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Huber SK, Knols RH, Held JPO, Betschart M, de Bruin ED. PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial. Trials 2024; 25:451. [PMID: 38965612 PMCID: PMC11223407 DOI: 10.1186/s13063-024-08283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors. METHODS This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis. DISCUSSION Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke. TRIAL REGISTRATION ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.
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Affiliation(s)
- S K Huber
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - R H Knols
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - J P O Held
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
| | - M Betschart
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Institute of Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - E D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Manser P, de Bruin ED. Test-retest reliability and validity of vagally-mediated heart rate variability to monitor internal training load in older adults: a within-subjects (repeated-measures) randomized study. BMC Sports Sci Med Rehabil 2024; 16:141. [PMID: 38926777 PMCID: PMC11210148 DOI: 10.1186/s13102-024-00929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Vagally-mediated heart rate variability (vm-HRV) shows promise as a biomarker of internal training load (ITL) during exergame-based training or motor-cognitive training in general. This study evaluated the test-retest reliability of vm-HRV during exergaming in healthy older adults (HOA) and its validity to monitor ITL. METHODS A within-subjects (repeated-measures) randomized study was conducted that included baseline assessments and 4 measurement sessions. Participants played 5 exergames at 3 standardized levels of external task demands (i.e., "easy", "challenging", and "excessive") in random order for 90 s. Test-retest reliability was assessed on the basis of repeated-measures analyses of variance (ANOVA), intraclass correlation coefficients (ICC3,1), standard errors of measurement (SEM), and smallest detectable differences (SDD). Validity was determined by examining the effect of game level on vm-HRV in the ANOVA. RESULTS Fourty-three HOA (67.0 ± 7.0 years; 58.1% females (25 females, 18 males); body mass index = 23.7 ± 3.0 kg·m-2) were included. Mean R-R time intervals (mRR) and parasympathetic nervous system tone index (PNS-Index) exhibited mostly good to excellent relative test-retest reliability with no systematic error. Mean SEM% and SDD% were 36.4% and 100.7% for mRR, and 44.6% and 123.7% for PNS-Index, respectively. Significant differences in mRR and PNS-Index were observed between standardized levels of external task demands, with mostly large effect sizes (mean r = 0.847). These results persisted irrespective of the type of neurocognitive domain trained and when only motoric and cognitive demands were manipulated while physical intensity was kept constant. The remaining vm-HRV parameters showed inconsistent or poor reliability and validity. CONCLUSION Only mRR and PNS-Index demonstrated reliable measurement and served as valid biomarkers for ITL during exergaming at a group level. Nonetheless, the presence of large SEMs hampers the detection of individual changes over time and suggests insufficient precision of these measurements at the individual level. Future research should further investigate the reliability and validity of vm-HRV with a specific focus on comparing different measurement methodologies and exercise conditions, particularly focusing on ultra-short-term HRV measurements, and investigate the potential implications (i.e., superiority to other markers of ITL or monitoring strategies?) of using vm-HRV as a biomarker of ITL.
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Affiliation(s)
- Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Eling D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Wunderlich A, Wollesen B, Asamoah J, Delbaere K, Li K. The impact of cognitive-motor interference on balance and gait in hearing-impaired older adults: a systematic review. Eur Rev Aging Phys Act 2024; 21:17. [PMID: 38914940 PMCID: PMC11194914 DOI: 10.1186/s11556-024-00350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Hearing impairments are a rising burden in our aging society. Hearing loss is associated with reduced cognitive performance as well as decrements in balance and gait. Therefore, impaired hearing affects also dual tasking (DT). The aim of this review is to summarize the evidence for DT performance decrements of older adults with hearing impairments during maintaining balance or walking. METHODS The systematic literature research according to PRISMA guidelines was conducted using MEDLINE, APA Psych-Info, and Web of Science. Inclusion criteria were: Independent living older people ≥ 60 years with hearing impairments, use of a DT paradigm to test hearing impaired older adults within a balance or walking condition. RESULTS N = 57 studies were found within the databases. Eight studies were included (N = 456 participants (58% women), including n = 200 older hearing-impaired persons with different levels of hearing loss). Most of the included studies oriented their inclusion criteria for hearing-impairments at thresholds for mild hearing loss with Pure Tone Average (0.5-4 kHz) ≥ 25 and < 40 dB. Three of the studies focused on DT balance performance and five used DT walking comparing participants with and without hearing loss. For DT balance and gait performance, higher decrements for the hearing-impaired group were observed compared to healthy older adults. Performance decrements were accompanied by reduced compensatory strategies in balance performance. CONCLUSION More pronounced decrements in DT performance were observed for participants with hearing impairments compared to those without. This implies that hearing-impaired older adults might need specific interventions to reduce the cognitive-motor interference (CMI) to maintain balance control or walking stability in daily situations that require managing of cognitive and motor tasks simultaneously. However, taking all results into account the underlying mechanisms of CMI for this target group needs to be further examined. TRIAL REGISTRATION This review was registered at Prospero with the ID CRD42022340232.
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Affiliation(s)
- Anna Wunderlich
- Technische Universität Berlin, Chair of Biopsychology and Neuroergonomics, Berlin, Germany.
| | - Bettina Wollesen
- Faculty of Psychology and Human Movement Science, Institute for Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Janek Asamoah
- Faculty of Psychology and Human Movement Science, Institute for Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Kim Delbaere
- Neuroscience Research Australia (NeuRA) Falls, Balance and Injury Research Centre, Sydney, NSW, Australia
- Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Karen Li
- Department of Psychology, Concordia University, Montreal, Canada
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Da Silva-Grigoletto ME, Pereira-Monteiro MR, Aragão-Santos JC, Vasconcelos ABS, Marcos-Pardo PJ, Fortes LDS. Brain functional training: a perspective article. FRONTIERS IN AGING 2024; 5:1368878. [PMID: 38974345 PMCID: PMC11224132 DOI: 10.3389/fragi.2024.1368878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/27/2024] [Indexed: 07/09/2024]
Abstract
Introduction: Physical exercise (PE) positively affects the nervous system, impacting morphology and physiology. It increases brain gray and white matter, improves cerebral blood flow, and stimulates neurogenesis, synaptogenesis, and angiogenesis, promoting brain function. Although exercise already affects cognition, some training modalities place greater demands on the cognitive aspects of physical exercise, such as perceptual-motor and visual-motor training. This type of approach aims to emphasize the cognitive adaptations that occur chronically. Specifically for older people, functional training, a multi-component approach, is a promising exercise modality that stimulates functionality using multi-joint, multi-planar exercises mirroring daily activities. However, applying a greater focus on cognitive adaptations in line with the functional training proposal for maximal benefits remains underexplored. Aim: Thus, this perspective article initially explores different exercise approaches emphasizing cognitive adaptations and proposes Brain Functional Training to improve older adult's functionality. Methods: Furthermore, we explain how brain functional training can be explored to emphasize cognitive aspects based on increasing complexity to stimulate the executive function and its subdomains. Conclusion: This proposal is one alternative to combining motor and cognitive stimuli to promote autonomy and health in older people.
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Affiliation(s)
- Marzo Edir Da Silva-Grigoletto
- Department of Physical Education, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Graduate Program in Physiological Sciences (PROCFIS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Graduate Program in Health Sciences (PPGCS), Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - José Carlos Aragão-Santos
- Graduate Program in Health Sciences (PPGCS), Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Alan Bruno Silva Vasconcelos
- Graduate Program in Physiological Sciences (PROCFIS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Health Education, Federal Univesity of Sergipe, Lagarto, Sergipe, Brazil
| | | | - Leonardo de Sousa Fortes
- Associate Graduate Program of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
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Büttiker J, Marks D, Hanke M, Ludyga S, Marsico P, Eggimann B, Giannouli E. Cognitive-motor exergame training on a labile surface in stroke inpatients: study protocol for a randomized controlled trial. Front Neurol 2024; 15:1402145. [PMID: 38966081 PMCID: PMC11223001 DOI: 10.3389/fneur.2024.1402145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/29/2024] [Indexed: 07/06/2024] Open
Abstract
Background Cognitive-motor training in form of exergames has been found to be feasible and effective for the improvement of motor and cognitive functioning in older adults and several patient populations. Exergame training under unstable conditions might increase the proprioceptive resources needed and thus might be a superior training approach compared to exergame training on stable ground for stroke patients, who often have proprioceptive deficits. Objective Aim of this study is to assess the feasibility and effects of exergame-based cognitive-motor training on a labile platform on physical and cognitive functioning in stroke inpatients. Methods This is two-armed pilot randomized controlled trial taking place in an inpatient neurologic rehabilitation clinic. A total of 30 persons that are undergoing inpatient rehabilitation due to a stroke will be randomly assigned to either the intervention group (IG) or the control group (CG). Participants of the IG will receive exergame-based motor-cognitive training on a labile surface, whereas participants of the CG will train on a stable surface. Primary outcome is feasibility comprising measures of adherence, attrition, safety and usability. Secondary outcomes will be measures of cognitive (psychomotor speed, inhibition, selective attention, cognitive flexibility, brain activity) and motor (functional mobility, gait speed, balance, proprioception) functioning. Results Data collection started in February 2024 and is expected to be completed by August 2024. Conclusion This is the first study looking into exergame training on labile surface in stroke patients. It will give valuable insights into the feasibility and potential added value of this type of training and thus inform further implementation efforts in the context of inpatient rehabilitation. Clinical trial registration ClinicalTrials.gov, NCT06296069.
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Affiliation(s)
- Joel Büttiker
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Detlef Marks
- Rehaklinik Zihlschlacht, Centre for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Manuel Hanke
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Petra Marsico
- Research Department, Swiss Children’s Rehab, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Benjamin Eggimann
- OST – Eastern Switzerland University of Applied Sciences, Rapperswil, Switzerland
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Huber SK, Manser P, de Bruin ED. PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example. Front Sports Act Living 2024; 6:1397949. [PMID: 38915297 PMCID: PMC11194322 DOI: 10.3389/fspor.2024.1397949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Background Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. Methods The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. Results A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. Conclusion We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.
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Affiliation(s)
- Simone K. Huber
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Manser P, de Bruin ED. "Brain-IT": Exergame training with biofeedback breathing in neurocognitive disorders. Alzheimers Dement 2024. [PMID: 38809948 DOI: 10.1002/alz.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/12/2024] [Accepted: 04/27/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION The combination of exergame-based motor-cognitive training with resonance breathing guided by heart-rate variability biofeedback (HRV-BF) targets various relevant mechanisms of action to alleviate the pathological state in mild neurocognitive disorders (mNCD). METHODS This randomized controlled trial (RCT) investigated the effectiveness of adding this novel intervention approach to usual care in mNCD. The individualized intervention was delivered via the "Brain-IT" training concept, which was iteratively co-designed, tested, and refined with patient and public involvement. RESULTS We observed statistically significant effects with large effect sizes for global cognitive performance, immediate verbal recall, and delayed verbal recall in favor of the intervention group. Fifty-five percent of participants showed a clinically relevant improvement in response to training. DISCUSSION Confirmatory RCTs are warranted to investigate whether the observed improvements in cognitive performance translate to affecting the rates of progression to or onset of dementia and test the implementation of the training in clinical practice. HIGHLIGHTS We proposed a novel intervention approach for mild neurocognitive disorders. It combines exergame-based training with biofeedback-guided resonance breathing. Our results confirm the effectiveness of this approach. Fifty-five percent of participants showed a clinically relevant improvement in response to training.
