No Overt Effects of a 6-Week Exergame Training on Sensorimotor and Cognitive Function in Older Adults. A Preliminary Investigation

Components of effective exergame-based training to improve cognitive functioning in middle-aged to older adults - A systematic review and meta-analysis

BACKGROUND

Exergame-based training is currently considered a more promising training approach than conventional physical and/or cognitive training.

OBJECTIVES

This study aimed to provide quantitative evidence on dose-response relationships of specific exercise and training variables (training components) of exergame-based training on cognitive functioning in middle-aged to older adults (MOA).

METHODS

We conducted a systematic review with meta-analysis including randomized controlled trials comparing the effects of exergame-based training to inactive control interventions on cognitive performance in MOA.

RESULTS

The systematic literature search identified 22,928 records of which 31 studies were included. The effectiveness of exergame-based training was significantly moderated by the following training components: body position for global cognitive functioning, the type of motor-cognitive training, training location, and training administration for complex attention, and exercise intensity for executive functions.

CONCLUSION

The effectiveness of exergame-based training was moderated by several training components that have in common that they enhance the ecological validity of the training (e.g., stepping movements in a standing position). Therefore, it seems paramount that future research focuses on developing innovative novel exergame-based training concepts that incorporate these (and other) training components to enhance their ecological validity and transferability to clinical practice. We provide specific evidence-based recommendations for the application of our research findings in research and practical settings and identified and discussed several areas of interest for future research.

PROSPERO REGISTRATION NUMBER

CRD42023418593; prospectively registered, date of registration: 1 May 2023.

Effectiveness of Physical Activity Programs for Older Adults during COVID-19 across Districts with Different Healthcare Resource: A Case Study of Keelung City in Taiwan

While past research has largely supported the importance of physical activity for the health of older adults, during the COVID-19 pandemic, older individuals may have reduced their opportunities and levels of physical activity to lower the risk of infection by minimizing outings or interactions with others. Additionally, the adequacy of medical resources in a region is often closely related to factors such as infrastructure and economic resources. Therefore, it is important to consider whether there are differences in health promotion among older adults living in areas with varying levels of medical resources. This study aimed to implement a physical activity program for older adults, selecting Keelung City, Taiwan, as the implementation area, and comparing the differences in implementation effectiveness among administrative districts with different levels of medical resources in the city. The study employed a two-way analysis of variance to examine the differences in the effectiveness of the physical activity program among administrative districts, where the average service population in medical institutions was higher or lower than the city average. The results revealed significant improvements in participants' right-hand grip strength and the number of sit-to-stand repetitions in the overall sample after the program intervention. Moreover, in administrative districts where the average service population in medical institutions was higher than the city average, participants showed greater improvement in grip strength, while in districts where it was lower than the city average, participants demonstrated greater improvement in sit-to-stand repetitions. Future research could draw upon these findings to design physical activity programs tailored to different regions with distinct allocations of medical resources. Tailored program designs considering local medical resources are necessary to optimize effectiveness. Governments and organizations should focus on elderly health, especially in resource-scarce areas, by increasing investment and support for these programs to promote well-being and bridge disparities.

The effects of a new immersive multidomain training on cognitive, dual-task and physical functions in older adults

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.

Examining technology-assisted rehabilitation for older adults' functional mobility: a network meta-analysis on efficacy and acceptability

Technological advancements facilitate feedback adaptation in rehabilitation through virtual reality (VR) exergaming, serious gaming, wearables, and telerehabilitation for older adults fall prevention. Although studies have evaluated these technologies, no comparisons of their effectiveness have been conducted to date. Thus, this study aims to assess the differences in effectiveness of these interventions on balance and functional mobility in the older adults. A systematic review and network meta-analysis (NMA) were conducted to identify the most effective interventions for improving balance and functional mobility in adults aged 60 and over. The search was conducted in five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) up to June 10, 2023. The eligibility criteria were: (1) older adults, (2) functional mobility, balance, or gait as the primary outcome, (3) new technology intervention, and (4) randomized study design. New technology interventions were classified into five categories: exergaming with balance platforms or motion capture technologies, other serious gaming, interventions with wearables, and telerehabilitation. Additionally, two categories of control interventions (conventional exercises and no treatment) were extracted. The NMA was performed for the aggregated results of all outcomes, and separately for clinical functional scales, functional mobility, and gait speed results. Fifty-two RCTs with 3081 participants were included. Exergaming with motion capture was found to be statistically significant in producing a better effect than no treatment in the analysis of the functional mobility with an SMD of -0.70 (P < 0.01). The network meta-analysis revealed that exergaming with motion capture offers greater therapeutic benefits for functional mobility and balance compared to no treatment control. The effectiveness of this approach is similar to that of conventional exercises. Further RCTs are needed to provide a more definitive conclusion, particularly with respect to the effectiveness of serious games, telerehabilitation, and interventions with wearables.

