The effects of exergames on anxiety levels: A systematic review and meta-analysis

A single session of a beach volleyball exergame did not improve state anxiety level in healthy adult women

This study evaluated the acute effect of the exergame Kinect Sports® beach volleyball on state anxiety level in adult women. Thirty healthy adult women (age: 21 [4] years, body mass: 54.70 [19.50] kg, height: 1.61 ± 0.05 m, and body mass index: 21.87 [5.76] kg/m2, data are expressed as median [interquartile range] and as the mean ± standard deviation) were assigned to play an exergame of beach volleyball in singleplayer mode session (intervention session) for ~ 30 min using the Xbox 360 Kinect® or remained seated (control session). State anxiety was evaluated before and after the intervention and control sessions through the State-Trait Anxiety Inventory. State anxiety obtained in both sessions (exergame and control) was classified as intermediate before (median: 36.00 [IQR: 4.75] and mean = 38.73 ± 7.23, respectively) and after (mean: 34.86 ± 6.81 and mean: 37.66 ± 8.44, respectively). Friedman test found no time significant effect on state anxiety of the sessions (χ2 [3] = 6.45, p-value = 0.092, Kendall's W = 0.07 "trivial"). In conclusion, the present study showed that there were no significant differences in the state anxiety level after an acute session of the exergame beach volleyball.

Effects of digital-based interventions on muscular strength in adults: a systematic review, meta-analysis and meta-regression of randomized controlled trials with quality of evidence assessment

BACKGROUND

In the last three decades, both medical and sports science professionals have recognized the considerable potential of digital-based interventions (DBI) to enhance the health-related outcomes of their practitioners.

OBJECTIVES

This study aimed to investigate the effectiveness and potential moderators of DBI on measures of muscular strength.

METHODS

Six databases (PubMed/MEDLINE, Web of Science, SportDiscus, Embase, Cochrane Register of Controlled Trials and Google Scholar) were searched for eligible studies up to June 2022. The GRADE, PEDRO, and TIDieR checklists were used to assess the quality of evidence, methodology, and completeness of intervention descriptions, respectively.

RESULTS

A total of 56 studies were included in the meta-analysis (n = 2346), and participants were classified as healthy (n = 918), stroke survivors (n = 572), diagnosed with other neurological disorders (n = 683), and frail (n = 173). The DBI showed a small effect (standardized mean difference [SMD] = 0.28, 95% CI 0.21 to 0.31; p < 0.001) on strength, regardless of the type of intervention, control group, or tested body part. More specifically, while splitting the studies into different subgroups, a meta-analysis of 19 studies (n = 918) showed a small effect (SMD = 0.38, 95% CI 0.12 to 0.63; p = 0.003) on strength in the asymptomatic population. Similarly, small but positive effects of DBI were observed for stroke survivors (SMD = 0.34, 95% CI 0.13 to 0.56; p = 0.002), patients diagnosed with other neurological disorders (SMD = 0.17, 95% CI 0.03 to 0.32; p = 0.021), and the frail population (SMD = 0.25, 95% CI 0.0 to 0.5; p = 0.051). Sub-group analysis and meta-regression revealed that neither variable modified the effects of the DBI on measures of strength.

CONCLUSIONS

Overall, DBI may serve as an effective method to improve measures of strength in adults, regardless of their health status as well as the type of digital device, the presence of human-computer interaction, and the age of participants. In addition, the DBI was found to be more effective than traditional training or rehabilitation methods.KEY MESSAGESDigital-based intervention (DBI) is effective in improving measures of muscular strength in adults regardless of participants' health statusDBIs were equally effective for strength improvements in lower and upper limbsAlthough, DBIs were found to be effective in improving muscular strength, most studies did not follow strength training guidelines when prescribing the interventions.

The impact of Exergames on emotional experience: a systematic review

Background

Gamification has proven to be a significant tool for health promotion, with a particular focus on physical activities such as Exergames, which improve not only physical, but also cognitive health. However, it is still not clear what effect the practice of Exergames has on changing the emotional experience.