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Affiliation(s)
- Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Huddinge, Sweden
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Chuang IC, Chen IC, Wu YR, Li KY. Prediction and mediation analysis for treatment responses to combined cognitive and physical training for older adults. Sci Rep 2024; 14:10571. [PMID: 38720025 PMCID: PMC11079002 DOI: 10.1038/s41598-024-61407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
Diminished cognitive and physical functions negatively affect the daily functions of individuals. Although combined cognitive and physical training prevents instrumental activities of daily living (IADL) disability in older adults, no predictive model or mediation analysis of IADL after combined training exists. This study aims to employ prediction and mediation analysis to identify the predictors of IADL performance and to elucidate the mediators of the association between baseline global cognition and subsequent IADL performance following combined cognitive and physical training. This study involved 177 participants aged 60 years and older who underwent combined training. Cognitive function was measured with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Color Trails Test, Word List, and a dual task; physical function with the Timed Up and Go (TUG) test; daily function with the Lawton IADL Scale. We conducted regression analyses to identify the predictors of IADL performance, and mediation analysis to examine whether DSST and TUG mediate the relationship between MoCA and IADL. The pre-intervention DSST and TUG were significant independent predictors of post-intervention IADL. The association between the pre-intervention MoCA and post-intervention IADL was mediated by pre-intervention DSST and TUG. This study highlighted the importance of measuring and improving processing speed and functional mobility before and during interventions to enhance IADL outcomes.Trial registration: NCT03619577, 23/07/2018; NCT04689776, 29/12/2020.
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Affiliation(s)
- I-Ching Chuang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Gueishan Township, Taoyuan, 333, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - I-Chen Chen
- Department of Occupational Therapy, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Yi Li
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Gueishan Township, Taoyuan, 333, Taiwan.
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
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Aminirakan D, Losekamm B, Wollesen B. Effects of combined cognitive and resistance training on physical and cognitive performance and psychosocial well-being of older adults ≥65: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e082192. [PMID: 38643006 PMCID: PMC11033638 DOI: 10.1136/bmjopen-2023-082192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION With increasing life expectancy of older adult population, maintaining independence and well-being in later years is of paramount importance. This study aims to investigate the impact of three distinct interventions: cognitive training, resistance training and a combination of both, compared with an inactive control group, on cognitive performance, mobility and quality of life in adults aged ≥65 years. METHODS AND ANALYSIS This trial will investigate healthy older adults aged ≥65 years living independently without cognitive impairments. Participants will be randomly assigned to one of four groups: (1) cognitive training, (2) resistance training, (3) combined cognitive and resistance training, and (4) control group (n=136 participants with 34 participants per group). The interventions will be conducted over 12 weeks. The cognitive training group will receive group-based activities for 45-60 min two times a week. The resistance training group exercises will target six muscle groups and the combined group will integrate cognitive tasks into the resistance training sessions. Primary outcomes are: Short Physical Performance Battery, Sit-to-Stand Test, Montreal Cognitive Assessment, Trail Making Test and Stroop Test combined with gait on a treadmill (dual task). Life satisfaction will be measured by the Satisfaction With Life Scale. Secondary outcomes encompass hand grip strength and the Functional Independence Measure. ETHICS AND DISSEMINATION Ethical approval was provided by the local Ethics Committee at the University of Hamburg (no. 2023_009). Informed consent will be obtained from all study participants. The results of the study will be distributed for review and discussion in academic journals and conferences. TRIAL REGISTRATION NUMBER DRKS00032587.
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Affiliation(s)
- Deniz Aminirakan
- Department of Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Björn Losekamm
- Department of Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Bettina Wollesen
- Department of Human Movement Science, Universität Hamburg, Hamburg, Germany
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Yan T, Liang W, Chan CWH, Shen Y, Liu S, Li M. Effects of motor imagery training on gait performance in individuals after stroke: a systematic review and meta-analysis. Disabil Rehabil 2024:1-15. [PMID: 38638087 DOI: 10.1080/09638288.2024.2337091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/09/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE This review systematically explores and summarise the effects of motor imagery training (MIT) compared to conventional therapy on gait performance in individuals after stroke. MATERIALS AND METHODS Randomised controlled trials (RCTs) were systematically searched in five electronic databases (PubMed, EMBASE, PsycINFO, OVID Nursing and CINAHL) from inception to 30 December 2022. Studies investigating MITs, targeted at individuals after stroke were eligible. Data were extracted related to study and intervention characteristics. RESULTS Sixteen studies were included. Compared with 'routine methods of treatment or training', the meta-analyses showed that MIT was more effective in improving cadence immediately post intervention (SMD: 1.22, 95% CI: 0.59, 1.85, p = 0.0001, I2 = 25%) and at 1- or 2-months post intervention (SMD: 0.78, 95% CI: 0.35, 1.20, p = 0.0004, I2 = 46%). The results also showed that MIT improves the step length of the affected side and the unaffected side at 1- or 2-months post intervention. Separate meta-analyses were also conducted on different tests of walking endurance (assessed by the 6-Minute Walk Test) and functional mobility (assessed by the Timed-Up-and-Go test). CONCLUSIONS MIT effectively improved gait performance. The findings in individuals after stroke remain inconclusive due to significant heterogeneity in included studies.
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Affiliation(s)
- Tingting Yan
- School of Nursing, Peking University, Beijing, China
| | - Wei Liang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Yao Shen
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuling Liu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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Béraud-Peigné N, Maillot P, Perrot A. The effects of a new immersive multidomain training on cognitive, dual-task and physical functions in older adults. GeroScience 2024; 46:1825-1841. [PMID: 37743415 PMCID: PMC10828343 DOI: 10.1007/s11357-023-00952-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
The aim of this study was to assess the potential of multidomain training using Immersive and Interactive Wall Exergames (I2WE) to improve the cognitive and physical functions of older adults. This new generation of exergames offers specific advantageous characteristics (e.g., immersion, virtual cognitive solicitation, high physical stimulation, complex motor skills, multiple social interactions) that could make I2WE an enjoyable multidomain training medium for older adults. A pilot study was set up with 34 participants (M = 69.91 years old). It used the pre-tests - training (3 months, 2 one-hour sessions per week for the 2 groups) - post-tests method to compare: a) the cognitive and the Dual-Task (DT) effects (primary outcomes), b) the physical effects and perceived pleasure (secondary outcomes) between an experimental group following an I2WE program (n = 19) to an active control group performing a Walking and Muscle-Strengthening (WMS) program (n = 15). While visuospatial short-term memory was improved for both groups, only I2WE training enhanced visuospatial working memory, inhibition, and DT. All physical functions, except upper body strength, were enhanced for the 2 groups. The perceived pleasure was higher for the I2WE group than the WMS group. The results of this first study have important clinical implications, showing that I2WE can optimize strategies to improve older adults' physical and cognitive health. Virtual and immersive cognitive stimulation combined with varied physical activity (i.e., aerobic, muscle-strengthening, complex motor skills) appear to be major assets of these new exergames. Moreover, the high level of perceived pleasure to I2WE makes it a promising tool for engaging older adults in sustained multidomain practice.
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Affiliation(s)
- Néva Béraud-Peigné
- CIAMS, Université Paris Saclay, Orsay, France.
- CIAMS, Université Paris Saclay, Orléans, France.
- I3SP, Université Paris-Cité, Paris, France.
| | | | - Alexandra Perrot
- CIAMS, Université Paris Saclay, Orsay, France
- CIAMS, Université Paris Saclay, Orléans, France
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Wu J, Qiu P, Lv S, Chen M, Li Y. The effects of cognitive-motor dual-task training on athletes' cognition and motor performance. Front Psychol 2024; 15:1284787. [PMID: 38390413 PMCID: PMC10881661 DOI: 10.3389/fpsyg.2024.1284787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Background Cognitive-Motor Dual Task (CMDT) training has been widely utilized in rehabilitation and sports practice. However, whether CMDT training can better enhance athletes' cognitive-motor performance compared to traditional single-task (ST) training remains unclear. Method A systematic review that complied with PRISMA was carried out (Prospero registration number: CRD42023443594). The electronic databases used for the systematic literature search from the beginning through 13 June 2023, included Web of Science, Embase, PubMed, and the Cochrane Library. After obtaining the initial literature, two researchers independently assessed it based on inclusion and exclusion criteria. Finally, the included literature was analyzed to compare the differences between ST training and CMDT training. Results After screening 2,094 articles, we included 10 acute studies and 7 chronic studies. Conclusion This systematic review shows that athletes typically show a degradation of performance in CMDT situations as opposed to ST when evaluated transversally. However, this performance decline is notably reduced following longitudinal training in CMDT, indicating the effectiveness of sustained CMDT training in enhancing cognitive-motor performance under dual-task conditions. Our study provides new insights into the application of CMDT in the field of sports training. Practitioners can utilize CMDT to assess athletic skill levels or optimize cognitive-motor performance of athletes, taking into account the specific needs of each sport. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42023443594.
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Affiliation(s)
- Junyu Wu
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Peng Qiu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuaibing Lv
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Mingxian Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Youqiang Li
- School of Physical Education, Shanghai University of Sport, Shanghai, China
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Zwingmann K, Schlesinger T, Müller K. The Impact of an Outdoor Motor-Cognitive Exercise Programme on the Health Outcomes of Older Adults in Community Settings: A Pilot and Feasibility Study. Sports (Basel) 2024; 12:49. [PMID: 38393269 PMCID: PMC10892309 DOI: 10.3390/sports12020049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Physical and cognitive exercises can prevent or at least mitigate the symptoms of certain diseases and help older adults perform a range of daily functions. Yet, most seniors do not meet the World Health Organisation's recommended guidelines for physical activity. The objective of this study is to promote and maintain the physical and cognitive capacity of older adults by implementing a feasible and effective low-threshold, age-appropriate, motor-cognitive training outdoors. In the German city of Chemnitz, citizens aged 60 years and older participated in a quasi-randomised intervention trial. Exercises to train coordination, strength, endurance, and cognition were integrated into a 12-week outdoor motor-cognitive exercise programme. Both the physical (e.g., 6MWT) and cognitive skills (e.g., TMT B) of the intervention group (n = 41) and control group (no intervention, n = 58) were measured before (T1) and after (T2) completion of the exercise programme. Some of the participants' physical and all their cognitive measures improved. Neurocognitive performance (DSST) showed a significant time × group interaction effect (F(1,95) = 6.943, p = 0.010, ηp2 = 0.068). Sex and age were found to be influencing factors. We consider our exercise programme to be successfully implemented, well received by the participants, and feasible and useful to promote the continued exercise of daily functions as part of healthy aging in community-dwelling older adults.
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Affiliation(s)
- Katharina Zwingmann
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany; (T.S.); (K.M.)
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Seinsche J, de Bruin ED, Hinrichs T, Giannouli E. Effects of home-based interventions using exergames on physical and cognitive functions in community-dwelling older adults: a PRISMA-P-compliant protocol for a systematic review. Front Public Health 2024; 11:1291120. [PMID: 38274539 PMCID: PMC10808653 DOI: 10.3389/fpubh.2023.1291120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Physical activity and exercise are crucial to counteract physical and cognitive decline in old age. Home-based exergame training can be a solution to overcome physical inactivity. This systematic review aims to provide a comprehensive overview of home-based exergame interventions and evaluate their effectiveness in improving cognitive and physical functions through physical activity enhancement in older adults. Methods and analysis We are conducting a systematic literature search including studies examining (1) community-dwelling older adults aged 60 years and older without any specific disease, (2) exergame-based exercise programs that take place at least partially in a home setting, and (3) intervention-related physical and/or cognitive outcomes. We will include randomized controlled trials and any other type of pre-post study published in English. There are no restrictions in terms of control group type and publication date. A search string was created and used in PubMed, Web of Science, Embase, Scopus and CINAHL. In addition, a hand search is carried out. This involves checking the references of the included studies and searching Google Scholar for further studies. The included studies will be summarized and, if homogeneity is sufficient, a random-effects meta-analysis will be performed. We will assess the risk of bias using RoB 2.0 and ROBINS-I. Conclusion The findings of this systematic review will help to define the most suitable exergame programs to counteract cognitive and physical decline in older adults. Additionally, they will inform the development of effective home-based exergame systems and point to future pathways of digital rehabilitation in older adults. Registration Prospero (ID: CRD42023374234).