Feasibility of a pilot dyadic randomized controlled trial testing the effects of three behavioral interventions on older adults' cognitive, physical and everyday function

Introduction: Maintaining functional abilities is critical for optimizing older adults' well-being and independence. This randomized controlled trial (RCT) pilot examined the feasibility of testing the effects of three commercially available interventions on function-related outcomes in older adults. Methods: Pairs of community-dwelling older adults (N=55, Mage=71.4) were randomized to a 10-week intervention (cognitive-COG, physical-EX, combined exergame-EXCOG, or control-CON). Cognitive, physical, and everyday function were assessed at baseline, immediately post-intervention, and 6-months post-intervention. Feasibility was evaluated using recruitment, enrollment, training adherence, and retention metrics. Variability and patterns of change in functional outcomes were examined descriptively. Results: A total of 208 individuals were screened, with 26% subsequently randomized. Across training arms, 95% of training sessions were completed and 89% of participants were retained at immediate post-test. Variability in functional outcomes and patterns of change differed across study arms. Discussion: Results support a fully powered RCT, with several modifications to the pilot study design, to investigate short- and long-term training impacts.

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

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

Twelve Weeks of Web-Based Low to Moderate Physical Activity Breaks with Coordinative Exercises at the Workplace Increase Motor Skills but Not Motor Abilities in Office Workers-A Randomised Controlled Pilot Study

Integrating physical activity interventions at the workplace can have positive effects on the employees' health. This study aimed to evaluate a physical activity break with coordinative exercises (PAB) including juggling and balance tasks and to assess its effects on motor abilities. Thirty-two university employees were randomly allocated to an intervention (IG:20) or a control (CG:12) group. The IG participated two times per week for 12 weeks in a PAB with a duration of 15 to 20 min. We measured the unimanual, bimanual finger, and hand dexterity with the Purdue Pegboard Test, the reaction time with the Fall Stick Test, and the dynamic balance with the Y Balance Test. Juggling performance was assessed by measuring the time(s) of performing a three-ball-cascade. Furthermore, an evaluation of the PAB was executed. Participants in the IG improved their juggling performance after six and twelve weeks. These increases were significantly different compared to the CG. However, no other parameters changed significantly. The evaluation showed that the PAB was enjoyable and led to subjective improvements in the participants health and working routine. To conclude, PAB can lead to improvements in juggling performance, subjective health, and the working routine.

Does the combination of exercise and cognitive training improve working memory in older adults? A systematic review and meta-analysis

Background

Cognitive functioning is dependent on working memory and a decline in working memory is the main cause of cognitive aging. Many studies have suggested that physical exercise or cognitive intervention can effectively improve working memory in the elderly. However, it is still unknown whether a combination of exercise and cognitive training (CECT) is more effective than either intervention alone. The present systematic review and meta-analysis were undertaken to evaluate the effect of CECT on working memory in the elderly.

Methods

The review was registered in the International Prospective Systematic Review (PROSPERO, CRD42021290138). Systematic searches were conducted on Web of Science, Elsevier Science, PubMed and Google Scholar. The data were extracted according to the PICOS framework. Comprehensive meta-analysis (CMA) software was used to perform the meta-analysis, moderator analysis and publication bias testing.

Results

The current meta-analysis included 21 randomized controlled trials (RCT). Results showed that CECT had a significantly greater impact on working memory in older adults compared to no intervention groups (SMD = 0.29, 95% CI [0.14-0.44], p < 0.01), with no significant difference between CECT and exercise (SMD = 0.16, 95% CI [-0.04-0.35], p = 0.12) or cognitive intervention alone (SMD = 0.08, 95% CI [-0.13-0.30], p = 0.44). Furthermore, the positive effect of CECT was moderated by intervention frequency and cognitive state.