Purpose

The objective of this systematic review is to evaluate the impact of Exergames training on emotional experience.

Methods

A systematic search was conducted in the PUBMED and SCOPUS databases. The relevant articles were screened independently by three researchers. Data concerning emotional measures and Exergame practice were extracted for analysis.

Results

The search yielded 38 articles, of which 16 were included. Exergames were found to significantly impact happiness, anxiety, depressive symptoms, mental health-related quality of life, self-worth, self-esteem, self-efficacy, perceived behavioral control, vigor, vitality, intrinsic motivation, perceived energy, and relaxation.

Conclusion

Our review supports the evidence that the practice of physical activity through Exergames, on the emotional experience generally generates an increase in positive emotions. In this sense, the results found support both the use of Exergames as a leisure activity that promotes wellbeing and emotional regulation, as well as for health promotion, public health, and clinical practice purposes. Our review strongly supports the notion that engaging in physical activity through Exergames generally leads to an increase in positive emotions. As a result, these findings endorse the utilization of Exergames as a leisure activity to promote well-being and emotional regulation. Moreover, Exergames hold potential for health promotion, public health, and clinical practice purposes.

Impact of virtual reality exercises on anxiety and depression in hemodialysis

Renal replacement therapy is associated with reduced physical activity. The aim of the study was to assess the relationship between regular physical activity performed with the use of virtual reality and the occurrence of symptoms of anxiety and depression in hemodialysis patients. The study involved 85 patients from the dialysis station at the Department of Nephrology, Transplantology and Internal Medicine PUM. The examined patients were randomly divided into study group and control group. The study group consisted of patients undergoing renal replacement therapy by hemodialysis, whose task was to perform VR exercises using the prototype of the NefroVR system for 20 min during hemodialysis. The control group consisted of patients undergoing renal replacement therapy by hemodialysis who were not assigned an intervention. An intragroup analysis was performed for the Beck and GAD scales. After the end of the exercise cycle in the study group there was a decrease in the score while in the control group there was an increase in comparison to the first result. The research showed that after a 3-month exercises on a bicycle with the use of low-intensity virtual reality, a decrease in depression symptoms measured by the Beck Depression Inventory was observed. The research showed that regular physical activity using virtual reality may be associated with a reduction in the occurrence of anxiety and depression symptoms in patients included in the chronic hemodialysis program.

Exergaming Among Young Adults in Canada: Longitudinal Study

BACKGROUND

Exergaming may be an important option to support an active lifestyle, especially during pandemics.

OBJECTIVE

Our objectives were: (i) to explore whether exergaming status from before to during the COVID-19 pandemic (stopped, started, sustained exergaming, never-exergamed) related to changes in walking, moderate-to-vigorous physical activity (MVPA), or meeting MVPA guidelines; and (ii) among past-year exergamers, to describe change in minutes/week exergaming from before to during the pandemic.

METHODS

681 participants (M(SD) age=33.6(0.5), 41% male) from the 22-year NDIT study provided data on walking, MVPA, and exergaming before (2017-20) and during the COVID-19 pandemic (2021). Physical activity (PA) change scores were described by exergaming status.

RESULTS

62.4% of participants never exergamed, 8.2% started exergaming during the pandemic, 19.7% stopped, and 9.7% sustained exergaming. Declines were observed in all three PA indicators in all four groups. Among the more salient findings: (i) participants who started exergaming during COVID-19 reported the highest MVPA levels before and during the pandemic and declined the least (mean -35 minutes/week) (ii) sustained exergamers reported the lowest MVPA levels during the pandemic (median 66 minutes/week), and they declined the most in MVPA (mean change of -92 minutes/week) and in meeting MVPA guidelines (-23.6%). During the pandemic, starters reported 85 minutes of exergaming/week and sustained exergamers increased exergaming by a median 60 minutes/week.

CONCLUSIONS

Although starting and sustaining exergaming did not appear to help exergamers maintain pre-pandemic PA levels, exergaming can contribute a substantial proportion of total PA in young adults and may still represent a useful option to promote PA during pandemics.

