therefore, the objective of the current investigation was to examine potential relationships among brain derived neurotropic factor (BDNF), peripheral vascular function, and body composition with cognition in a sample of midlife, African American/Black individuals. Midlife adults (men: n = 3, 60 ± 4 years; women: n = 9, 58 ± 5 years) were invited to complete two baseline visits separated by 4 weeks. Peripheral vascular function was determined by venous occlusion plethysmography, a dual-energy X-ray absorptiometry was used to determine body composition, and plasma was collected to quantify BDNF levels. The CNS Vital Signs computer-based test was used to provide scores on numerous cognitive domains. The principal results included that complex attention (r = 0.629) and processing speed (r = 0.734) were significantly (p < 0.05) related to the plasma BDNF values. However, there was no significant (p > 0.05) relationship between any vascular measure and any cognitive domain or BDNF value. Secondary findings included the relationship between lean mass and peak hyperemia (r = 0.758) as well as total hyperemia (r = 0.855). The major conclusion derived from these results was that there is rationale for future clinical trials to use interventions targeting increasing BDNF to potentially improve cognition. Additionally, these results strongly suggest that clinicians aiming to improve cognitive health via improvements in the known risk factor of vascular function should consider interventions capable of promoting the size and function of skeletal muscle, especially in the African American/Black population.

Development of a Combined Exercise and Cognitive Stimulation Intervention for People with Mild Cognitive Impairment-Designing the MEMO_MOVE PROGRAM

Dementia patients are at high risk for the decline of both physical and cognitive capacities, resulting in an increased risk of the loss of autonomy. Exercise is regarded as a non-pharmacological therapy for dementia, considering the potential benefits of preventing cognitive decline and improving physical fitness. In this paper, we aim to describe the different design stages for an exercise program combined with cognitive stimulation for a population with mild cognitive impairment, i.e., the MEMO_MOVE program.

METHODS

The intervention design followed the Medical Research Council's guidelines for complex interventions and was structured according to the six steps in quality intervention development (6SQuID). The intervention was described considering the Template for Intervention Description and Replication (TIDieR). In order to establish the intervention characteristics, a literature review was conducted to collate and analyze previous work, which provided a summary the type of exercise that should be implemented among this population.

RESULTS

The MEMO_MOVE program was structured and described, regarding (i) inclusion of a cognitive stimulation component; (ii) the kind of cognitive stimulation; and (iii) the type of exercise, duration, frequency, intensity, and program length.

CONCLUSIONS

A systematic step-by-step process design was followed to create a specific intervention to promote physical fitness and cognitive stimulation in individuals with mild dementia.

Effectiveness and Acceptability of e- and m-Health Interventions to Promote Physical Activity and Prevent Falls in Nursing Homes—A Systematic Review

Age-related decreases in physical activity (PA) and a decline in physical functioning lead to increased fall risk. As falls are a major cause of accidental deaths and hospitalization in older adults, PA promotion and fall prevention are important measures, especially in nursing homes (NH). With advances in information and communication technology, e- and m-health solutions have been developed to positively influence various health-related factors. To date, only little research exists on the implementation of these technologies to promote health in NH. Therefore, the objective of this systematic review was to provide an overview of the effectiveness, acceptability, and feasibility of e- and m-health interventions aimed at promoting PA and preventing falls in NH. Additionally, the effectiveness of such interventions regarding the secondary outcomes physical function, cognitive function, neuropsychiatric symptoms, and psychosocial status was examined. A systematic literature search was performed in five databases and studies published until 15 November 2021, were considered for inclusion. All studies that examined the effectiveness and/or the acceptability and feasibility of e- or m-health interventions in promoting PA and preventing falls in NH, without restriction on language or date of publication, were included in the final synthesis. Of the 1,358 records retrieved, 28 studies were included in this systematic review. Twenty-four studies contained digital exergaming as an intervention or as a part of the intervention, the four additional studies on e-health interventions only examined a small number of outcomes. No m-health intervention study was identified. Data synthesis indicates that exergaming may be effective in reducing the number of falls and fall risk in NH residents. Several significant improvements were also reported regarding secondary outcomes albeit not consistent across studies. No conclusion can be drawn about the effects of exergaming and other e-health interventions on PA, as data is scarce. E-health interventions were mostly reported as feasible and well accepted by NH residents. However, these findings may not be applicable to NH residents with advanced physical and/or cognitive impairments, since they were excluded in many studies. Therefore, more research examining other digital solutions besides exergaming to promote PA in this specific population is critical.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42021289488