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Affiliation(s)
- Julia Seinsche
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Eling D. de Bruin
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Eleftheria Giannouli
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Cheng CH, Hsieh YW, Chang CC, Hsiao FJ, Chen LF, Wang PN. Effects of 6-Month Combined Physical Exercise and Cognitive Training on Neuropsychological and Neurophysiological Function in Older Adults with Subjective Cognitive Decline: A Randomized Controlled Trial. J Alzheimers Dis 2024; 100:175-192. [PMID: 38848174 DOI: 10.3233/jad-231257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background Multidomain intervention may delay or ameliorate cognitive decline in older adults at risk of Alzheimer's disease, particularly in the memory and inhibitory functions. However, no study systematically investigates the changes of brain function in cognitively-normal elderly with subjective cognitive decline (SCD) when they receive multidomain intervention. Objective We aimed to examine whether a multidomain intervention could improve neuropsychological function and neurophysiological activities related to memory and inhibitory function in SCD subjects. Methods Eight clusters with a total of 50 community-dwelling SCD older adults were single-blind, randomized into intervention group, which received physical and cognitive training, or control group, which received treatment as usual. For the neuropsychological function, a composite Z score from six cognitive tests was calculated and compared between two groups. For the neurophysiological activities, event-related potentials (ERPs) of memory function, including mismatch negativity (MMN) and memory-P3, as well as ERPs of inhibitory function, including sensory gating (SG) and inhibition-P3, were measured. Assessments were performed at baseline (T1), end of the intervention (T2), and 6 months after T2 (T3). Results For the neuropsychological function, the effect was not observed after the intervention. For the neurophysiological activities, improved MMN responses of ΔT2-T1 were observed in the intervention group versus the control group. The multidomain intervention produced a sustained effect on memory-P3 latencies of ΔT3-T1. However, there were no significant differences in changes of SG and inhibition-P3 between intervention and control groups. Conclusions While not impactful on neuropsychological function, multidomain intervention enhances specific neurophysiological activities associated with memory function.
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Affiliation(s)
- Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Laboratory of Brain Imaging and Neural Dynamics - BIND Lab, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology, Cognition and Aging Center, Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Jung Hsiao
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Fen Chen
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Ning Wang
- Department of Neurological Institute, Division of General Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
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Herold F, Theobald P, Gronwald T, Kaushal N, Zou L, de Bruin ED, Bherer L, Müller NG. Alexa, let's train now! - A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:30-46. [PMID: 36736727 PMCID: PMC10818117 DOI: 10.1016/j.jshs.2023.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging. Consequently, the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions. In this context, digital and home-based physical training interventions might be a promising alternative to center-based intervention programs. Thus, this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance. METHODS In this pre-registered systematic review (PROSPERO; ID: CRD42022320031), 5 electronic databases (PubMed, Web of Science, PsycInfo, SPORTDiscus, and Cochrane Library) were searched by 2 independent researchers (FH and PT) to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults. The systematic literature search yielded 8258 records (extra 17 records from other sources), of which 27 controlled trials were considered relevant. Two reviewers (FH and PT) independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX scale). RESULTS Of the 27 reviewed studies, 15 reported positive effects on cognitive and motor-cognitive outcomes (i.e., performance improvements in measures of executive functions, working memory, and choice stepping reaction test), and a considerable heterogeneity concerning study-related, population-related, and intervention-related characteristics was noticed. A more detailed analysis suggests that, in particular, interventions using online classes and technology-based exercise devices (i.e., step-based exergames) can improve cognitive performance in healthy older adults. Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence (≤85%) and monitoring of the level of regular physical activity in the control group. CONCLUSION The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall, though there is limited evidence that specific types of digital and home-based physical training interventions (e.g., online classes and step-based exergames) can be an effective strategy for improving cognitive performance in older adults. However, due to the limited number of available studies, future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.
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Affiliation(s)
- Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China.
| | - Paula Theobald
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg 20457, Germany
| | - Navin Kaushal
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Liye Zou
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich 8093, Switzerland; Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm 17177, Sweden; Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen 9001, Switzerland
| | - Louis Bherer
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada; Department of Medicine, Universite de Montreal, Montreal, QC H3T 1J4, Canada; Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal, Montreal, QC H3W 1W5, Canada
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China
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Seinsche J, de Bruin ED, Saibene E, Rizzo F, Carpinella I, Ferrarin M, Moza S, Ritter T, Giannouli E. A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study. JMIR Hum Factors 2023; 10:e48845. [PMID: 38060283 PMCID: PMC10739244 DOI: 10.2196/48845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). OBJECTIVE This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. METHODS At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants' perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire-3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. RESULTS A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system's usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ρ=0.35, P=.02 to ρ=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ρ=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ρ=-0.35; P=.02) and the UTAUT total score (ρ=-0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. CONCLUSIONS The study's findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system's feasibility and effectiveness.
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Affiliation(s)
- Julia Seinsche
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Enrico Saibene
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Francesco Rizzo
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Ilaria Carpinella
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Maurizio Ferrarin
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | | | - Tanja Ritter
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eleftheria Giannouli
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Seinsche J, de Bruin ED, Saibene E, Rizzo F, Carpinella I, Ferrarin M, Ifanger S, Moza S, Giannouli E. Feasibility and Effectiveness of a Personalized Home-Based Motor-Cognitive Training Program in Community-Dwelling Older Adults: Protocol for a Pragmatic Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49377. [PMID: 37943591 PMCID: PMC10667977 DOI: 10.2196/49377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Exergame-based motor-cognitive training in older adults has been associated with improvements in physical, cognitive, and psychological functioning. The novel Cocare system (Dividat GmbH), developed through a user-centered design process, allows motor-cognitive training in a telerehabilitation setting. It includes (1) a stationary stepping platform for supervised exergame training (Dividat Senso; Dividat GmbH), (2) a home-based version (Dividat Senso Flex, which is a rollable pressure-sensitive mat; Dividat GmbH), (3) an assessment system (including motor-cognitive tests), and (4) a rehabilitation cockpit for remote training supervision and management. OBJECTIVE The aim of this study is to test the feasibility and effectiveness of this novel training system. METHODS A total of 180 older adults from Switzerland, Italy, and Cyprus aged ≥60 years with a prescription for rehabilitation are randomly allocated to an intervention group or a control group. Both groups continue with their usual care, whereas participants in the intervention group additionally perform a 2-week supervised exergame training program at rehabilitation centers, followed by a 10-week home training program under remote supervision. The assessment system is used to indicate the start level of each participant, and, in both intervention periods, standardized progression rules are applied. The measures of feasibility include adherence, attrition, exergame enjoyment, willingness to perform such a training program, and the number and types of help requests. Effectiveness is assessed in terms of cognitive and physical functioning, balance confidence, and quality of life. RESULTS Data collection started in February 2023 and is ongoing. Final measurements are expected to be performed in January 2024. CONCLUSIONS Owing to the user-centered design approach, the Cocare system is expected to be user-friendly and offers several novel features to cover the whole continuum of care. This pragmatic trial will provide valuable information regarding final necessary adaptations and subsequent implementation efforts. TRIAL REGISTRATION ClinicalTrials.gov NCT05751551; https://www.clinicaltrials.gov/study/NCT05751551. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49377.
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Affiliation(s)
- Julia Seinsche
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Enrico Saibene
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Francesco Rizzo
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Ilaria Carpinella
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Maurizio Ferrarin
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Sarina Ifanger
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | | | - Eleftheria Giannouli
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Chen IC, Chuang IC, Chang KC, Chang CH, Wu CY. Dual task measures in older adults with and without cognitive impairment: response to simultaneous cognitive-exercise training and minimal clinically important difference estimates. BMC Geriatr 2023; 23:663. [PMID: 37845603 PMCID: PMC10580601 DOI: 10.1186/s12877-023-04390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Responsiveness and minimal clinically important difference (MCID) are critical indices to understand whether observed improvement represents a meaningful improvement after intervention. Although simultaneous cognitive-exercise training (SCET; e.g., performing memory tasks while cycling) has been suggested to enhance the cognitive function of older adults, responsiveness and MCID have not been established. Hence, we aimed to estimate responsiveness and MCIDs of two dual task performance involving cognition and hand function in older adults with and without cognitive impairment and to compare the differences in responsiveness and MCIDs of the two dual task performance between older adults with and without cognitive impairment. METHODS A total of 106 older adults completed the Montreal Cognitive Assessment and two dual tasks before and after SCET. One dual task was a combination of Serial Sevens Test and Box and Block Test (BBT), and the other included frequency discrimination and BBT. We used effect size and standardized response mean to indicate responsiveness and used anchor- and distribution-based approaches to estimating MCID ranges. When conducting data analysis, all participants were classified into two cognitive groups, cognitively healthy (Montreal Cognitive Assessment ≥ 26) and cognitively impaired (Montreal Cognitive Assessment < 26) groups, based on the scores of the Montreal Cognitive Assessment before SCET. RESULTS In the cognitively healthy group, Serial Seven Test performance when tasked with BBT and BBT performance when tasked with Serial Seven Test were responsive to SCET (effect size = 0.18-0.29; standardized response mean = 0.25-0.37). MCIDs of Serial Seven Test performance when tasked with BBT ranged 2.09-2.36, and MCIDs of BBT performance when tasked with Serial Seven Test ranged 3.77-5.85. In the cognitively impaired group, only frequency discrimination performance when tasked with BBT was responsive to SCET (effect size = 0.37; standardized response mean = 0.47). MCIDs of frequency discrimination performance when tasked with BBT ranged 1.47-2.18, and MCIDs of BBT performance when tasked with frequency discrimination ranged 1.13-7.62. CONCLUSIONS Current findings suggest that a change in Serial Seven Test performance when tasked with BBT between 2.09 and 2.36 corrected number (correct responses - incorrect responses) should be considered a meaningful change for older adults who are cognitively healthy, and a change in frequency discrimination performance when tasked with BBT between 1.47 and 2.18 corrected number (correct responses - incorrect responses) should be considered a meaningful change for older adults who are cognitively impaired. Clinical practitioners may use these established MCIDs of dual tasks involving cognition and hand function to interpret changes following SCET for older adults with and without cognitive impairment. TRIAL REGISTRATION NCT04689776, 30/12/2020.
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Affiliation(s)
- I-Chen Chen
- Department of Occupational Therapy, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - I-Ching Chuang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Gueishan Township, Taoyuan, 333, Taiwan.