CLINICALTRIAL

Not applicable.

The Effect of a Virtual Reality-Mediated Gamified Rehabilitation Program on Pain, Disability, Function, and Balance in Knee Osteoarthritis: A Prospective Randomized Controlled Study

Background: This prospective randomized controlled study is the first study that evaluates the disease-specific gamification through virtual reality (VR) glasses on pain, disability, functionality, and balance in knee osteoarthritis (OA). Materials and Methods: The demographic data of the patients were recorded. A total of 73 patients were divided into two groups (35 in experimental group and 38 in control group). All patients were evaluated with pain (visual analog scale [VAS]), functionality (Lysholm functional knee score [LFKS], 6 minutes walking test [6MWT]), disability (Western Ontario and McMaster Universities Arthritis Index [WOMAC]), and balance (Berg Balance Scale [BBS]) before treatment, after treatment (3th weeks), and 4 weeks after treatment (7th weeks). In the experimental group, plus the conservative treatment, a total of 15 sessions of a disease-specific gamification through VR glasses were applied. Results: VAS and WOMAC scores of the experimental group were lower at the 3th and 7th weeks than those of the control group (P = 0.005, P = 0.000), (P = 0.000). LFKS of the experimental group was higher at the 3th and 7th weeks than that of the control group (P = 0.005, P = 0.013). No difference was found between the groups in terms of 6MWTs (P > 0.05). BBS score of the experimental group was higher in the 7th week than that of the control group (P = 0.021). Conclusion: In knee OA, the disease-specific gamification through VR glasses added to the conservative treatment has a positive effect on pain, functionality, and balance. Side effects such as mild nausea, headache that did not last long, require additional treatment. In light of this, disease-specific gamification through VR glasses is effective and safe in knee OA, more studies that reveal the long-term effect on structural healing must be planned.

Changes and correlates of screen time in adults and children during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

Screen time has increased as a result of the COVID-19 pandemic, and several correlates have been associated with these increases. These changes, however, have not been aggregated. It was the aim of this review to (a) aggregate changes in screen time in adults and children, and (b) report on variables in relation to screen time during the COVID-19 pandemic.

METHODS

A systematic review of major databases was undertaken for studies published from inception to 06/12/2021, using a pre-published protocol (PROSPERO ID: CRD42021261422). Studies reporting (a) screen time pre-versus-during the pandemic, (b) screen time percentage change, or (c) correlates of screen time during the pandemic were included. A random effects meta-analysis was undertaken with subgroup analysis by age group and type of screen time.

FINDINGS

After review, 89 studies (n = 204,734; median age=20·6; median female=53·3%) were included. The majority of studies were cross-sectional. With regards to total screen time, primary aged children (6-10 years) reported largest increases (1·4 hrs/day; 95%CI 1·1-1·7), followed by adults (>18 years; 1·0 hrs/day; 95%CI 0·7-1·2), adolescents (11-17 years; 0·9 hrs/day; 95%CI 0·3-1·5), and young children (0-5 years; 0·6 hrs/day 95%CI 0·3-0·9 hrs/day). For leisure screen time (non-work/non-academic), primary aged children reported largest increases (1·0 hrs/day 95%CI 0·8-1·3), followed by adults (0·7hr/day 95%CI 0·3-1·2), young children (0·6 hrs/day; 95%CI 0·4-0·8), with adolescents reporting the lowest increase (0·5 hrs/day 95%CI 0·3-0·7). Several correlates were associated with reported increases in screen time, including adverse dietary behaviours, sleep, mental health, parental health, and eye health.

INTERPRETATION

Pooled evidence suggest that primary aged children reported the highest increase in both total and leisure screen time during COVID-19. It is recommended that screen time should be reduced in favour of non-sedentary activities. This study has the potential to inform public health policy and future guidance regarding screen time, and to inform future research in this area.

FUNDING

No funding was received for this study.