The Effects of Aerobic Exercise Training on Cerebrovascular and Cognitive Function in Sedentary, Obese, Older Adults

Cerebrovascular function and cognition decline with age and are further exacerbated by obesity and physical inactivity. This decline may be offset by aerobic exercise training (AT). We investigated the effects of 16 weeks AT on cerebrovascular and cognitive function in sedentary, obese, older adults. Twenty-eight participants were randomly allocated to AT or a control group. Before and after the intervention, transcranial Doppler ultrasonography was used to measure the cerebrovascular responsiveness (CVR) to physiological (hypercapnia, 5% carbon dioxide) and cognitive stimuli. AT increased the CVR to hypercapnia (98.5 ± 38.4% vs. 58.0 ± 42.0%, P = 0.021), CVR to cognitive stimuli (25.9 ± 6.1% vs. 16.4 ± 5.4%, P < 0.001) and total composite cognitive score (111 ± 14 vs. 104 ± 14, P = 0.004) compared with the control group. A very strong relationship was observed between the number of exercise sessions completed and CVR to cognitive stimuli (r = 0.878, P < 0.001), but not for CVR to hypercapnia (r = 0.246, P = 0.397) or total composite cognitive score (r = 0.213, P = 0.465). Cerebrovascular function and cognition improved following 16 weeks of AT and a dose-response relationship exists between the amount of exercise sessions performed and CVR to cognitive stimuli.

Effects of Sport Stacking on Neuropsychological, Neurobiological, and Brain Function Performances in Patients With Mild Alzheimer's Disease and Mild Cognitive Impairment: A Randomized Controlled Trial

Objective

To investigate the effects of sport stacking on the overall cognition and brain function in patients with mild Alzheimer's disease (AD) and mild cognitive impairment (MCI).

Methods

A single-blind randomized controlled design was performed using sport stacking for 30 min, 5 days/week for 12 weeks. Forty-eight subjects with mild AD or MCI were randomly divided into the sport stacking group (T-mAD = 12, T-MCI = 12) and the active control group (C-mAD = 11, C-MCI = 13). Auditory Verbal Learning Test (AVLT), Alzheimer's Disease Cooperative Study–Activities of Daily Living scale (ADCS-ADL), Geriatric Depression Scale (GDS-30), and Pittsburgh Sleep Quality Index (PSQI) were performed, the level of amyloid β-protein-40 (Aβ-40), Aβ-42, brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1(IGF-1), tumor necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6), and soluble trigger receptor expressed on myeloid cells 2 (sTREM2) in plasma were tested, and brain functional connectivity in resting state and activation under finger movement task were analyzed by functional near-infrared spectroscopy (fNIRS).

Results

Thirty-nine patients completed the trial. After 4 weeks, we found a significant increase in AVLT score in T-MCI (6.36 ± 5.08 vs. −1.11 ± 4.23, p = 0.004), and T-mAD group (4.60 ± 4.77 vs. −0.11 ± 2.89, p = 0.039). After 12 weeks, there was a significantly improved in AVLT (9.64 ± 4.90 vs. −0.33 ± 6.10, p = 0.002) and ADCS-ADL (3.36 ± 3.59 vs. −1.89 ± 2.71, p = 0.003) in T-MCI. There was a significant improvement in AVLT (5.30 ± 5.42 vs. 0.44 ± 2.40) in T-mAD (p < 0.05). Plasma levels of BDNF were upregulated in both T-MCI and T-mAD, and IGF-1 increased in T-MCI (P < 0.05) compared to the control groups. The functional connectivity in MCI patients between DLPFC.R and SCA.R, SMA.L, and SCA.R was decreased. In contrast, in mAD patients, the brain regional function connection was increased between DLPFC.R and Broca's.L. The activation of channel 36 located in the left primary somatosensory cortex was significantly increased after 12-week training, which was correlated with the improved AVLT and the increase of BDNF.

Conclusion

Our findings suggested that sport stacking is effective for patients with MCI and mild AD, possibly through increasing the expression of neuroprotective growth factors and enhancing neural plasticity to improve neurocognitive performance.

Clinical Trial Registration

https://www.ClinicalTrials.gov, ChiCTR.org.cn, identifier: ChiCTR-2100045980.