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Ku-Chou Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hung Chang
- Program in Occupational Therapy, School of Medicine, Washington University , St. Louis, MO, USA
- Department of Medicine, School of Medicine, Washington University , St. Louis, MO, USA
- Department of Orthopedic Surgery, School of Medicine, Washington University , St. Louis, MO, USA
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Gueishan Township, Taoyuan, 333, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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20
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Meng L, Wang D, Shi Y, Li Z, Zhang J, Lu H, Zhu X, Ming D. Enhanced brain functional connectivity and activation after 12-week Tai Chi-based action observation training in patients with Parkinson's disease. Front Aging Neurosci 2023; 15:1252610. [PMID: 37881362 PMCID: PMC10595151 DOI: 10.3389/fnagi.2023.1252610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Motor-cognitive interactive interventions, such as action observation training (AOT), have shown great potential in restoring cognitive function and motor behaviors. It is expected that an advanced AOT incorporating specific Tai Chi movements with continuous and spiral characteristics can facilitate the shift from automatic to intentional actions and thus enhance motor control ability for early-stage PD. Nonetheless, the underlying neural mechanisms remain unclear. The study aimed to investigate changes in brain functional connectivity (FC) and clinical improvement after 12 weeks of Tai Chi-based action observation training (TC-AOT) compared to traditional physical therapy (TPT). Methods Thirty early-stage PD patients were recruited and randomly assigned to the TC-AOT group (N = 15) or TPT group (N = 15). All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans before and after 12 weeks of training and clinical assessments. The FCs were evaluated by seed-based correlation analysis based on the default mode network (DMN). The rehabilitation effects of the two training methods were compared while the correlations between significant FC changes and clinical improvement were investigated. Results The results showed that the TC-AOT group exhibited significantly increased FCs between the dorsal medial prefrontal cortex and cerebellum crus I, between the posterior inferior parietal lobe and supramarginal gyrus, and between the temporal parietal junction and clusters of middle occipital gyrus and superior temporal. Moreover, these FC changes had a positive relationship with patients' improved motor and cognitive performance. Discussion The finding supported that the TC-AOT promotes early-stage PD rehabilitation outcomes by promoting brain neuroplasticity where the FCs involved in the integration of sensorimotor processing and motor learning were strengthened.
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Affiliation(s)
- Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Deyu Wang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Yu Shi
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Zhuo Li
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinghui Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hanna Lu
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Department of Biomedical Engineering, School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
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21
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Leavy B, Sedhed J, Kalbe E, Åkesson E, Franzén E, Johansson H. Design of the STEPS trial: a phase II randomized controlled trial evaluating eHealth-supported motor-cognitive home training for Parkinson's disease. BMC Neurol 2023; 23:356. [PMID: 37794320 PMCID: PMC10548709 DOI: 10.1186/s12883-023-03389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Electronic health (eHealth) technology offers the potential to support and motivate physical activity for symptom management in Parkinson's disease (PD). It is also recommended that motor exercise in PD be complemented with cognitive training aimed at attentional or executive functions. This paper describes the protocol for a double-blind randomized controlled trial to evaluate the effects of motor-cognitive training in the home environment, supported by eHealth. METHODS/DESIGN The Support for home Training using Ehealth in Parkinsons diseaSe (STEPS) is a double-blind single center randomized controlled trial. Two parallel groups will include in total 120 participants with mild to moderate PD who will receive either (i) the intervention (a progressive 10-week individualized motor-cognitive eHealth training with cognitive behavioral elements to increase physical activity levels) or (ii) an active control group (an individualized 10-week paper-based home exercise program). The active control group will not receive motor-cognitive exercises or cognitive behavioral approaches to increase physical activity level. The primary outcome is walking capacity assessed by the six-minute walk test (6MWT). Secondary outcomes will include gait performance during single and dual task conditions, gait speed, functional mobility and lower limb strength, balance, physical activity behavior and a range of patient reported outcome measures relevant in PD. DISCUSSION The STEPS trial will answer the question whether 10 weeks of eHealth supported motor-cognitive exercise in the home environment can improve walking capacity in PD when compared to a standard paper exercise program. Findings from this study will also strengthen the evidence concerning the efficacy of PD-specific eHealth interventions with a view meeting future health care demands by addressing issues of inaccessibility to specialized neurological rehabilitation in PD. TRIAL REGISTRATION ClinicalTrials.gov August 2022, NCT05510739.
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Affiliation(s)
- Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden.
| | - Jenny Sedhed
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elisabet Åkesson
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
- Theme Womens Health and Allied Health Professionals, Medical unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
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22
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Embrechts E, McGuckian TB, Rogers JM, Dijkerman CH, Steenbergen B, Wilson PH, Nijboer TCW. Cognitive and Motor Therapy After Stroke Is Not Superior to Motor and Cognitive Therapy Alone to Improve Cognitive and Motor Outcomes: New Insights From a Meta-analysis. Arch Phys Med Rehabil 2023; 104:1720-1734. [PMID: 37295704 DOI: 10.1016/j.apmr.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate whether cognitive and motor therapy (CMT) is more effective than no therapy, motor therapy, or cognitive therapy on motor and/or cognitive outcomes after stroke. Additionally, this study evaluates whether effects are lasting and which CMT approach is most effective. DATA SOURCES AMED, EMBASE, MEDLINE/PubMed, and PsycINFO databases were searched in October 2022. STUDY SELECTION Twenty-six studies fulfilled the inclusion criteria: randomized controlled trials published in peer-reviewed journals since 2010 that investigated adults with stroke, delivered CMT, and included at least 1 motor, cognitive, or cognitive-motor outcome. Two CMT approaches exist: CMT dual-task ("classical" dual-task where the secondary cognitive task has a distinct goal) and CMT integrated (where cognitive components of the task are integrated into the motor task). DATA EXTRACTION Data on study design, participant characteristics, interventions, outcome measures (cognitive/motor/cognitive-motor), results and statistical analysis were extracted. Multilevel random effects meta-analysis was conducted. DATA SYNTHESIS CMT demonstrated positive effects compared with no therapy on motor outcomes (g=0.49; 95% confidence interval [CI], 0.10, 0.88) and cognitive-motor outcomes (g=0.29; 95% CI, 0.03, 0.54). CMT showed no significant effects compared with motor therapy on motor, cognitive, and cognitive-motor outcomes. A small positive effect of CMT compared with cognitive therapy on cognitive outcomes (g=0.18; 95% CI, 0.01, 0.36) was found. CMT demonstrated no follow-up effect compared with motor therapy (g=0.07; 95% CI, -0.04, 0.18). Comparison of CMT dual-task and integrated revealed no significant difference for motor (F1,141=0.80; P=.371) or cognitive outcomes (F1,72=0.61, P=.439). CONCLUSIONS CMT was not superior to monotherapies in improved outcomes after stroke. CMT approaches were equally effective, suggesting that training that enlists a cognitive load per se may benefit outcomes.
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Affiliation(s)
- Elissa Embrechts
- Rehabilitation Sciences and Physical Therapy, Research group MOVANT, University of Antwerp, Belgium; Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Jeffrey M Rogers
- Faculty of Health Sciences, University of Sydney, New South Wales, Australia
| | - Chris H Dijkerman
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Peter H Wilson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Tanja C W Nijboer
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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23
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Manser P, Poikonen H, de Bruin ED. Feasibility, usability, and acceptance of "Brain-IT"-A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trial. Front Aging Neurosci 2023; 15:1163388. [PMID: 37810620 PMCID: PMC10557950 DOI: 10.3389/fnagi.2023.1163388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Exergames provide a promising new approach to implement simultaneous motor-cognitive training, which may support preventing the decline in cognitive functioning in older adults who have a mild neurocognitive disorder (mNCD). Objectives To evaluate feasibility, system usability, and acceptance of "Brain-IT", a newly developed training concept combining exergame-based motor-cognitive training and heart rate variability (HRV) guided resonance breathing for the secondary prevention of mNCD. Methods A pilot randomized controlled trial (RCT) with an allocation ratio of 2:1 (i.e., intervention:control) was conducted. The control group proceeded with usual care. The intervention group performed a 12-week training according to the "Brain-IT" training concept implemented with the "Senso Flex" (Dividat AG) exergaming system in addition to usual care. Feasibility and usability outcomes were analyzed using descriptive statistics. User acceptance was analyzed qualitatively and using Friedman analysis of variance (ANOVA), as well as Wilcoxon signed-rank tests. Results Eighteen participants (77.3 ± 9.8 years; 44.4% females) were included. On average, we recruited 2.2 participants per month, and 35.3% of the individuals contacted were included. The intervention group had an attrition rate of 20% and mean adherence and compliance rates of 85.0 and 84.1%, respectively. The mean system usability score, measured with the system usability scale, was 71.7. High levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness, were observed. Preliminary data on the effects of the "Brain-IT" training are promising. Conclusion The feasibility and usability of the "Brain-IT" training are acceptable. However, frequent occurrences of technical problems and difficulties in using the exergame training system were identified as barriers to performing the "Brain-IT" training. To optimize feasibility, either improvements or alternative solutions are required in the hardware and software of the exergame used to implement the "Brain-IT" training. The "Brain-IT" training itself was well-accepted by older adults who have mNCD. Therefore, the effectiveness of the "Brain-IT" training concept should be investigated in future studies. Trial registration clinicaltrials.gov/ct2/show/NCT04996654.
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Affiliation(s)
- Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Hanna Poikonen
- Learning Sciences and Higher Education, Department of Humanities, Social and Political Sciences, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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24
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Klimecki OM, Liebscher M, Gaubert M, Hayek D, Zarucha A, Dyrba M, Bartels C, Buerger K, Butryn M, Dechent P, Dobisch L, Ewers M, Fliessbach K, Freiesleben SD, Glanz W, Hetzer S, Janowitz D, Kilimann I, Kleineidam L, Laske C, Maier F, Munk MH, Perneczky R, Peters O, Priller J, Rauchmann BS, Roy N, Scheffler K, Schneider A, Spruth EJ, Spottke A, Teipel SJ, Wiltfang J, Wolfsgruber S, Yakupov R, Düzel E, Jessen F, Wagner M, Roeske S, Wirth M. Long-term environmental enrichment is associated with better fornix microstructure in older adults. Front Aging Neurosci 2023; 15:1170879. [PMID: 37711996 PMCID: PMC10498282 DOI: 10.3389/fnagi.2023.1170879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/04/2023] [Indexed: 09/16/2023] Open
Abstract
Background Sustained environmental enrichment (EE) through a variety of leisure activities may decrease the risk of developing Alzheimer's disease. This cross-sectional cohort study investigated the association between long-term EE in young adulthood through middle life and microstructure of fiber tracts associated with the memory system in older adults. Methods N = 201 cognitively unimpaired participants (≥ 60 years of age) from the DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) baseline cohort were included. Two groups of participants with higher (n = 104) or lower (n = 97) long-term EE were identified, using the self-reported frequency of diverse physical, intellectual, and social leisure activities between the ages 13 to 65. White matter (WM) microstructure was measured by fractional anisotropy (FA) and mean diffusivity (MD) in the fornix, uncinate fasciculus, and parahippocampal cingulum using diffusion tensor imaging. Long-term EE groups (lower/higher) were compared with adjustment for potential confounders, such as education, crystallized intelligence, and socio-economic status. Results Reported participation in higher long-term EE was associated with greater fornix microstructure, as indicated by higher FA (standardized β = 0.117, p = 0.033) and lower MD (β = -0.147, p = 0.015). Greater fornix microstructure was indirectly associated (FA: unstandardized B = 0.619, p = 0.038; MD: B = -0.035, p = 0.026) with better memory function through higher long-term EE. No significant effects were found for the other WM tracts. Conclusion Our findings suggest that sustained participation in a greater variety of leisure activities relates to preserved WM microstructure in the memory system in older adults. This could be facilitated by the multimodal stimulation associated with the engagement in a physically, intellectually, and socially enriched lifestyle. Longitudinal studies will be needed to support this assumption.