Exergames to Improve Rehabilitation for Shoulder Injury: Systematic Review and GRADE Evidence Synthesis

INTRODUCTION

The use of exergames has become an increasingly frequent intervention in rehabilitation, referred to as a fun and motivating activity that involves patients. This systematic review aimed to evaluate the effectiveness of exergames in the rehabilitation of the shoulder joint compared to other types of care.

METHODS

We performed a systematic review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) evidence synthesis. The search was conducted using the following databases: MEDLINE, CINAHL, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, and PEDRo. Databases were searched from the first record until July 2021. Randomized controlled trials using exergames as an intervention were included.

RESULTS

The search resulted in 1,048 records. A total of 10 articles published between 2013 and 2020 met inclusion criteria and were reviewed for this study. A positive impact was observed in using exergames to increase shoulders' range of motion, namely, extension, flexion, abduction, internal and external rotation, and functionality postinjury.

CONCLUSIONS

The results of this review provide evidence of the benefits of exergames in shoulder joint rehabilitation. However, more robust clinical trials need to be developed that assess the effectiveness of using exergames as a complement to traditional rehabilitation and assess participants' degree of satisfaction, motivation, and adherence.

Technology and Sleep Quality: Friend or Foe? Let the Exergames Come into Play!

Low sleep quality is associated with many health problems. Although physical exercise is a nonpharmacological tool that positively impacts sleep quality, there are many barriers (lack of energy, lack of motivation, lack of skills, lack of resources, and fear of injury) for people to adopt an active lifestyle. Exergames are an alternative way of physical exercise that are funnier and more attractive than traditional forms of physical exercise and, therefore, has the potential to increase adherence to a physical exercise program. Given that previous studies showed that exergames presents similar physiological and psychological outcomes to traditional forms of exercise, we aimed to discuss in this narrative review potentials applications, limitations and perspectives of using exergames to improve sleep quality.

The Effects of Exergames on Muscle Architecture: A Systematic Review and Meta-Analysis

Muscle architectural parameters play a crucial role in the rate of force development, strength, and sports performance. On the other hand, deteriorated muscle architectural parameters are associated with injuries, sarcopenia, mortality, falls, and fragility. With the development of technology, exergames have emerged as a complementary tool for physical therapy programs. The PRISMA 2020 statement was followed during the systematic review and meta-analysis. CENTRAL, CINAHL, PROQUEST, PubMed, and OpenGrey databases were searched last time on 22 September 2021. In total, five controlled trials were included in the systematic review. Twelve weeks of virtual dance exercise (Dance Central game for Xbox 360®) showed a medium effect on the improvement of hamstrings (g = 0.55, 95% CI (−0.03, 1.14), I2 = 0%) and the quadriceps femoris muscle cross-sectional area (g = 0.58, 95% CI (0.1, 1.00), I2 = 0%) in community-dwelling older women. Additionally, a four-week virtual balance-training program (the ProKin System) led to significant increments in the cross-sectional areas of individual paraspinal muscles (14.55–46.81%). However, previously investigated exergame programs did not show any medium or large effects on the architectural parameters of the medial gastrocnemius muscle in community-dwelling older women. Distinct exergame programs can be used as a complementary therapy for different prevention and rehabilitation programs.

Acute effects of exergame-based calisthenics versus traditional calisthenics on state-anxiety levels in young adult men: a randomized trial

Purpose

This study compared the acute effects of an exergame-based calisthenics (EXG) session versus a traditional calisthenics (TC) session on state anxiety levels in healthy adult men, and compared the mean heart rate, number of repetitions performed, enjoyment, and affective valence reported by the participants between sessions.

Methods

Thirty-six young adult men performed two 30-min sessions of physical exercise in random order (EXG and TC). The same exercise protocol was used for each session; however, the TC session was guided by an exercise science professional. State anxiety was assessed before and immediately after each session. Heart rate was monitored during the sessions. Enjoyment and affective valence were assessed immediately after the sessions. In addition, the number of repetitions performed was recorded.