Conclusions

The CECT can effectively improve working memory of older adults, but the effect of CECT compared to single intervention needs to be further explored.

Effects of exergames on mood and cognition in healthy older adults: A randomized pilot study

The elderly population is increasing and the implementation of stimulating training to promote active aging has become a research issue. This study aimed at investigating the effects of a cognitive-motor exergame training on cognitive functions and mood, in healthy older adults. A randomized controlled pilot study was conducted to compare a cognitive-motor exergame training with a passive control group. The training consisted of 8 sessions of 45 min each, including 10 interactive activities focused on several cognitive functions such as memory, processing speed and executive functions, all requiring motor planning and execution. A total of 57 participants were administered a battery of cognitive tests before and after the training. A mixed-effect ANOVA with group (experimental vs. control) as between factor and time (pre-and post-test) as within factor, was performed to evaluate the effect of the exergame training on cognitive abilities and mood. Results showed significant interaction effects in processing speed [STROOPC: F (1,53.4) = 9.04, p = 0.004, R 2 = 0.82], inhibition [3backs' false alarms: F (1,47.5) = 5.5, p = 0.02, R 2 = 0.79], and mood [Beck Depression Inventory: F (1,55) = 4.15, p = 0.04, R 2 = 0.6]. Even though post-hoc analyses did not provide statistical evidence supporting the interactions, overall data showed a trend toward better scores only for the experimental group, suggesting a potential improvement in information processing speed, working memory and mood. Exergaming may be a motivating and enjoyable approach to healthy and active aging.

Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions

Objective

The use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies.

Methods

To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being.

Results

The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions.

Conclusion

This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.

Integrated cognitive and physical fitness training enhances attention abilities in older adults

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.

The application of technology to improve cognition in older adults: A review and suggestions for future directions

The rapidly increasing worldwide population of older adults, along with the increasing prevalence of cognitive impairment and dementia in this population, is a growing health‐care problem. As such, advances in technology‐based cognitive interventions and games are playing an increasingly key role in preserving and improving older adults' cognitive function, especially during the COVID‐19 pandemic when opportunities for face‐to‐face activities or training are few. In this paper, we summarize from previous studies systematic reviews and meta‐analyses on the various types of technology used in cognitive interventions (namely, computerized cognitive training, virtual‐reality interventions and robot‐assisted interventions) and the empirical evidence on the effects of these technologies on global and specific cognitive functions in healthy and clinical populations of older adults (e.g., older adults with mild cognitive impairment or dementia). We also describe older adults' perceptions, experiences and acceptance of these technologies. Finally, we discuss the limitations, challenges and future avenues of research in this field.

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

Background

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

Methods

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

Results

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

Conclusion

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

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

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

The Effect of Video Game-Based Interventions on Performance and Cognitive Function in Older Adults: Bayesian Network Meta-analysis

Background

The decline in performance of older people includes balance function, physical function, and fear of falling and depression. General cognitive function decline is described in terms of processing speed, working memory, attention, and executive functioning, and video game interventions may be effective.

Objective

This study evaluates the effect of video game interventions on performance and cognitive function in older participants in terms of 6 indicators: balance function, executive function, general cognitive function, physical function, processing speed, and fear of falling and depression.

Methods

Electronic databases were searched for studies from inception to June 30, 2020. Randomized controlled trials and case-controlled trials comparing video game interventions versus nonvideo game control in terms of performance and cognitive function outcomes were incorporated into a Bayesian network meta-analysis. All data were continuous variables.

Results

In total, 47 studies (3244 participants) were included. In pairwise meta-analysis, compared with nonvideo game control, video game interventions improved processing speed, general cognitive function, and depression scores. In the Bayesian network meta-analysis, interventions with video games improved balance function time (standardized mean difference [SMD] –3.34, 95% credible interval [CrI] –5.54 to –2.56), the cognitive function score (SMD 1.23, 95% CrI 0.82-1.86), processing speed time (SMD –0.29, 95% CrI –0.49 to –0.08), and processing speed number (SMD 0.72, 95% CrI 0.36-1.09), similar to the pairwise meta-analysis. Interventions with video games with strong visual senses and good interactivity ranked first, and these might be more beneficial for the elderly.