Effectiveness of non-pharmaceutical interventions on cognitive function among non-demented African American and Latino older adults in the USA: a scoping review

OBJECTIVE

African Americans and Latinos/Hispanics have a higher prevalence of dementia compared to non-Latino Whites. This scoping review aims to synthesize non-pharmaceutical interventions to delay or slow age-related cognitive decline among cognitively healthy African American and Latino older adults.

DESIGN

A literature search for articles published between January 2000 and May 2019 was performed using the databases PubMed, CINAHL, PsycINFO and Web of Science. Relevant cited references and grey literature were also reviewed. Four independent reviewers evaluated 1,181 abstracts, and full-article screening was subsequently performed for 145 articles. The scoping review consisted of eight studies, which were evaluated according to the peer-reviewed original manuscript, non-pharmaceutical intervention, cognitive function as an outcome, separate reporting of results for African American and Latinos, minimum age of 40, and conducted in the US. A total of 8 studies were considered eligible and were analyzed in the present scoping review.

RESULTS

Eight studies were identified. Four studies focused on African Americans and four focused on Latinos. Through the analysis, results indicated cognitive training-focused interventions were effective in improving memory, executive function, reasoning, visuospatial, psychological function, and speed among African Americans. Exercise interventions were effective in improving cognition among Latinos.

CONCLUSION

This scoping review identified effective non-pharmaceutical interventions among African American and Latinos. Effective interventions focused on cognitive training alone for African Americans and exercise combined with group educational sessions for Latinos. Future research should explore developing culturally appropriate non-pharmaceutical interventions to reduce disparities and to enhance cognition among older African American and Latinos.

Molecular and Brain Volume Changes Following Aerobic Exercise, Cognitive and Combined Training in Physically Inactive Healthy Late-Middle-Aged Adults: The Projecte Moviment Randomized Controlled Trial

Behavioral interventions have shown promising neuroprotective effects, but the cascade of molecular, brain and behavioral changes involved in these benefits remains poorly understood. Projecte Moviment is a 12-week (5 days per week—45 min per day) multi-domain, single-blind, proof-of-concept randomized controlled trial examining the cognitive effect and underlying mechanisms of an aerobic exercise (AE), computerized cognitive training (CCT) and a combined (COMB) groups compared to a waitlist control group. Adherence was > 80% for 82/109 participants recruited (62% female; age = 58.38 ± 5.47). In this study we report intervention-related changes in plasma biomarkers (BDNF, TNF-α, HGF, ICAM-1, SDF1-α) and structural-MRI (brain volume) and how they related to changes in physical activity and individual variables (age and sex) and their potential role as mediators in the cognitive changes. Our results show that although there were no significant changes in molecular biomarker concentrations in any intervention group, changes in ICAM-1 and SDF1-α were negatively associated with changes in physical activity outcomes in AE and COMB groups. Brain volume changes were found in the CCT showing a significant increase in precuneus volume. Sex moderated the brain volume change in the AE and COMB groups, suggesting that men may benefit more than women. Changes in molecular biomarkers and brain volumes did not significantly mediate the cognitive-related benefits found previously for any group. This study shows crucial initial molecular and brain volume changes related to lifestyle interventions at early stages and highlights the value of examining activity parameters, individual difference characteristics and using a multi-level analysis approach to address these questions.

MetaCogs: Mitigating Executive Dysfunction via Agent-Based Modeling for Metacognitive Strategy Development

Executive functions (EF) are a collection of cognitive domains governing task initiation, motor planning, attention, and goal-oriented action. Difficulties with EF have marked impacts on adaptive living skills, learning outcomes, and quality of life for people with cognitive and psychosocial disabilities, as well as the broader population. While there is considerable research interest in EF training intervention for disabled populations, very few studies explore metacognitive intervention for people with cognitive disabilities. Metacognition comprises conscious beliefs and strategies around task management and goal setting. Metacognitive awareness has been shown to mediate the effects of executive function on self-regulated learning. Metacognitive interventions have also shown promise in general education, military training, and medical practice. We present a virtual reality experience deploying agent-based modeling to support explicit metacognitive strategy instruction for undergraduate students of all neurotypes. Our results support that explicit instructional material explaining executive function and metacognition in relation to problem-solving experiences influenced participant self-concept and awareness of personal traits and cognitive processes.