Results

There was no significant interaction between sessions (EXG vs. TC) and time (pre vs. post-session) (p = 0.102), no significant effect of session (p = 0.587), and no significant effect of time (p = 0.121). Participants presented a higher mean heart rate (+ 3.5%, p = 0.020) and number of repetitions performed (+ 43.7%, p < 0.001) in the TC session compared with the EXG session. There was no difference in enjoyment (p = 0.804) and affective (p = 0.195) valence between the EXG and TC sessions.

Conclusion

The EXG and TC sessions did not reduce state anxiety levels. Nor did they increase enjoyment or affective valence in healthy young adult men. However, the TC session evoked a higher mean heart rate and higher training volume than the EXG session.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11332-021-00841-9.

The effectiveness of serious games in alleviating anxiety: A systematic review and meta-analysis (Preprint)

Background

Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses.

Objective

This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review.

Methods

We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.

Results

Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low–quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03).

Conclusions

This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety.

The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis (Preprint).. [DOI: 10.2196/preprints.29137]

BACKGROUND

Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses.

OBJECTIVE

This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review.

METHODS

We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.

RESULTS

Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low–quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (<i>P</i>=.70) and no intervention (<i>P</i>=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (<i>P</i>=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (<i>P</i>=.03).

CONCLUSIONS

This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety.

Gaming Your Mental Health: A Narrative Review on Mitigating Symptoms of Depression and Anxiety Using Commercial Video Games

Globally, depression and anxiety are the two most prevalent mental health disorders. They occur both acutely and chronically, with various symptoms commonly expressed subclinically. The treatment gap and stigma associated with such mental health disorders are common issues encountered worldwide. Given the economic and health care service burden of mental illnesses, there is a heightened demand for accessible and cost-effective methods that prevent occurrence of mental health illnesses and facilitate coping with mental health illnesses. This demand has been exacerbated post the advent of the COVID-19 pandemic and the subsequent increase in incidence of mental health disorders. To address these demands, a growing body of research is exploring alternative solutions to traditional mental health treatment methods. Commercial video games have been shown to impart cognitive benefits to those playing regularly (ie, attention control, cognitive flexibility, and information processing). In this paper, we specifically focus on the mental health benefits associated with playing commercial video games to address symptoms of depression and anxiety. In light of the current research, we conclude that commercial video games show great promise as inexpensive, readily accessible, internationally available, effective, and stigma-free resources for the mitigation of some mental health issues in the absence of, or in addition to, traditional therapeutic treatments.

The effects of exergames on muscle strength: A systematic review and meta-analysis

This systematic review and meta-analysis examined studies on the chronic effects of exergames on muscle strength in humans. PubMed, Scopus, CENTRAL, Web of Science, SciELO, Biblioteca Virtual em Saúde, and Google Scholar were searched, and manual searches of the reference lists of included studies and hand-searches on Physiotherapy Evidence Database and ResearchGate were conducted from inception to August 10, 2020. Randomized and non-randomized exergame intervention studies with or without a non-exercise group and/or a "usual care intervention group" (any other intervention that did not incorporate exergames), which evaluated muscle strength through direct measurements, were included. Forty-seven and 25 studies were included in the qualitative review and meta-analysis, respectively. The between-groups meta-analyses showed no significant differences between exergames and non-exercise control groups for handgrip strength in heathy/unhealthy middle-aged/older adults or knee extension maximum voluntary isometric contraction (MVIC) in healthy older adults. However, exergames provided a greater increase in handgrip strength, knee flexion MVIC, and elbow extension MVIC, but not knee extension MVIC or elbow flexion MVIC, in individuals with different health statuses when compared to usual care interventions. Also, there was a greater increase in handgrip strength in children with hemiplegic cerebral palsy favouring usual care plus exergames compared to usual care interventions. These results suggest that exergames may improve upper and lower limb muscle strength in individuals with different heath statuses compared to usual care interventions, but not muscle strength in middle age/older adults after accounting for random error. Also, exergames appear to be a useful tool for improving handgrip strength in children with hemiplegic cerebral palsy when added to usual care. However, as the exergame interventions were applied in different populations and there currently are many different approaches to perform exergames, future randomized controlled trials with high methodological quality and large sample sizes are needed to provide more compelling evidence in favour of a specific exergame protocol, or to elucidate exergame protocol design principles that appear to strongly influence outcomes.