Conclusions

Our comprehensive Bayesian network meta-analysis provides evidence that video game interventions could be considered for the elderly for improving performance and cognitive function, especially general cognitive scores and processing speed. Games with better interactivity and visual stimulation have better curative effects. Based on the available evidence, we recommend video game interventions for the elderly.

Trial Registration

PROSPERO CRD42020197158; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197158

Feasibility and Enjoyment of Exercise Video Games in Older Adults

Introduction: Several interventions have been developed to enhance social connectedness among older adults. However, little research has demonstrated their performance in a social distancing environment. Exergames are not only beneficial to older adults' physical and cognitive health, but they also allow players to interact with each other at a distance, which can reduce loneliness and increase social connection. The aim of this pilot study was to investigate older adults' perceptions of two commercially available exergames.

Methods: Twenty healthy community-dwelling older adults (M age = 73.30, SD = 5.95, range = 65–84 years, 80% women) were recruited in this pilot study between July 2019 and February 2020. They were asked to play two exergames for 10 min each on the Xbox One with Kinect console: Just Dance and Kinect Sports Rivals. After gameplay, they provided both quantitative and qualitative feedback on these games.

Results: Participants reported an average rating for exergame enjoyment. Greater enjoyment was significantly related with younger age and greater extraversion but not gender. Participants were highly motivated to do well on the games but reported lower scores for likelihood of playing these games in the future. Greater likelihood of future play was associated with younger age but not gender or extraversion. “Not aerobic or strengthen enough; not enough exertion,” and “slower movements, repetition, clear purpose of doing the exercise” were some factors that would influence their decision to buy and play these games.

Discussion: The preliminary results of this pilot study suggest that exergames may help address social isolation and loneliness—particularly during times of social distancing. Before applying exergames as a social isolation or loneliness intervention for older adults, study replication in larger representative studies and future work that examines important design issues related to older adults' experiences with these games is needed.

Exergame training-induced neuroplasticity and cognitive improvement in institutionalized older adults: A preliminary investigation

BACKGROUND

Prior research has reported cognitive improvements in elderly individuals when mental and physical exercise are practiced simultaneously, as in exergaming. However, the molecular mechanisms driving this beneficial response remain unclear. Moreover, there is robust evidence that regular exercise increases neurotrophic factors and promotes neuroplasticity, contributing to cognitive improvement. This research aimed to assess the impact of a 6-week Xbox 360 Kinect exergame protocol on cognitive function and brain-derived neurotrophic factor (BDNF) levels in institutionalized older individuals.

METHODS

Participants living in a long-term care facility were included. The intervention (Xbox 360 Kinect exergame protocol) was conducted individually and consisted of two sessions per week (40 min each) over 6 weeks. Participants' cognitive function (Montreal Cognitive Assessment, MoCA) was evaluated before and after the intervention. Blood samples (15 ml) were collected at the same time to measure BDNF levels.

RESULTS

Although there were no changes in total MoCA scores, exergame training improved the "language" domain and demonstrated a tendency toward an improvement in the "abstraction" and "memory/delayed recall" domains. Furthermore, BDNF levels were significantly increased after the intervention.

CONCLUSION

BDNF enhancement might mediate, at least in part, the cognitive changes induced by a 6-week Xbox 360 Kinect exergame protocol in institutionalized older adults.

Meta-analysis of the effects of game types and devices on older adults-video game interaction: Implications for video game training on cognition

Video game training can effectively improve the cognition of older adults. However, whether video game types and game devices influence the training effects of video games remains controversial. This meta-analysis aimed to access and evaluate the effects of video game types and game devices in video game training on the cognition of older adults. Interestingly, results indicated that mouse/keyboard was superior over other video game devices on perceptual-motor function. The effect size (Hedge's g) for perceptual-motor function decreased by 1.777 and 1.722 when the video game training device changed from mouse/keyboard to driving simulator and motion controller. The effects of cognitive training game and conventional video game were moderated by session length. More well-designed studies are required to clarify the unique efficacy of video game types and devices for older adults with video game training.