Effects of exergaming on executive function of older adults: a systematic review and meta-analysis

Background

Executive function (EF) involves a series of high-level processes, such as inhibition, switching, and updating. Aging-related cognitive decline has been shown to be strongly associated with EF worsening. The aims of this study were to perform a meta-analysis to evaluate the effects of exergaming, an emerging intervention, on EF performance in older adults and to conduct a moderator analysis of exergaming effects on EF.

Methods

Randomized controlled trials examining exergaming influences on EF in older adults were collated by searching the Web of Science, Elsevier Science, PubMed, and Google Scholar databases. Statistical data were quantified in Comprehensive Meta-analysis software. Overall EF and EF domains (inhibition, switching, and updating) were analyzed separately.

Results

A total of 15 studies were included. The meta-analysis results indicated that exergaming had a significant influence on overall EF in the older adult (standardized mean difference (SMD) = 0.349, 95% confidence interval (CI) [0.191-0.506], p < 0.001). The same effects were also found in EF domains of inhibition (SMD = 0.415, 95% CI [0.102-0.729], p = 0.009), switching (SMD = 0.243, 95% CI [0.071-0.415], p = 0.005), and updating (SMD = 0.366, 95% CI [0.140-0.592], p = 0.002). The effects of exergaming on overall EF were found to be moderated by the frequency of the intervention (Q₍₁₎ = 3.537, p = 0.06).

Conclusion

Exergaming was confirmed to improve overall EF, as well as in older adults, and the effect of exergaming on EF was shown to be moderated by intervention frequency.

SAR-Connect: A Socially Assistive Robotic System to Support Activity and Social Engagement of Older Adults

Multi-domain activities that incorporate physical, cognitive, and social stimuli can enhance older adults' overall health and quality of life. Several robotic platforms have been developed to provide these therapies in a quantifiable manner to complement healthcare personnel in resource-strapped long-term care settings. However, these platforms are primarily limited to one-to-one human robot interaction (HRI) and thus do not enhance social interaction. In this paper, we present a novel HRI framework and a realized platform called SAR-Connect to foster robot-mediated social interaction among older adults through carefully designed tasks that also incorporate physical and cognitive stimuli. SAR-Connect seamlessly integrates a humanoid robot with a virtual reality-based activity platform and a multimodal data acquisition module including game interaction, audio, visual and electroencephalography responses of the participants. Results from a laboratory-based user study with older adults indicates the potential of SAR-Connect that showed this system could 1) involve one or multiple older adults to perform multi-domain activities and provide dynamic guidance, 2) engage them in the robot-mediated task and foster human-human interaction, and 3) quantify their social and activity engagement from multiple sensory modalities.

Effects of Exergames on Brain and Cognition in Older Adults: A Review Based on a New Categorization of Combined Training Intervention

The literature on exergames has reported inconsistent benefits on brain and cognitive functions. Moreover, it is still unknown whether they yield to equal or superior benefits as compared to other forms of physical exercise. However, until now, a review of exergaming literature was lacking, that would reverse the “product first” approach to replacing it with a “training first” approach that is, an analysis of the different studies based on a detailed description of the type of combined training interventions that was supported by the utilized exergames. In the present review, thanks to a structured framework build around seven interacting constructs (stimuli, settings, targets, markers, outcomes, moderators, and mechanisms), which collectively afford a global picture of the determining factors of exergames training, we aimed to determine whether and under which conditions exergames could be more effective than conventional training. Twenty three studies were finally selected for review and analyzed. We concluded that, in spite of their potential to improve brain and cognition, beneficial factors contributing to exergaming efficacy as well as its underlying mechanisms need to be investigated more systematically thanks to common experimental designs based on gold standards. We proposed some directions in this respect.

Simultaneous Dual-Task Interventions That Improve Cognition in Older Adults: A Scoping Review of Implementation-Relevant Details