Virtual Reality Exergames for Improving Older Adults' Cognition and Depression: A Systematic Review and Meta-Analysis of Randomized Control Trials

OBJECTIVES

Virtual reality (VR) exergames are an innovative approach to promote older adults' mental health. VR exergames are active video games controlled by bodily movements in a safe surrounding with advantages of physical activity engagement and interactions. The purpose of this study was to explore the effectiveness of VR exergames in improving older adults' cognition and ameliorating depressive outcome by a systematic review, meta-analysis, subgroup analysis, and meta-regression.

DESIGN

This is a systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Adults over 60 years old.

METHODS

Four electronic databases, including PubMed, Embase, Medline, and Cochrane, were searched for related articles. After evaluation, 18 randomized control trials were selected for qualitative and quantitative synthesis.

RESULTS

The meta-analytical results found moderate effects of VR exergames on overall cognitive function and memory, and a large effect on depressive outcomes in older adults. Commercial VR games had more-significant and larger effects on depressive outcomes than exergames with VR devices. The meta-regression results revealed that the total intervention duration had a significant effect on depressive outcomes. A higher intervention duration had greater effects on depressive outcomes.

CONCLUSIONS AND IMPLICATIONS

This meta-analytical study suggests that VR exergames can provide potential positive influences on cognition, memory, and depression in older adult populations. VR exergames could be an interesting strategy for active aging and a good mental health status.

Effect of both dance exergame and a traditional exercise on state anxiety and enjoyment in women

BACKGROUND

Anxiety disorders affect many people around the world and women are more affected than men. Physical exercise might be an important nonpharmacological tool to ameliorate these disorders. The aim of this study was to compare state anxiety level and enjoyment between a dance exergame session and a traditional aerobic exercise.

METHODS

Twenty healthy young women completed 3 visits, on separate days. At the first visit, participants performed a graded exercise testing and familiarization procedures. In other two visits, participants completed two exercise sessions (dance exergame and traditional aerobic exercise), with similar intensities and duration. Each session lasted approximately 45 minutes. State anxiety level was evaluated before, immediately post- and 10 minutes post sessions. Enjoyment was evaluated immediately post sessions.

RESULTS

There was a significant interaction between session and time (p<0.001), a main effect of time (p=0.007) but no significant main effect of session (p=0.057) on state anxiety level. State anxiety level immediately post (p<0.001) and 10 minutes post-session (p<0.001) were significantly lower than pre-dance exergame session. There were no significant changes between pre-, immediately post and 10 minutes post-traditional aerobic exercise session (p>0.05). State anxiety level at immediately post dance exergame session was significantly lower than immediately post traditional aerobic exercise session (p=0.026). Dance exergame session was significantly more enjoyable than traditional aerobic exercise session (p<0.0001).

CONCLUSIONS

Dance exergames might be used as a tool to reduce anxiety level in young women.

Comment on: Problematic online gaming and the COVID-19 pandemic - The role of exergames

Although significant increases in gaming may not always be beneficial, exergames (a new generation of video games also known as exergaming or active video games) appear as an alternative, feasible, attractive, and safe way to perform physical exercise for most clinical and nonclinical populations. Therefore, it is important to recognize that exergames can be considered a useful tool for coping with the COVID-19 outbreak and the recommended social distancing period.