Comparison of exergames versus conventional exercises on the cognitive skills of older adults: a systematic review with meta-analysis

PURPOSE

To compare the effects of exergames versus conventional physical training on the cognitive skills of older adults.

MATERIALS AND METHODS

Scientific studies published in PubMed, Web of Science, and Cochrane Library databases were searched. Individual studies were assessed using the Cochrane Risk-of-bias tool for randomized trials (RoB 2). The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE Pro). The cognitive outcomes were Trail Making Test (TMT)-A, TMT-B, Stroop Word-Color test, Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA).

RESULTS

We identified 256 studies, in which 13 studies were included in the systematic review and 11 in the meta-analysis. The majority of the exergame interventions were based on the Xbox 360's Kinect, followed by the Impact Dance Platform, Nintendo Wii, and the Bike Labyrinth. We observed heterogeneity in the conventional exercise group and in the duration of training, which ranged from 12 to 52 sessions. There was no statistically significant difference between groups in TMT-A (p=0.083), TMT-B (p=0.122), and Stroop (p=0.191). There were differences in favor of exergames in MMSE (raw mean difference=-1.58, 95% CI: -2.87 to -0.28, p<0.001) and MoCA (raw mean difference=-1.22, 95% CI: -2.24 to -0.20, p=0.019).

CONCLUSIONS

Despite statistical differences in MMSE and MoCA, these results should be interpreted with caution due to methodological heterogeneity. Some studies reported possible neurophysiological benefits induced by exergames, which should be explored in future investigations.

Can Exergames Be Improved to Better Enhance Behavioral Adaptability in Older Adults? An Ecological Dynamics Perspective

Finding effective training solutions to attenuate the alterations of behavior and cognition in the growing number of older adults is an important challenge for Science and Society. By offering 3D computer-simulated environments to combine perceptual-motor and cognitive exercise, exergames are promising in this respect. However, a careful analysis of meta-analytic reviews suggests that they failed to be more effective than conventional motor-cognitive training. We analyzed the reasons for this situation, and we proposed new directions to design new, conceptually grounded, exergames. Consistent with the evolutionary neuroscience approach, we contend that new solutions should better combine high level of metabolic activity with (neuro)muscular, physical, perceptual-motor, and cognitive stimulations. According to the Ecological Dynamics rationale, we assume that new exergames should act at the agent-environment scale to allow individuals to explore, discover, and adapt to immersive and informationally rich environments that should include cognitively challenging tasks, while being representative of daily living situations.

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

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

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

OBJECTIVES

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

DESIGN

This is a systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Adults over 60 years old.

METHODS

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

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

The Effects of Exergaming Training on Balance in Healthy Elderly Women-A Pilot Study

Our aim was to observe, through objective testing using an assessment module incorporated in a new exergaming system, whether elderly people's static and functional balance is improved by a balance exergaming training program based on movements performed in everyday life. Thirteen healthy elderly women participated in 12 sessions of balance-based exergaming training (three times a week, 30 min per session). All objective outcomes, the quiet standing test, functional balance test (FBT), and limit of stability (LOS) test, were measured on three occasions: before intervention, after six training sessions, and after the completion of the four-week program. The results showed a significant improvement in LOS performance after the intervention. In FBT, participants exhibited a significant decrease (p < 0.01; Kendall's W = 0.5) in the average time to target hit after six trainings. The average center of pressure velocity increased after six and 12 sessions, however did not reach significance (p = 0.053); nevertheless the size of the effect was large (η_p2 = 0.22). The parameters of the quiet standing test were not significantly affected by the training. The results support the need for more definite and objective studies assessing exergaming for balance in elderly.

The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis

Background

Ageing is associated with physical and cognitive decline, affecting independence and quality of life in older people. Recent studies show that in particular executive functions are important for daily-life function and mobility. This systematic review investigated the effectiveness of cognitive-motor training including exergaming on executive function (EF, set-shifting, working memory, inhibitory control) in healthy older people.

Methods

An electronic database search for randomised controlled trials (RCT), controlled clinical trials (CCT) and parallel group trials was performed using MEDLINE, EMBASE, and PsychINFO following PRISMA guidelines. Inclusion criteria were: (1) community-dwelling participants > 60 years without a medical condition or medical treatment, (2) reporting at least one cognitive-motor intervention while standing or walking, (3) use of dual-task interventions using traditional methods or modern technology to deliver a cognitive-motor task, (4) inclusion of at least one cognitive outcome. The PEDro scale was used for quality assessment.