Cognitive change occurs as a person ages and may result in decreased cognitive functioning in older adults (60 years and older). Simultaneous dual-task (SDT) interventions—activities that require the person to engage physically and cognitively at the same time—are effective in improving cognition in this group. This scoping review analysed published implementation-relevant details about effective SDT interventions, to assist the translation of the available evidence into various practice needs and contexts. A total of 23 databases were searched for relevant studies published between 2009 and 2020 inclusively. Randomised controlled trials (RCTs) that revealed statistically significant improvement in one or more aspects of cognitive function were appraised for methodological quality, using the Joanna Briggs Institute RCT checklist. The 14 RCTs scoring over 50% on the checklist were further analysed. Implementation-relevant data—for example, intervention nature, session length and frequency, equipment and space requirements, target group, and outcomes—were extracted, collated, and synthesised. The effective SDT interventions varied considerably in their nature and outcomes, meaning that suitable SDT interventions exist for a range of contexts. However, the resources required to implement some of the interventions either were not reported and/or may be prohibitive in some real-world practice contexts. Whilst “challenge” and “group interaction” were common features of effective SDT interventions, most studies failed to report on key implementation details required to facilitate translation into practice. It also remains unclear for how long the cognitive benefits are sustained following an effective SDT intervention. In future, more consistent publication of information about how to implement effective SDT interventions, for whom these interventions are engaging/enjoyable, and why would help to translate the available research into improved cognitive outcomes for older adults.

The Effects of Combined Cognitive-Physical Interventions on Cognitive Functioning in Healthy Older Adults: A Systematic Review and Multilevel Meta-Analysis

Research has shown that both physical exercise and cognitive training help to maintain cognition in older adults. The question is whether combined training might produce additive effects when the group comparisons are equated in terms of exercise intensity and modality. We conducted a systematic electronic search in MEDLINE, PsycInfo, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify relevant studies published up to February 2021. Seven hundred and eighty-three effect sizes were obtained from 50 published intervention studies, involving 6,164 healthy older adults, and submitted to a three-level meta-analysis. Results showed that combined training produced a small advantage in comparison to single cognitive training on executive functions, whereas both types of training achieved similar effects on attention, memory, language, processing speed, and global cognition. Combined training achieved higher training gains in balance than single physical training, indicating a transfer from cognitive training to balance. Performing cognitive and physical exercise simultaneously, and interactive training (e.g., exergames, square stepping) produced the largest gains in executive functions, speed, and global cognition, as well as the largest improvements in physical functions. Aerobic training was associated with higher effects in attention and fitness, whereas non-aerobic training produced larger effects in global cognition and balance. For all cognitive and physical outcomes, training resulted more advantageous when performed in a social context, even though individual training obtained similar results in balance as group training.

Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier: CRD42020175632.

Virtual reality and mental health in older adults: a systematic review

IMPORTANCE

Virtual reality (VR) is a promising tool with the potential to enhance care of cognitive and affective disorders in the aging population. VR has been implemented in clinical settings with adolescents and children; however, it has been less studied in the geriatric population.

OBJECTIVE

The objective of this study is to determine the existing levels of evidence for VR use in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults.

DESIGN AND MEASUREMENTS

We conducted a systematic review in PubMed and Web of Science in November 2019 for peer-reviewed journal articles on VR technology and its applications in older adults. We reviewed article content and extracted the number of study participants, study population, goal of the investigation, the level of evidence, and categorized articles based on the indication of the VR technology and the study population.

RESULTS

The database search yielded 1554 total results, and 55 articles were included in the final synthesis. The most represented study design was cross-sectional, and the most common study population was subjects with cognitive impairment. Articles fell into three categories for VR Indication: Testing, Training, and Screening. There was a wide variety of VR environments used across studies.

CONCLUSIONS

Existing evidence offers support for VR as a screening and training tool for cognitive impairment in older adults. VR-based tasks demonstrated validity comparable to some paper-based assessments of cognition, though more work is needed to refine diagnostic specificity. The variety of VR environments used shows a need for standardization before comparisons can be made across VR simulations. Future studies should address key issues such as usability, data privacy, and confidentiality. Since most literature was generated from high-income countries (HICs), it remains unclear how this may be translated to other parts of the world.

Digital Health Promotion and Prevention in Settings: Scoping Review

BACKGROUND

Digital technologies are increasingly integrating into people's daily living environments such as schools, sport clubs, and health care facilities. These settings play a crucial role for health promotion and prevention because they affect the health of their members, as the World Health Organization has declared. Implementing digital health promotion and prevention in settings offers the opportunity to reach specific target groups, lower the costs of implementation, and improve the health of the population. Currently, there is a lack of scientific evidence that reviews the research on digital health promotion and prevention in settings.

OBJECTIVE

This scoping review aims to provide an overview of research targeting digital health promotion and primary prevention in settings. It assesses the range of scientific literature regarding outcomes such as applied technology, targeted setting, and area of health promotion or prevention, as well as identifies research gaps.