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Affiliation(s)
- Olga M Klimecki
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Maxie Liebscher
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Malo Gaubert
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neuroradiology, Rennes University Hospital Centre Hospitalier Universitaire (CHU), Rennes, France
| | - Dayana Hayek
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Alexis Zarucha
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Martin Dyrba
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Göttingen, Germany
| | - Katharina Buerger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Michaela Butryn
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Peter Dechent
- Magnetic Resonance (MR)-Research in Neurosciences, Department of Cognitive Neurology, Georg-August-University Goettingen, Göttingen, Germany
| | - Laura Dobisch
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Michael Ewers
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Silka Dawn Freiesleben
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Wenzel Glanz
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Section for Dementia Research, Department of Psychiatry and Psychotherapy, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Franziska Maier
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Matthias H Munk
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Robert Perneczky
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, United Kingdom
| | - Oliver Peters
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- University of Edinburgh and United Kingdom Dementia Research Institute (UK DRI), Edinburgh, United Kingdom
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Nina Roy
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Klaus Scheffler
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Eike Jakob Spruth
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Neurosciences and Signaling Group, Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Steffen Wolfsgruber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Renat Yakupov
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Sandra Roeske
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Miranka Wirth
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
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Hülsdünker T, Friebe D, Giesche F, Vogt L, Pfab F, Haser C, Banzer W. Validity of the SKILLCOURT® technology for agility and cognitive performance assessment in healthy active adults. J Exerc Sci Fit 2023; 21:260-267. [PMID: 37497363 PMCID: PMC10366450 DOI: 10.1016/j.jesf.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 07/28/2023] Open
Abstract
Background/Objectives Agility and cognitive abilities are typically assessed separately by different motor and cognitive tests. While many agility tests lack a reactive decision-making component, cognitive assessments are still mainly based on computer-based or paper-pencil tests with low ecological validity. This study is the first to validate the novel SKILLCOURT technology as an integrated assessment tool for agility and cognitive-motor performance. Methods Thirty-two healthy adults performed agility (Star Run), reactive agility (Random Star Run) and cognitive-motor (executive function test, 1-back decision making) performance assessments on the SKILLCOURT. Cognitive-motor tests included lower limb responses in a standing position to increase the ecological validity when compared to computer-based tests. Test results were compared to established motor and agility tests (countermovement jump, 10 m linear sprint, T-agility tests) as well as computer-based cognitive assessments (choice-reaction, Go-NoGo, task switching, memory span). Correlation and multiple regression analyses quantified the relation between SKILLCOURT performance and motor and cognitive outcomes. Results Star Run and Random Star Run tests were best predicted by linear sprint (r = 0.68, p < 0.001) and T-agility performance (r = 0.77, p < 0.001), respectively. The executive function test performance was well explained by computer-based assessments on choice reaction speed and cognitive flexibility (r = 0.64, p < 0.001). The 1-back test on the SKILLCOURT revealed moderate but significant correlations with the computer-based assessments (r = 0.47, p = 0.007). Conclusion The results support the validity of the SKILLCOURT technology for agility and cognitive assessments in more ecologically valid cognitive-motor tasks. This technology provides a promising alternative to existing performance assessment tools.
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Affiliation(s)
- Thorben Hülsdünker
- Department of Exercise and Sport Science, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute (LHSSRI), Differdange, Luxembourg
| | - David Friebe
- Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt/Main, Goethe University, Frankfurt, Germany
| | - Florian Giesche
- Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt/Main, Goethe University, Frankfurt, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt/Main, Germany
| | - Florian Pfab
- Medical Department Eintracht Frankfurt, Frankfurt, Germany
| | | | - Winfried Banzer
- Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt/Main, Goethe University, Frankfurt, Germany
- Medical Department Eintracht Frankfurt, Frankfurt, Germany
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26
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Podolski OS, Whitfield T, Schaaf L, Cornaro C, Köbe T, Koch S, Wirth M. The Impact of Dance Movement Interventions on Psychological Health in Older Adults without Dementia: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:981. [PMID: 37508913 PMCID: PMC10377702 DOI: 10.3390/brainsci13070981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Lifestyle-based multimodal interventions that integrate physical, sensory, cognitive and social enrichment are suggested to promote healthy mental aging and resilience against aging and Alzheimer's disease (AD). OBJECTIVES This meta-analysis examined the efficacy of dance movement interventions (DMI) as an integrated mind-body activity on outcomes of psychological health in older adults. METHODS Pre-registration was carried out with PROSPERO (CRD42021265112). PubMed, Web of Science and PsycINFO were searched for randomized controlled trials (RCT) evaluating the effects of DMI (>4 weeks' duration) compared to comparators on measures of psychological health (primary outcome) and cognitive function (additional outcome) among older adults without dementia (aged ≥55). Data of 14 primary RCT (n = 983, n-DMI = 494, n-control = 489) were synthesized using a random effects meta-analysis with robust variance estimation. RESULTS DMI had a small positive effect on overall psychological health (g = 0.30; 95% confidence interval [CI]: 0.06, 0.53; p = 0.02, I2= 65.04) compared to control conditions. Small effects of DMI on positive and negative psychological domains as well as quality of life were not statistically significant. DMI had a medium positive effect on general cognitive function (g = 0.50; 95% CI: 0.12, 0.89, p = 0.02, I2= 79.61) over comparators. None of the primary intervention studies evaluated measures of neuroplasticity. CONCLUSIONS We found that DMI was effective in promoting mental health amongst older adults without dementia, suggesting that the multimodal enrichment tool is a potential strategy for health promotion and prevention of AD. High-quality intervention studies are needed to expand evidence on DMI-induced changes in specific psychological domains and identify underlying neurophysiological correlates.
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Affiliation(s)
| | - Tim Whitfield
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Leah Schaaf
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Clara Cornaro
- Research Institute for Creative Arts Therapies (RIArT), Alanus University of Arts and Social Sciences, 53347 Alfter, Germany
- Faculty of Therapy Sciences, SRH University Heidelberg, 69123 Heidelberg, Germany
| | - Theresa Köbe
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Sabine Koch
- Research Institute for Creative Arts Therapies (RIArT), Alanus University of Arts and Social Sciences, 53347 Alfter, Germany
- Faculty of Therapy Sciences, SRH University Heidelberg, 69123 Heidelberg, Germany
- Faculty of Fine Arts and Music, CAMTRU, University of Melbourne, Melbourne, VIC 3006, Australia
| | - Miranka Wirth
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
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Buele J, Palacios-Navarro G. Cognitive-motor interventions based on virtual reality and instrumental activities of daily living (iADL): an overview. Front Aging Neurosci 2023; 15:1191729. [PMID: 37396651 PMCID: PMC10311491 DOI: 10.3389/fnagi.2023.1191729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Non-invasive, non-pharmacological interventions utilizing virtual reality (VR) represent a promising approach to enhancing cognitive function in patients with degenerative cognitive disorders. Traditional "pen and paper" therapies often lack the practical engagement in everyday activities that older individuals encounter in their environment. These activities pose both cognitive and motor challenges, underscoring the necessity of understanding the outcomes of such combined interventions. This review aimed to assess the advantages of VR applications that integrate cognitive-motor tasks, simulating instrumental activities of daily living (iADLs). We systematically searched five databases-Scopus, Web of Science, Springer Link, IEEE Xplore, and PubMed, from their inception until January 31, 2023. Our review revealed that motor movements, coupled with VR-based cognitive-motor interventions, activate specific brain areas and foster improvements in general cognition, executive function, attention, and memory. VR applications that meld cognitive-motor tasks and simulate iADLs can offer significant benefits to older adults. Enhanced cognitive and motor performance can promote increased independence in daily activities, thereby contributing to improved quality of life.
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Affiliation(s)
- Jorge Buele
- SISAu Research Group, Facultad de Ingeniería, Industria y Producción, Universidad Indoamérica, Ambato, Ecuador
- Department of Electronic Engineering and Communications, University of Zaragoza, Teruel, Spain
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Yano N, Hosokawa K. The importance of comprehensive support based on the three pillars of exercise, nutrition, and sleep for improving core symptoms of autism spectrum disorders. Front Psychiatry 2023; 14:1119142. [PMID: 37260760 PMCID: PMC10228143 DOI: 10.3389/fpsyt.2023.1119142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/15/2023] [Indexed: 06/02/2023] Open
Abstract
Autism spectrum disorder (ASD) is classified as a neurodevelopmental disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-V, which first described ASD, lists persistent deficits in social communication and interrelationships, as well as limited and recurrent modes of behavior, interests, and activities as diagnostic items. Until recently, understanding the pathophysiology of ASD has been mostly from a neurophysiological perspective, and interventions have been mostly behavioral and psychological. In recent years, however, it has become clear that ASD also affects many bodily systems, including the immune system, the sensorimotor system, and the gut-brain axis, and that these factors simultaneously influence it. In light of this background, a new "connectivome theory" has been proposed as a hypothesis for understanding ASD. "Exercise," "nutrition," and "sleep," which are discussed in this mini-review, have a particularly strong relationship with the immune, musculoskeletal, and gut systems among the pathologies mentioned in the "connectivome theory," furthermore, many reports suggest improvements in stereo-responsive behavior and social and communication skills, which are the core symptoms of ASD. In addition, these interventions are characterized by being less subject to location and cost limitations and excel in the continuity of therapeutic intervention, and the three interventions may have a reciprocal positive impact and may function as three pillars to support ASD.
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Affiliation(s)
- Nozomu Yano
- Graduate School of Health Sciences, Doctoral Course, Kagoshima University Graduate School, Kagoshima, Japan
| | - Kenji Hosokawa
- Department of Child Care and Education, Odawara Junior College, Nagoya, Japan
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Anzeneder S, Zehnder C, Martin-Niedecken AL, Schmidt M, Benzing V. Acute exercise and children's cognitive functioning: What is the optimal dose of cognitive challenge? PSYCHOLOGY OF SPORT AND EXERCISE 2023; 66:102404. [PMID: 37665845 DOI: 10.1016/j.psychsport.2023.102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/26/2022] [Accepted: 02/08/2023] [Indexed: 09/06/2023]
Abstract
Acute bouts of exercise have the potential to benefit children's cognition. Inconsistent evidence on the role of qualitative exercise task characteristics calls for further investigation of the cognitive challenge level in exercise. Thus, the study aim was to investigate which "dose" of cognitive challenge in acute exercise benefits children's cognition, also exploring the moderating role of individual characteristics. In a within-subject experimental design, 103 children (Mage = 11.1, SD = 0.9, 48% female) participated weekly in one of three 15-min exergames followed by an Attention Network task. Exergame sessions were designed to keep physical intensity constant (65% HRmax) and to have different cognitive challenge levels (low, mid, high; adapted to the ongoing individual performance). ANOVAs performed on variables that reflect the individual functioning of attention networks revealed a significant effect of cognitive challenge on executive control efficiency (reaction time performances; p = .014, ƞ2p = .08), with better performances after the high-challenge condition compared to lower ones (ps < .015), whereas alerting and orienting were unaffected by cognitive challenge (ps > .05). ANOVAs performed on variables that reflect the interactive functioning of attention networks revealed that biological sex moderated cognitive challenge effects. For males only, the cognitive challenge level influenced the interactive functioning of executive control and orienting networks (p = .004; ƞ2p = .07). Results suggest that an individualized and adaptive cognitively high-challenging bout of exercise is more beneficial to children's executive control than less challenging ones. For males, the cognitive challenge in an acute bout seems beneficial to maintain executive control efficiency also when spatial attention resources cannot be validly allocated in advance. Results are interpreted referring to the cognitive stimulation hypothesis and arousal theory.