Results

A total of 1557 studies were retrieved, of which 25 studies were included in this review. Eleven studies used a technology-based dual-task intervention, while 14 trials conducted a general cognitive-motor training. The age range of the cohort was 69 to 87 years. The interventions demonstrated positive effects on global cognitive function [mean difference 0.6, 95% CI 0.29–0.90] and inhibitory control [mean difference 0.61, 95% CI 0.28–0.94]. Effects were heterogeneous (I² range: 60–95) and did not remain after a sensitivity analysis. Processing speed and dual-task costs also improved, but meta-analysis was not possible.

Conclusion

Cognitive-motor and technology-based interventions had a positive impact on some cognitive functions. Dual-task interventions led to improvements of domains related global cognitive functions and inhibitory control. Likewise, technology-based exergame interventions improved functions related to processing speed, attentional and inhibitory control. Training interventions with a certain level of exercise load such as progression in difficulty and task specificity were more effective to gain task-related adaptations on cognitive functions.

The Impact of Physical Activities on Cognitive Performance among Healthy Older Individuals

The population is aging in developed countries. This aging process results in many changes, both physical and mental. Over the years, there has been a gradual decline in the level of cognitive functions closely related to the ageing process, which is most often connected with ageing diseases such as dementia. So far, pharmacological treatment has not yet been able to cure this neurological disorder. Health policies around the world seek to find alternative programs and strategies to help a healthy population prevent cognitive decline and prolong active life. One such strategy appears to be physical activity. The aim of this review is to discuss the impact of physical activity on cognitive performance among healthy older individuals. The methodology of this study is based on a systematic electronic literature search of available studies found in three databases: PubMed, Web of Science and Scopus. The findings suggest that any physical activity in older age seems to have a positive impact on the improvement of cognitive function. Furthermore, it appears that dancing, due to its multiple mechanisms, might have the biggest effect on the enhancement of cognitive performance in healthy older individuals. However, controlled clinical trials of physical activity intervention in older adults are rare. Therefore, further research in this area (particularly on the amount of physical activity, its intensity and type) is needed.

Cognitive effects of video games in older adults and their moderators: a systematic review with meta-analysis and meta-regression

The growing interest in preserving cognition through video games in the ageing population is evidenced by its wealth of literature. However, there has been a lack of consensus on video games efficacy and even limited understanding on the factors moderating its effectiveness. The present review sought to evaluate video game effects, relative to no-game control condition, on cognitive functions in older adults. The functions included processing speed, attention, delayed memory, reasoning, and executive functions (inhibition, shifting and updating memory). Personal and methodological moderators were explored to explain the variability in cognitive effects using meta-regression. Through a systematic literature search of online databases, 27 intervention studies were eligible, with a total of 1126 participants, for analysis. Using random-effect models, small but significant training effects were found on updating memory but none were detected in other cognitive functions. The heterogeneity across studies was in general high for all cognitive functions and was partially accounted for, in all cognitive functions except for inhibition and updating, by different moderators such as the proportion of females, outcome measure parameters, training intensity, and game type. The findings highlight limited effects of video games on cognitive functions that were largely influenced by factors related to study design.

Effects of Exergames on Physical Fitness in Middle-Aged and Older Adults in Taiwan

Using exergaming for exercise training was found to improve physical fitness. Yet, few studies have used the "Xbox Kinect" to examine its effects on physical fitness in healthy middle-aged and older adults. The purpose of this study was to investigate the effect of 10-weeks of Xbox Kinect training on physical fitness in healthy middle-aged and older adults. Forty participants (average 64.00 ± 4.44 years old, eight males and 32 females) were randomized to either intervention (n = 20) or control group (n = 20). The intervention group played Xbox Kinect three times per week, for an average of 50 min per session for 10 weeks. The control group was instructed to maintain their levels of physical activity. All the participants completed assessments of body composition, muscle strength, flexibility, balance and cardiopulmonary endurance at baseline and after 10-week intervention. After 10 weeks of training, the intervention group showed significant improvements in cardiopulmonary endurance and leg muscle strength. Moreover, there were significant differences between the intervention and control group in changes in aerobic fitness and leg muscle strength. The exergame program effectively improved cardiopulmonary endurance and leg muscle strength in healthy middle-aged and older adults. It could be an alternative to conventional exercise.