METHODS

The scoping review was conducted following the Levac, Colquhoun, and O'Brien framework. We searched scientific databases and gray literature for articles on digital setting-based health promotion and prevention published from 2010 to January 2020. We included empirical and nonempirical publications in English or German and excluded secondary or tertiary prevention and health promotion at the workplace.

RESULTS

From 8888 records, the search resulted in 200 (2.25%) included publications. We identified a huge diversity of literature regarding digital setting-based health promotion and prevention. The variety of technology types extends from computer- and web-based programs to mobile devices (eg, smartphone apps) and telemonitoring devices (sensors). We found analog, digital, and blended settings in which digital health promotion and prevention takes place. The most frequent analog settings were schools (39/200, 19.5%) and neighborhoods or communities (24/200, 12%). Social media apps were also included because in some studies they were defined as a (digital) setting. They accounted for 31.5% (63/200) of the identified settings. The most commonly focused areas of health promotion and prevention were physical activity (81/200, 40.5%), nutrition (45/200, 22.5%), and sexual health (34/200, 17%). Most of the interventions combined several health promotion or prevention methods, including environmental change; providing information, social support, training, or incentives; and monitoring. Finally, we found that the articles mostly reported on behavioral rather than structural health promotion and prevention.

CONCLUSIONS

The research field of digital health promotion and prevention in settings is heterogeneous. At the same time, we identified research gaps regarding the absence of valid definitions of relevant terms (eg, digital settings) and the lack of literature on structural health promotion and prevention in settings. Therefore, it remains unclear how digital technologies can contribute to structural (or organizational) changes in settings. More research is needed to successfully implement digital technologies to achieve health promotion and prevention in settings.

Effects of Intradialytic Cognitive and Physical Exercise Training on Cognitive and Physical Abilities in Hemodialysis Patients: Study Protocol for a Randomized Controlled Trial

The prevalence of cognitive impairment in hemodialysis (HD) patients is extremely high. Despite the well-documented benefits of interventions on cognitive function, there is a widespread call for effective strategies that will show the long-term consequences in patients undergoing dialysis. The aim of this research protocol was to investigate the effect of cognitive training combined with physical exercise on cognitive function, physical performance, and frailty indicators in the HD population. We will conduct a randomized controlled intervention trial to examine the effects of a combined non-pharmacological intervention in the form of intradialytic physical exercise and intradialytic cognitive training on cognitive function, indicators of frailty, and physical performance measures in HD patients. The group of patients receiving the study intervention will be compared to the control group receiving standard HD care. The duration of the intervention will be 12 weeks. We will use sensitive instruments (cognitive domain tests) to assess cognitive functions. The primary outcome of the study at 12 weeks will be performance on the Alertness subtest of the computerized Test of Attentional Performance. Secondary study outcomes are: Performance in other domains of cognitive function (executive function, psychomotor speed, information processing efficiency, working memory, and attention), physical fitness (10 repetition sit-to-stand test, timed up and go test, handgrip strength test, spontaneous gait speed, and stork balance test), and assessment of frailty (Edmonton Frail Scale). Study outcomes will be assessed at baseline, immediately after the 12-week intervention, and 6 months after the end of the study without specific further intervention (retention effect assessment). This study will be among the first to test the synergistic effects of a uniquely designed physical exercise and cognitive training intervention on functional status in HD patients. We believe our results will contribute to dementia prevention research by demonstrating the long-term efficacy of our combined intervention. Clinical Trial Registration: ClinicalTrials.Gov, NCT05150444.

Effect of virtual reality exercise on interventions for patients with Alzheimer's disease: A systematic review

Virtual reality (VR) interventions are increasingly being used in rehabilitating and treating patients with neurological disorders. This study aimed to explore the effects of VR exercise interventions for patients with Alzheimer's disease (AD). A systematic review of the published literature on randomized controlled trials of VR technology applied to patients with AD was conducted using the preferred reporting entry for systematic reviews and Meta-analysis guidelines. Descriptive analyses were performed to assess the quality of the studies in terms of the characteristics of the included studies, samples, diagnoses, types of VR technologies, subjective and objective levels of immersion, and quality of studies. Eight studies were included, including a pooled sample of 362 patients with AD. A systematic review showed that most studies focused on patients with AD's cognitive and physical functions. The main finding was that VR interventions could help improve cognitive and physical balance in patients with AD. However, future studies should emphasize design and use well-accepted assessment tools to validate the effects of VR interventions further.