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Affiliation(s)
- Sofia Anzeneder
- Institute of Sport Science, University of Bern, Bern, Switzerland.
| | - Cäcilia Zehnder
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | | | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Valentin Benzing
- Institute of Sport Science, University of Bern, Bern, Switzerland
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Torre MM, Langeard A, Alliou L, Temprado JJ. Does bimanual coordination training benefit inhibitory function in older adults? Front Aging Neurosci 2023; 15:1124109. [PMID: 37091520 PMCID: PMC10116065 DOI: 10.3389/fnagi.2023.1124109] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
IntroductionWhether complex movement training benefits inhibitory functions and transfers the effects to non-practiced motor and cognitive tasks is still unknown. The present experiment addressed this issue using a bimanual coordination paradigm. The main hypothesis was that bimanual coordination training allows for improving the involved cognitive (i.e., inhibition) mechanisms and then, transferring to non-practiced cognitive and motor tasks, that share common processes.Methods17 older participants (72.1 ± 4.0 years) underwent 2 training and 3 test sessions (pre, post, and retention one week after) over three weeks. Training included maintaining bimanual coordination anti-phase pattern (AP) at high frequency while inhibiting the in-phase pattern (IP). During the test sessions, participants performed two bimanual coordination tasks and two cognitive tasks involving inhibition mechanisms. Transfer benefits of training on reaction time (RT), and total switching time (TST) were measured. In the cognitive tasks (i.e., the Colour Word Stroop Task (CWST) and the Motor and Perceptual Inhibition Test (MAPIT)), transfer effects were measured on response times and error rates. Repeated one-way measures ANOVAs and mediation analyses were conducted.ResultsResults confirmed that training was effective on the trained task and delayed the spontaneous transition frequency. Moreover, it transferred the benefits to untrained bimanual coordination and cognitive tasks that also involve inhibition functions. Mediation analyses confirmed that the improvement of inhibitory functions mediated the transfer of training in both the motor and cognitive tasks.DiscussionThis study confirmed that bimanual coordination practice can transfer training benefits to non-practiced cognitive and motor tasks since presumably they all share the same cognitive processes.
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Affiliation(s)
- Marta Maria Torre
- Aix-Marseille Université and CNRS, ISM UMR 7287, Institut des Sciences du Mouvement, Marseille, France
- *Correspondence: Marta Maria Torre
| | - Antoine Langeard
- Normandie Université, Université de Caen Normandie, Institut National de la Santé et de la Recherche Médicale, COMETE, Caen, France
| | - Louis Alliou
- Aix-Marseille Université and CNRS, ISM UMR 7287, Institut des Sciences du Mouvement, Marseille, France
| | - Jean-Jacques Temprado
- Aix-Marseille Université and CNRS, ISM UMR 7287, Institut des Sciences du Mouvement, Marseille, France
- Jean-Jacques Temprado
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Perrot A, Maillot P. Factors for optimizing intervention programs for cognition in older adults: the value of exergames. NPJ AGING 2023; 9:4. [PMID: 36991073 DOI: 10.1038/s41514-023-00103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
AbstractThis 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.
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Chueh TY, Hung CL, Chang YK, Huang CJ, Hung TM. Effects of cognitive demand during acute exercise on inhibitory control and its electrophysiological indices: A randomized crossover study. Physiol Behav 2023; 265:114148. [PMID: 36913988 DOI: 10.1016/j.physbeh.2023.114148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
The aim of this study was to examine the effects of cognitive demand during acute exercise on the behavioral and electrophysiological correlates of inhibitory control. In a within- participants design, 30 male participants (age range = 18-27 years) performed 20-min sessions of high cognitive-demand exercise (HE), low cognitive-demand exercise (LE), and an active control (AC) on separate days in a randomized order. A moderate-to-vigorous intensity interval step exercise was used as the exercise intervention. During the exercise periods, the participants were instructed to respond to the target among competing stimuli to impose different cognitive demands with their feet. A modified flanker task was administered to assess inhibitory control before and after the interventions, and electroencephalography was used to derive stimulus-elicited N2 and P3 components. Behavioral data showed that the participants performed significantly shorter reaction time (RT), regardless of congruency and a reduced RT flanker effect following HE and LE compared with the AC condition with large (ds = -0.934 to -1.07) and medium effect sizes (ds = -0.502 to -0.507), respectively. Electrophysiological data revealed that compared with the AC condition, acute HE and LE had facilitative effects on stimuli evaluation, as indicated by significantly shorter N2 latency for congruent trials and P3 latency regardless of congruency with medium effect sizes (ds = -0.507 to -0.777). Compared with the AC condition, only acute HE elicited more efficient neural processes in conditions requiring high inhibitory control demand, as indicated by significantly shorter N2 difference latency, with a medium effect size (d = -0.528). Overall, the findings suggest that acute HE and LE facilitate inhibitory control and the electrophysiological substrates of target evaluation. Acute exercise with higher cognitive demand may be associated with more refined neural processing for tasks demanding greater amounts of inhibitory control.
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Affiliation(s)
- Ting-Yu Chueh
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan; Department of Kinesiology, University of Maryland, College Park, MD 20742, USA
| | - Chiao-Ling Hung
- Department of Athletics, National Taiwan University, Taipei, Taiwan
| | - Yu-Kai Chang
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan; Institute for Research Excellence and Learning Science, National Taiwan Normal University, Taipei, Taiwan
| | - Chung-Ju Huang
- Graduate Institute of Sport Pedagogy, University of Taipei, Taipei, Taiwan
| | - Tsung-Min Hung
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan; Graduate Institute of Sport Pedagogy, University of Taipei, Taipei, Taiwan.
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Xiao Y, Yang T, Shang H. The Impact of Motor-Cognitive Dual-Task Training on Physical and Cognitive Functions in Parkinson’s Disease. Brain Sci 2023; 13:brainsci13030437. [PMID: 36979247 PMCID: PMC10046387 DOI: 10.3390/brainsci13030437] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Rehabilitation is a high-potential approach to improving physical and cognitive functions in Parkinson’s disease (PD). Dual-task training innovatively combines motor and cognitive rehabilitation in a comprehensive module. Patients perform motor and cognitive tasks at the same time in dual-task training. The previous studies of dual-task training in PD had high heterogeneity and achieved controversial results. In the current review, we aim to summarize the current evidence of the effect of dual-task training on motor and cognitive functions in PD patients to support the clinical practice of dual-task training. In addition, we also discuss the current opinions regarding the mechanism underlying the interaction between motor and cognitive training. In conclusion, dual-task training is suitable for PD patients with varied disease duration to improve their motor function. Dual-task training can improve motor symptoms, single-task gait speed, single-task steep length, balance, and objective experience of freezing of gait in PD. The improvement in cognitive function after dual-task training is mild.
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Douglas JT. My experience of living with nonfluent/agrammatic variant primary progressive aphasia: Challenges, compensatory strategies and adaptations. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:542-554. [PMID: 36239167 DOI: 10.1111/1460-6984.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a rare neurodegenerative brain disorder characterized by declining language ability. There is currently no way to reverse or slow the course of the progressive brain degeneration, nor is there a cure for PPA. Throughout the course of the disease, any treatment must therefore be palliative in nature and should be designed to manage symptoms and improve the quality of life of the affected person. There is little information in the medical literature about strategies to make meaningful improvements to the quality of life of people with PPA written from the perspective of those living with this condition. AIMS I have a clinical diagnosis of the nonfluent/agrammatic variant of PPA (nfvPPA), supported by imaging. In this report I discuss my experience of the progressive loss of language and communication skills, and detail the challenges I have been facing. I also describe how my quality of life has been enhanced by the early initiation of treatment focusing on communication strategies targeted to my specific impairments and designed to support my individual interests and goals. METHODS & PROCEDURES I was fortunate to obtain an early diagnosis from a cognitive neurologist experienced with PPA. From the onset of my language difficulties, I have received excellent personalized care from a multidisciplinary medical team including speech-language pathologists, a cognitive neurologist and other doctors. MAIN CONTRIBUTIONS My life during the early stage of nfvPPA has been enriched by personalized care focused on supporting the particular activities, interests and goals that are most important and meaningful to me. As my disease has progressed, I have benefited from an evolving range of strategies and adaptations targeted to the specific deficits in the areas of speaking, writing and reading that I have been facing at any given time. In addition, I have adopted methods to enhance the benefit of these language-directed strategies. And I have been employing evidence-based approaches that improve general brain health and thereby indirectly support my language. CONCLUSIONS & IMPLICATIONS My experience represents a model for the personalized care of people in the early stage of nfvPPA. WHAT THIS PAPER ADDS What is already known on the subject There is minimal information in the medical literature describing the subjective experience of a person with PPA. There is little information in the medical literature about strategies to make meaningful improvements to the quality of life of people in the early stage of PPA. What this paper adds to existing knowledge I have a clinical diagnosis of nfvPPA, supported by imaging. In this paper I give a first-person account of my experience of the progressive loss of language and communication skills, and I detail the challenges I have been facing. I describe how my quality of life during the early stage of nfvPPA has been enhanced by an evolving range of strategies and adaptations tailored to my speech and language deficits as they have arisen. These compensatory strategies have focused on supporting the particular activities, interests and goals that are most important and meaningful to me. What are the potential or actual clinical implications of this work? The description of my subjective experience of the progressive loss of language and communication skills offers insight for speech-language pathologists, neurologists and other professionals involved in the clinical care of people in the early stage of nfvPPA. My experience represents a model for the personalized clinical care of people in the early stage of this disorder.
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Affiliation(s)
- Joanne T Douglas
- Volunteer, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL, USA
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Downs TL, Whiteside EJ, Foot G, Mills DE, Bliss ES. Differences in total cognition and cerebrovascular function in female breast cancer survivors and cancer-free women. Breast 2023; 69:358-365. [PMID: 37018967 PMCID: PMC10122006 DOI: 10.1016/j.breast.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Reduced cognition is often reported by breast cancer patients and survivors, but the mechanisms for this decline are yet to be determined. We compared the differences in cerebrovascular function and cognition in breast cancer survivors (n = 15) and cancer-free women (n = 15) matched by age and body mass index. Participants undertook anthropometric, mood, cardiovascular, exercise performance, strength, cerebrovascular, and cognitive measurements. Transcranial Doppler ultrasound was used to measure the cerebrovascular responsiveness (CVR) to physiological (hypercapnia; 5% carbon dioxide) and psychological stimuli. Breast cancer survivors had a lower CVR to hypercapnia (21.5 ± 12.8 vs 66.0 ± 20.9%, P < 0.001), CVR to cognitive stimuli (15.1 ± 1.5 vs 23.7 ± 9.0%, P < 0.001) and total composite cognitive score (100 ± 12 vs. 113 ± 7, P = 0.003) than cancer-free women. These parameters remained statistically different between the groups following adjustments for covariates using an analysis of co-variance. We observed significant correlations between multiple measures and exercise capacity the only variable positively correlated to all primary measures (CVR to hypercapnia, r = 0.492, P = 0.007; CVR to cognitive stimuli r = 0.555, P = 0.003; and total composite cognitive score, r = 0.625, P < 0.001). In this study, breast cancer survivors had lower cerebrovascular and cognitive function than age-matched cancer-free women, which may be attributable to the effects of cancer and cancer treatment on brain health.
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Chuang IC, Chen IC, Su KH, Wu YR, Wu CY. The effects of high versus low frequency of combined physical and cognitive training on cognitive function in older adults with cognitive decline: a quasi-experimental study. BMC Geriatr 2023; 23:94. [PMID: 36788482 PMCID: PMC9926662 DOI: 10.1186/s12877-023-03802-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The effects of combined training can be affected by training characteristics such as frequency, session length, and duration. No empirical studies to date have directly compared how combined physical and cognitive training offered at different training frequencies affects cognitive function for older adults with cognitive decline. This study investigated the impact of training frequency on cognitive outcomes after combined physical and cognitive training for older adults with cognitive decline. METHODS A quasi-experimental study was conducted in community facilities and day care centers. The study assigned 89 older adults with cognitive decline into high-frequency (HF) or low-frequency (LF) training groups. The participants received 90- to 105-min training sessions, one (LF) or three (HF) times a week, for 12 weeks. Outcome measures were the Montreal Cognitive Assessment, Word List subtest of the Wechsler Memory Scale, Digit Symbol Substitution Test (DSST), and Stroop Color Word Test. RESULTS The HF group demonstrated greater improvement in immediate memory measured by the WL-IM (F = 8.7, P = 0.004) and in executive function measured by the SCWT (F = 5.89, P = 0.017) than the LF group. Compared with the HF group, the LF group showed a great improvement in delayed memory measured by the WL-DM (F = 9.62, P = 0.003). The HF and LF groups both increased in processing speed and global cognitive function. CONCLUSIONS Our study indicated that the different training frequency of combined physical and cognitive training may result in benefits on different cognitive functions in older adults with cognitive decline. These findings may assist clinical practitioners in choosing appropriate training frequencies based on various intervention purposes for the elderly with cognitive decline. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03619577 (08/08/2018).