Effects of Exergaming on Balance of Healthy Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Balance is critical for older adults to perform daily activities. However, age-related declines in balance increase the risk of falls and severe injuries, such as bone fractures and head injuries. Exergames have been widely applied to improve health-related outcomes in older adults. This meta-analysis aims to quantify the effects of exergaming interventions on balance performance in healthy older adults. A literature search was performed using PubMed, ScienceDirect, SPORTDiscus, COCHRANE, EBSCO, and EMBASE. A total of 16 experimental studies met inclusion criteria for a full-text review. Data synthesis examined balance functions, including static, dynamic, proactive, and perceived balance abilities when performing daily activities. Intervention protocols of the reviewed studies included an average of two to three 40-minute exergaming sessions per week for 8 weeks. A random effects model identified significant effects in favor of the exergaming group, with moderate effect size in dynamic balance (Hedges' g = 0.36, 95% CI = 0.26-1.30, P < 0.001), and perceived balance (Hedges' g = 0.31, 95% CI = 0.04-0.58, P = 0.02); and considerable effect size in Chair Stand Test (Hedges' g = 0.78, 95% CI = 0.26-1.30, P = 0.003), and balance test batteries (Hedges' g = 0.72, 95% CI = 0.42-1.02, P < 0.001). No significant effect was found in the static balance (Hedges' g = 0.22, 95% CI = -0.31 to 0.76, P = 0.42), or proactive balance (Hedges' g = 0.54, 95% CI = -0.12 to 1.20, P = 0.11). Meta-analysis identified exergaming-associated benefits in older adults' balance function and confidence. This finding supports the feasibility of exergaming as a supplementary approach to improve balance for healthy older adults. Health professionals may optimize treatment effect by integrating exergaming sessions into a traditional balance exercise program.

A Piezoresistive Array Armband With Reduced Number of Sensors for Hand Gesture Recognition

Human machine interfaces (HMIs) are employed in a broad range of applications, spanning from assistive devices for disability to remote manipulation and gaming controllers. In this study, a new piezoresistive sensors array armband is proposed for hand gesture recognition. The armband encloses only three sensors targeting specific forearm muscles, with the aim to discriminate eight hand movements. Each sensor is made by a force-sensitive resistor (FSR) with a dedicated mechanical coupler and is designed to sense muscle swelling during contraction. The armband is designed to be easily wearable and adjustable for any user and was tested on 10 volunteers. Hand gestures are classified by means of different machine learning algorithms, and classification performances are assessed applying both, the 10-fold and leave-one-out cross-validations. A linear support vector machine provided 96% mean accuracy across all participants. Ultimately, this classifier was implemented on an Arduino platform and allowed successful control for videogames in real-time. The low power consumption together with the high level of accuracy suggests the potential of this device for exergames commonly employed for neuromotor rehabilitation. The reduced number of sensors makes this HMI also suitable for hand-prosthesis control.

Study Protocol: Does an Acute Intervention of High-Intensity Physical Exercise Followed by a Brain Training Video Game Have Immediate Effects on Brain Activity of Older People During Stroop Task in fMRI?-A Randomized Controlled Trial With Crossover Design

Background: Elderly people are affected by processes leading to decline in various aspects of daily living that impair their quality of life. Regarding neurological aspects, executive functions have been shown to be valuable for daily life and to slow decline during aging. Most intervention studies intended to improve cognitive functions during aging specifically address long-term destructive processes and countermeasures. However, to an increasing degree, studies also investigate the acute benefits that prove to be useful for daily life, such as physical exercise or video games in the form of exercise video gaming (“exergaming”). Because little is known about the change in cognitive ability following acute intervention of a combination of physical exercise and video gaming, especially for older people, this work is designed as an attempt to address this matter.

Methods: This study is a randomized crossover controlled trial to test the response to an acute bout of high-intensity physical exercise followed by a short session with a brain training (Brain Age) video game in physically active and cognitively healthy older adults (60–70 years). The response is measured using Stroop task performance (cognitive task for executive function) and related brain activity assessed with functional magnetic resonance imaging (fMRI). The control conditions are low-intensity physical exercise and Tetris for video gaming.