Lifestyle factors in the prevention of COVID-19

Confinement to the home and psychological distress due to the coronavirus disease 2019 (COVID-19) pandemic may lead to harmful health behaviors, such as overeating, sedentary behavior with reduced physical activity, elevated alcohol and tobacco use and increased screen time causing impaired sleep. All of these behaviors are associated with non-communicable diseases and can interfere with immunity. While no foods, single nutrients or dietary supplements are capable of preventing infection with COVID-19, a balanced diet containing sufficient amounts of macronutrients and diverse micronutrients is a prerequisite of an optimally functioning immune system. High-energy "Western" diets and obesity are major risk factors for a more severe course of COVID-19. Alcohol use and tobacco also have detrimental effects on the immune system. Therefore, population-wide body weight control, reduction of smoking rates and limitation of alcohol consumption are important preventive measures. Furthermore, sufficient restorative sleep is needed for adequate immune functioning. Appropriate lifestyle changes in regard to nutrition, exercise, sleep, smoking and alcohol intake may help shift the population distribution of infection risk and aid in preventing severe COVID-19 disease. Large-scale surveys should explore the effects of lifestyle changes, and the provision of reliable lifestyle information and effective interventions to individuals and communities during the pandemic is a pressing need.

Staying Physically Active During the Quarantine and Self-Isolation Period for Controlling and Mitigating the COVID-19 Pandemic: A Systematic Overview of the Literature

The COVID-19 pandemic has created an unprecedented worldwide public health concern. Characterized by rapid and high frequency human-to-human transmission, the World Health Organization has recommended implementation of public health measures, including isolation of all suspected infectious individuals for a 14-day quarantine period, while governments have introduced "social distancing" and "lock-downs" of varying severity to curtail COVID-19 spread. Recent COVID-19 research further suggests there are major sleep problems and psychological disorders (e.g., stress, anxiety, depression) associated with the reduction of movement and activities, as well as the reduced social interaction. There have been no studies examining the effect of physical activity at home during such periods of isolation. However, based on previous research, potential tactics to overcome these negative effects include home-based exercise, exergaming, dancing to music, and participation in yoga. Adults should accumulate at least 150 min of moderate-intensity and at least 75 min of vigorous-intensity of activity divided in to 5-7 sessions per week. This training volume could be reduced by 30% for children and adolescents if replaced by recess or active play in and around the home. Additionally, exercises should be adapted to the fitness level of the participant and a progressive model of intensity and training volume should be utilized, preferably monitored by telephone applications and wearable sensors.

Virtual reality in psychiatric disorders: A systematic review of reviews

BACKGROUND

Virtual reality (VR) is being used more and more often as a therapeutic tool in psychology or psychiatry. In recent years, VR interventions appear more extensively also in disorders such as depression, anxiety and phobia. However, there has yet to be a comprehensive synthesis and critical review of the literature to identify future directions to advance the field in this area.

OBJECTIVES

To broadly characterize the literature to date on the application of VR in psychiatric disorders by conducting a systematic review of reviews, describe the limitations of existing research, suggest avenues for future research to address gaps in the current literature and provide practical recommendations for incorporating VR into various treatments for psychiatric disorders.

METHODS

PubMed and Web of Science databases were searched for reviews on VR use in psychiatric disorders (e.g. various pain perceptions, post-traumatic stress disorder, phobias, attention deficit hyperactivity disorder, psychosis, depression). The methodological quality of each literature review was assessed using AMSTAR.

RESULTS

The original search identified 848 reviews, of which 70 were included in the systematic review of reviews. Broadly, the literature indicates that various VR interventions could be useful in different psychiatric disorders.

CONCLUSION

This study provides evidence supporting the positive impact of VR therapy in psychiatric disorders. However, the impact is defined differently according to the studied area. Nevertheless, due to the continuous development of VR hardware and software, it is essential to conduct further research in the area of psychiatric disorders, especially as no review has concluded that VR does not work.

Exergames as Coping Strategies for Anxiety Disorders During the COVID-19 Quarantine Period

The COVID-19 outbreak has led to wide-scale self-isolation, as a result of the quarantine period recommended by the World Health Organization. Consequently, people's mental health, including their anxiety levels, may be becoming impaired. To cope with the situation, the exergame appears to be an enjoyable easy-to-use tool for reducing social isolation, as well as an interesting mode of home-based exercise for tackling anxiety disorders and sedentary behavior. This article critically appraises the opportunities and challenges exergames present for the prevention and treatment of anxiety disorders in a home-based environment during the COVID-19 quarantine period.