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Affiliation(s)
- I-Ching Chuang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259 Wen-Hwa 1St Road, Taoyuan, Taiwan.,Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Chen Chen
- Department of Occupational Therapy, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Ken-Hsien Su
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259 Wen-Hwa 1St Road, Taoyuan, Taiwan
| | - Yih-Ru Wu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259 Wen-Hwa 1St Road, Taoyuan, Taiwan. .,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. .,Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Mavragani A, Michels L, Schmidt A, Barinka F, de Bruin ED. Effectiveness of an Individualized Exergame-Based Motor-Cognitive Training Concept Targeted to Improve Cognitive Functioning in Older Adults With Mild Neurocognitive Disorder: Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41173. [PMID: 36745483 PMCID: PMC9941909 DOI: 10.2196/41173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Simultaneous motor-cognitive training is considered promising for preventing the decline in cognitive functioning in older adults with mild neurocognitive disorder (mNCD) and can be highly motivating when applied in the form of exergaming. The literature points to opportunities for improvement in the application of exergames in individuals with mNCD by developing novel exergames and exergame-based training concepts that are specifically tailored to patients with mNCD and ensuring the implementation of effective training components. OBJECTIVE This study systematically explores the effectiveness of a newly developed exergame-based motor-cognitive training concept (called "Brain-IT") targeted to improve cognitive functioning in older adults with mNCD. METHODS A 2-arm, parallel-group, single-blinded randomized controlled trial with a 1:1 allocation ratio (ie, intervention: control), including 34 to 40 older adults with mNCD will be conducted between May 2022 and December 2023. The control group will proceed with the usual care provided by the (memory) clinics where the patients are recruited. The intervention group will perform a 12-week training intervention according to the "Brain-IT" training concept, in addition to usual care. Global cognitive functioning will be assessed as the primary outcome. As secondary outcomes, domain-specific cognitive functioning, brain structure and function, spatiotemporal parameters of gait, instrumental activities of daily living, psychosocial factors, and resting cardiac vagal modulation will be assessed. Pre- and postintervention measurements will take place within 2 weeks before starting and after completing the intervention. A 2-way analysis of covariance or the Quade nonparametric analysis of covariance will be computed for all primary and secondary outcomes, with the premeasurement value as a covariate for the predicting group factor and the postmeasurement value as the outcome variable. To determine whether the effects are substantive, partial eta-squared (η2p) effect sizes will be calculated for all primary and secondary outcomes. RESULTS Upon the initial submission of this study protocol, 13 patients were contacted by the study team. Four patients were included in the study, 2 were excluded because they were not eligible, and 7 were being informed about the study in detail. Of the 4 included patients, 2 already completed all premeasurements and were in week 2 of the intervention period. Data collection is expected to be completed by December 2023. A manuscript of the results will be submitted for publication in a peer-reviewed open-access journal in 2024. CONCLUSIONS This study contributes to the evidence base in the highly relevant area of preventing disability because of cognitive impairment, which has been declared a public health priority by the World Health Organization. TRIAL REGISTRATION ClinicalTrials.gov NCT05387057; https://clinicaltrials.gov/ct2/show/NCT05387057. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41173.
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Affiliation(s)
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - André Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Filip Barinka
- Clinic for Neurology, Hirslanden Hospital Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
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Gallou-Guyot M, Mandigout S, Marie R, Robin L, Daviet JC, Perrochon A. Feasibility and potential cognitive impact of a cognitive-motor dual-task training program using a custom exergame in older adults: A pilot study. Front Aging Neurosci 2023; 15:1046676. [PMID: 36819724 PMCID: PMC9932982 DOI: 10.3389/fnagi.2023.1046676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Dual-task training may be relevant and efficient in the context of active aging. An issue in training programs lies in enhancing the adherence of participants. This can potentially be improved using games as support. We designed and developed a custom interactive exergame in this way. The objective of this pilot study was to explore the potential use of this exergame and the feasibility of our intervention, including the level of safety and adherence. The result's trends on cognitive and motor capacities, as well as on the level of motivation for physical activity, fear of falling, and quality of life of participants, were also explored. Methods Older adults aged 65 years or older were recruited and realized 30 min of supervised training in groups of 4, 2-3 times a week for 12 weeks. Exercises consisted of incorporated cognitive and motor dual tasks, with an increased difficulty over the weeks. Our program's safety, engagement, attendance, and completion levels were evaluated. Participants' postural control in single-task and dual-task conditions, as well as their performances in mental inhibition, flexibility, working memory, mobility, and postural control, and their levels of motivation for physical activity, fear of falling, and quality of life were also assessed. We realized a per protocol statistical analysis with a p-value set at 0.05. Results Thirty-nine participants (aged 84.6 ± 8.5 years) were recruited. No adverse events, and 89% adherence, 88% attendance, and 87% completion rates were observed. A potentially significant effect of our exergame on working memory in single-task conditions and on the cognitive aspect of dual-task conditions was also observed. We observed no differences in other parameters. Discussion Our exergame seemed feasible and safe and was enjoyed by participants, mainly due to the gamification of our training program. Moreover, our exergame may be efficient for cognitive training in older adults, as well as for the maintenance of motor functions, motivation for physical activity, fear of falling, and quality of life levels. This constitutes the first step for our solution with interesting results that need to be further studied.
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Affiliation(s)
- Matthieu Gallou-Guyot
- Laboratoire HAVAE (UR20217), Université de Limoges, Limoges, France,*Correspondence: Matthieu Gallou-Guyot,
| | | | - Romain Marie
- Institut d’Ingénierie Informatique de Limoges, Limoges, France,3iL Ingénieurs, Limoges, France
| | - Louise Robin
- Laboratoire HAVAE (UR20217), Université de Limoges, Limoges, France,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec City, QC, Canada
| | - Jean-Christophe Daviet
- Laboratoire HAVAE (UR20217), Université de Limoges, Limoges, France,Pôle Neurosciences Tête et Cou, Service de Médecine Physique et de Réadaptation, Hôpital Jean Rebeyrol, CHU Limoges, Limoges, France
| | - Anaick Perrochon
- Laboratoire HAVAE (UR20217), Université de Limoges, Limoges, France
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Zary N, Adcock-Omlin M, de Bruin ED. Design Considerations for an Exergame-Based Training Intervention for Older Adults With Mild Neurocognitive Disorder: Qualitative Study Including Focus Groups With Experts and Health Care Professionals and Individual Semistructured In-depth Patient Interviews. JMIR Serious Games 2023; 11:e37616. [PMID: 36602851 PMCID: PMC9853342 DOI: 10.2196/37616] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/28/2022] [Accepted: 10/10/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Exergames have attracted growing interest in the prevention and treatment of neurocognitive disorders. The most effective exergame and training components (ie, exercise and training variables such as frequency, intensity, duration, or volume of training and type and content of specific exergame scenarios) however remain to be established for older adults with mild neurocognitive disorders (mNCDs). Regarding the design and development of novel exergame-based training concepts, it seems of crucial importance to explicitly include the intended users' perspective by adopting an interactive and participatory design that includes end users throughout different iterative cycles of development. OBJECTIVE This study aimed to determine the capabilities, treatment preferences, and motivators for the training of older adults with mNCD and the perspectives of individuals on training goals and settings and requirements for exergame and training components. METHODS A qualitative study including expert focus groups and individual semistructured in-depth patient interviews was conducted. Data were transcribed to a written format to perform qualitative content analysis using QCAmap software. RESULTS In total, 10 experts and health care professionals (80% females) and 8 older adults with mNCD (38% females; mean age 82.4, SD 6.2 years) were recruited until data saturation was observed. CONCLUSIONS The psychosocial consequences of patients' self-perceived cognitive deterioration might be more burdensome than the cognitive changes themselves. Older adults with mNCD prefer integrative forms of training (such as exergaming) and are primarily motivated by enjoyment or fun in exercising and the effectiveness of the training. Putting the synthesized perspectives of training goals, settings, and requirements for exergames and training components into context, our considerations point to opportunities for improvement in research and rehabilitation, either by adapting existing exergames to patients with mNCDs or by developing novel exergames and exergame-based training concepts specifically tailored to meet patient requirements and needs.
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Affiliation(s)
| | - Manuela Adcock-Omlin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Health, OST - Eastern Swiss University of Applied Sciences, St.Gallen, Switzerland
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Chuang IC, Chiau HY, Liao WW, Wu YR, Chang CH, Wu CY. Effects of computer-based cognitive training combined with physical training for older adults with cognitive impairment: A four-arm randomized controlled trial. Digit Health 2023; 9:20552076231203633. [PMID: 37744745 PMCID: PMC10515553 DOI: 10.1177/20552076231203633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Objective Combined physical (PHY) and cognitive (COG) training in sequential (SEQ) and simultaneous (SIMUL) sessions may delay the progression of cognitive impairment. To date, no study has directly compared in older adults with cognitive impairment the effects of COG training, PHY training, SEQ motor-cognitive training and SIMUL motor-cognitve training on specific indices of cognitive performance and activities of daily living (ADL). The purpose of this study was to determine whether SEQ and SIMUL motor-cognitive training can improve treatment outcomes compared with PHY or COG training alone. We also aimed to compare the effects of SEQ versus SIMUL motor-cognitive training on cognitive functions and instrumental ADL (IADL) in older adults with cognitive impairment. Methods A cluster randomized controlled trial was conducted. Eighty older adults with cognitive impairment were randomly assigned to COG, PHY, SEQ or SIMUL training groups. The intervention consisted of 90-min training sessions, totaling 36 sessions. Outcome measures were the Montreal Cognitive Assessment, three subtests of the Wechsler Memory Scale (WMS) and the Lawton IADL scale. Results Significant interaction effects between group and time were found in WMS-spatial span (p = 0.04) and WMS-word lists (p = 0.041). For WMS-spatial span, the SIMUL group showed outperformed the COG (p = 0.039), PHY (p = 0.010) and SEQ groups (p = 0.017). For WMS-word lists, the SEQ group improve more than COG (p = 0.013), PHY (p = 0.030) and SIMUL (p = 0.019) groups. No significant differences were found in IADL performance among four groups (p = 0.645). Conclusions Our study showed SEQ and SIMUL motor-cognitive training led to more pronounced improvements in visuospatial working memory or verbal memory compared with isolated COG or PHY training for community-based older adults with cognitive impairment. For enhancing effects on IADL, we suggest the use of sensitive measurement tools and context-enriched cognitive training involving real-life task demands.
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Affiliation(s)
- I-Ching Chuang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan
| | - Hui-Yan Chiau
- Institute of Cognitive Neuroscience, National Central University, Taoyuan
| | - Wan-Wen Liao
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei City
| | - Yih-Ru Wu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan
- College of Medicine, Chang Gung University, Taoyuan
| | - Chih-Hung Chang
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Department of Medicine, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan
- Healthy Aging Research Center, Chang Gung University, Taoyuan
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan
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D’Agostino O, Castellotti S, Del Viva MM. Time estimation during motor activity. Front Hum Neurosci 2023; 17:1134027. [PMID: 37151903 PMCID: PMC10160443 DOI: 10.3389/fnhum.2023.1134027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Several studies on time estimation showed that the estimation of temporal intervals is related to the amount of attention devoted to time. This is explained by the scalar timing theory, which assumes that attention alters the number of pulses transferred by our internal clock to an accumulator that keeps track of the elapsed time. In a previous study, it was found that time underestimation during cognitive-demanding tasks was more pronounced while walking than while sitting, whereas no clear motor-induced effects emerged without a concurrent cognitive task. What remains unclear then is the motor interference itself on time estimation. Here we aim to clarify how the estimation of time can be influenced by demanding motor mechanisms and how different motor activities interact with concurrent cognitive tasks during time estimation. To this purpose, we manipulated simultaneously the difficulty of the cognitive task (solving arithmetic operations) and the motor task. We used an automated body movement that should require no motor or mental effort, a more difficult movement that requires some motor control, and a highly demanding movement requiring motor coordination and attention. We compared the effects of these three types of walking on time estimation accuracy and uncertainty, arithmetic performance, and reaction times. Our findings confirm that time estimation is affected by the difficulty of the cognitive task whereas we did not find any evidence that time estimation changes with the complexity of our motor task, nor an interaction between walking and the concurrent cognitive tasks. We can conclude that walking, although highly demanding, does not have the same effects as other mental tasks on time estimation.