Discussion: This study is intended to provide insight into the alteration of executive function and its related brain activity from an acute intervention with a combination of physical exercise and video gaming in older people. The protocol might not be implementable in daily life to improve cognitive abilities. However, the results can support future studies that investigate cognition and the combination of physical exercise and video gaming. Moreover, it can provide real-life implications.

Trial registration: This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (UMIN000033054). Registered 19 July 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000037687.

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

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

A systematic literature review and meta-analysis of real-world interventions for cognitive ageing in healthy older adults

Activities running in community-based-settings offer a method of delivering multimodal interventions to older adults beyond cognitive training programmes. This systematic review and meta-analysis investigated the impact of randomised controlled trials (RCTs) of 'real-world' interventions on the cognitive abilities of healthy older adults. Database searches were performed between October 2016 and September 2018. Forty-three RCTs were eligible for inclusion with 2826 intervention participants and 2234 controls. Interventions to enhance cognitive ability consisted of participation in activities that were physical (25 studies), cognitive (9 studies), or mixed (i.e., physical and cognitive; 7 studies), and two studies used other interventions that included older adults assisting schoolchildren and engagement via social network sites. Meta-analysis revealed that Trail Making Test (TMT) A, p =  0.05, M = 0.43, 95% CI [-0.00, 0.86], digit symbol substitution, p =  0.05, M = 0.30, 95% CI [0.00, 0.59], and verbal fluency, p =  0.04, M = 0.31, 95% CI [0.02, 0.61], improved after specific types of interventions versus the control groups (which were either active, wait-list or passive controls). When comparing physical activity interventions against all control groups, TMT A, p =  0.04, M = 0.25, 95% CI [0.01, 0.48], and digit span forward, p =  0.05, M = 0.91, 95% CI [-0.00, 1.82], significantly improved. Results remained non-significant for all outcomes when comparing cognitive activity interventions against all control groups. Results therefore suggest that healthy older adults are more likely to see cognitive improvements when involved in physical activity interventions. In addition, TMT A was the only measure that consistently showed significant improvements following physical activity interventions. Visuospatial abilities (as measured by TMT A) may be more susceptible to improvement following physical activity-based interventions, and TMT A may be a useful tool for detecting differences in that domain.

Cognitive Training Does Not Enhance General Cognition

Due to potential theoretical and societal implications, cognitive training has been one of the most influential topics in psychology and neuroscience. The assumption behind cognitive training is that one's general cognitive ability can be enhanced by practicing cognitive tasks or intellectually demanding activities. The hundreds of studies published so far have provided mixed findings and systematic reviews have reached inconsistent conclusions. To resolve these discrepancies, we carried out several meta-analytic reviews. The results are highly consistent across all the reviewed domains: minimal effect on domain-general cognitive skills. Crucially, the observed between-study variability is accounted for by design quality and statistical artefacts. The cognitive-training program of research has showed no appreciable benefits, and other more plausible practices to enhance cognitive performance should be pursued.

"Walking" through the sensory, cognitive, and temporal degradations of healthy aging

As we age, there is a wide range of changes in motor, sensory, cognitive, and temporal processing due to alterations in the functioning of the central nervous and musculoskeletal systems. Specifically, aging is associated with degradations in gait; altered processing of the individual sensory systems; modifications in executive control, memory, and attention; and changes in temporal processing. These age-related alterations are often inter-related and have been suggested to result from shared neural substrates. Additionally, the overlap between these brain areas and those controlling walking raises the possibility of facilitating performance in several tasks by introducing protocols that can efficiently target all four domains. Attempts to counteract these negative effects of normal aging have been focusing on research to prevent falls and/or enhance cognitive processes, while ignoring the potential multisensory benefits accompanying old age. Research shows that the aging brain tends to increasingly rely on multisensory integration to compensate for degradations in individual sensory systems and for altered neural functioning. This review covers the age-related changes in the above-mentioned domains and the potential to exploit the benefits associated with multisensory integration in aging so as to improve one's mobility and enhance sensory, cognitive, and temporal processing.