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Executive function during exercise is diminished by prolonged cognitive effort in men. Sci Rep 2022; 12:22408. [PMID: 36575274 PMCID: PMC9794810 DOI: 10.1038/s41598-022-26788-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The speed and accuracy of decision-making (i.e., executive function (EF) domains) is an integral factor in many sports. At rest, prolonged cognitive load (pCL) impairs reaction time (RT). In contrast, exercise improves RT and EF. We hypothesized that RT and EF during exercise would be diminished by prolonged 'dual tasking' as a consequence of pCL. To test the hypothesis, twenty healthy male participants performed four conditions [resting control (Rest), pCL only (pCLRest), exercise only (EX), and pCL + exercise (pCLEX)] in a randomized-crossover design. Both exercise conditions utilized a 50-min cycling exercise protocol (60% VO2 peak) and the pCL was achieved via a 50-min colour-word Stroop task (CWST). Compared with Rest, pCLRest caused a slowed CWST RT (P < 0.05) and a large SD (i.e., intraindividual variability) of CWST RT (P < 0.01). Similarly, compared with EX, the slowed CWST RT (P < 0.05) and large SD of CWST RT (P < 0.01) were also observed in pCLEX. Whereas the reverse-Stroop interference was not affected in pCLRest (P = 0.46), it was larger (i.e., declined EF) in pCLEX than EX condition (P < 0.05). These observations provide evidence that the effort of pCL impairs RT and EF even during exercise.
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Zhao X, Huang X, Cai Y, Cao T, Wan Q. The relative effectiveness of different combination modes for exercise and cognitive training on cognitive function in people with mild cognitive impairment or Alzheimer's disease: a network meta-analysis. Aging Ment Health 2022; 26:2328-2338. [PMID: 35037809 DOI: 10.1080/13607863.2022.2026879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To compare and rank the relative effectiveness of different modes for exercise combined cognitive training (ECT) in people with Alzheimer's disease (AD) or Mild Cognitive Impairment (MCI). METHODS We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycInfo, and OpenGrey systematically from inception to May 2020. Studies were included that met the inclusion criteria: randomized controlled trials, involving people with MCI or dementia, performing ECT without other interventions, and assessing global cognitive function, memory function, and executive function. Pairwise and network meta-analyses were performed using a random effects model. RESULTS We included 20 articles from 16 studies with 1180 participants. For global cognition, separate modality had the highest probability of being the optimal approach (the surface under the cumulative ranking curve (SUCRA) value = 77.5%). For memory function, the interactive mode had the greatest probability of being the best choice (SUCRA = 84.7%). Concerning executive function, the dual-task modality and separate modality had similar SUCRA values. Subgroup analysis revealed no differences for the relative effectiveness of ECT among people with MCI or among all participants. CONCLUSIONS Separate and interactive combination modality had the highest probability of being the most effective mode for overall cognition and memory performance. However, the evidence is insufficient to reveal the best combination mode for executive function. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2026879 .
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Affiliation(s)
- Xiaoyan Zhao
- School of Nursing, Peking University, Beijing, China
| | - Xiuxiu Huang
- School of Nursing, Peking University, Beijing, China
| | - Ying Cai
- School of Nursing, Peking University, Beijing, China
| | - Ting Cao
- School of Nursing, Peking University, Beijing, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
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Holfelder B, Schott N. Object Control Skill Performance Across the Lifespan: A Cross Sectional Study. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2022; 93:825-834. [PMID: 34781831 DOI: 10.1080/02701367.2021.1924351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/23/2021] [Indexed: 06/13/2023]
Abstract
Purpose: Studies on object control skills (OCS) have described changes in movement patterns over time, but mostly in children and adolescents, young adults, or older adults. Most of these studies focused on only one skill and usually only on the process- or product-oriented outcomes. Thus, this study aimed to explore OCS performance in children, younger adults, and older adults. Methods: A total of 120 male participants took part in this study, including 78 primary school children (7.96 ± 1.22 years), 22 young adults (23.5 ± 2.34 years), and 20 older adults (69.5 ± 4.43 years). We assessed the process-oriented performance of throwing, kicking, and catching performance using the component approach. Throwing and kicking velocity was recorded with a STALKER SOLO 2.0 radar gun. For catching, the number of caught balls was assessed. Results. Young adults had the highest component levels in all OCS; they also produced significantly higher throwing and kicking velocities than children and older adults. The proportion of participants achieving mastery or advanced skill proficiency varied significantly in children (6.4-32.1%), young adults (63.6-100.0%), and older adults (10.0-95.0%). With few exceptions, the results showed mainly moderately significant correlations between developmental levels and throwing/kicking velocity or number of successfully caught balls for all age groups. Conclusion: Our data indicate that children in particular rarely demonstrate advanced OCS and that there is a decrease in throwing and kicking but not in catching in older adults compared to the younger age groups.
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Affiliation(s)
- Benjamin Holfelder
- Department of Sport Psychology & Human Movement Science, Institute for Sport and Exercise Science, University of Stuttgart
| | - Nadja Schott
- Department of Sport Psychology & Human Movement Science, Institute for Sport and Exercise Science, University of Stuttgart
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Castaño LAA, Castillo de Lima V, Barbieri JF, de Lucena EGP, Gáspari AF, Arai H, Teixeira CVL, Coelho-Júnior HJ, Uchida MC. Resistance Training Combined With Cognitive Training Increases Brain Derived Neurotrophic Factor and Improves Cognitive Function in Healthy Older Adults. Front Psychol 2022; 13:870561. [PMID: 36312128 PMCID: PMC9613948 DOI: 10.3389/fpsyg.2022.870561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background The present study compared the effects of a traditional resistance training (TRT) and resistance training combined with cognitive task (RT + CT) on body composition, physical performance, cognitive function, and plasma brain-derived neurotrophic factor (BNDF) levels in older adults. Methods Thirty community-dwelling older adults were randomized into TRT (70.0 ± 8.1; 25% men) and RT + CT (66.3 ± 4.6; 31% men). Exercise groups performed a similar resistance training (RT) program, twice a week over 16 weeks. Cognitive Training involved performing verbal fluency simultaneously with RT. Exercise sessions (eight resistance exercises) were performed 2–3 sets, 8–15 repetitions at 60%–70% of 1-repetition maximum (1RM). Body composition, physical function, cognitive performance, and BDNF levels were assessed before and after intervention period. Results The physical performance was similarly improved in response to both TRT and RT + CT (p = 0.001). However, exclusive improvements on cognitive function (p < 0.001) and BDNF levels (p = 0.001) were observed only after RT + CT. Conclusion The RT program associated with a cognitive task, improved physical and cognitive performance in healthy older adults.
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Affiliation(s)
- Luz Albany Arcila Castaño
- Applied Kinesiology Laboratory, Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas, Brazil
- *Correspondence: Luz Albany Arcila Castaño,
| | - Vivian Castillo de Lima
- Applied Kinesiology Laboratory, Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas, Brazil
| | - João Francisco Barbieri
- Laboratory of Electromyography Studies, Department of Sport Science, School of Physical Education, University of Campinas, Campinas, Brazil
| | - Erick Guilherme Peixoto de Lucena
- Applied Kinesiology Laboratory, Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas, Brazil
| | - Arthur Fernandes Gáspari
- Laboratory of Electromyography Studies, Department of Sport Science, School of Physical Education, University of Campinas, Campinas, Brazil
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | | | - Hélio José Coelho-Júnior
- Applied Kinesiology Laboratory, Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas, Brazil
| | - Marco Carlos Uchida
- Applied Kinesiology Laboratory, Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas, Brazil
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Béraud-Peigné N, Maillot P, Perrot A. The User Experience of an Immersive and Interactive Wall Exergame in Older Adults. Games Health J 2022; 12:220-227. [DOI: 10.1089/g4h.2022.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Alexandra Perrot
- Université Paris-Saclay, CIAMS, Orsay Cedex, France
- Université d'Orléans, CIAMS, Orléans, France
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Mundada PH, Dadgal RM. Comparison of Dual Task Training Versus Aerobics Training in Improving Cognition in Healthy Elderly Population. Cureus 2022; 14:e29027. [PMID: 36237766 PMCID: PMC9552703 DOI: 10.7759/cureus.29027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
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Embon-Magal S, Krasovsky T, Doron I, Asraf K, Haimov I, Gil E, Agmon M. The effect of co-dependent (thinking in motion [TIM]) versus single-modality (CogniFit) interventions on cognition and gait among community-dwelling older adults with cognitive impairment: a randomized controlled study. BMC Geriatr 2022; 22:720. [PMID: 36045345 PMCID: PMC9429752 DOI: 10.1186/s12877-022-03403-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive impairment. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive impairment has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with “Thinking in Motion (TIM),” a co-dependent group intervention, among community-dwelling older adults with cognitive impairment. Methods Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive impairment were randomly assigned to 8 weeks of thrice-weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome; and gait, under single- and dual-task conditions, as a secondary outcome. Results CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p < .001, ηp2 = .283] but not for group [F (1, 44) = 0.001, p = .970]. No time X group interaction [F (1, 44) = 1.29, p = .261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. Conclusions The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive impairment. Such investigations should be extended to include various populations and a broader set of outcome measurements. Trial registration ACTRN12616001543471. Date: 08/11/2016.
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Integrated cognitive and physical fitness training enhances attention abilities in older adults. NPJ AGING 2022; 8:12. [PMID: 36042247 PMCID: PMC9427998 DOI: 10.1038/s41514-022-00093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Preserving attention abilities is of great concern to older adults who are motivated to maintain their quality of life. Both cognitive and physical fitness interventions have been utilized in intervention studies to assess maintenance and enhancement of attention abilities in seniors, and a coupling of these approaches is a compelling strategy to buttress both cognitive and physical health in a time- and resource-effective manner. With this perspective, we created a closed-loop, motion-capture video game (Body-Brain Trainer: BBT) that adapts a player’s cognitive and physical demands in an integrated approach, thus creating a personalized and cohesive experience across both domains. Older adults who engaged in two months of BBT improved on both physical fitness (measures of blood pressure and balance) and attention (behavioral and neural metrics of attention on a continuous performance task) outcome measures beyond that of an expectancy matched, active, placebo control group, with maintenance of improved attention performance evidenced 1 year later. Following training, the BBT group’s improvement on the attention outcome measure exceeded performance levels attained by an untrained group of 20-year olds, and showed age-equilibration of a neural signature of attention shown to decline with age: midline frontal theta power. These findings highlight the potential benefits of an integrated, cognitive-physical, closed-loop training platform as a powerful tool for both cognitive and physical enhancement in older adults.
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Patel RD, Mans KB. Review: Effect of Supplemental Activities on Motor and Nonmotor Outcomes in the Parkinson’s Population. AMERICAN JOURNAL OF DANCE THERAPY 2022. [DOI: 10.1007/s10465-022-09367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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