Effects of Exergaming on Physical and Cognitive Functions in Individuals with Autism Spectrum Disorder: A Systematic Review

Exercise Interventions for Autistic People: An Integrative Review of Evidence from Clinical Trials

PURPOSE OF REVIEW

This review integrates recent findings from randomized controlled clinical trial (RCT) research examining the impacts of physical exercise activities on various aspects and areas of functioning for autistic individuals.

RECENT FINDINGS

Recent meta-analytic and clinical trials research indicates physical exercise intervention programs improve social and communication skills for autistic children and adolescents, improve executive functioning skills for autistic children, improve sleep-related behavior for autistic children and adolescents, and may be helpful for improving physical health for autistic children. There is very limited RCT research evidence on exercise intervention approaches or impacts for autistic adults, for autistic girls or women, for autistic people with co-occurring intellectual disability, and for reducing negative emotional symptoms (e.g., anxiety, depression) for any autistic population. The extant clinical trials research provides convincing, consistent evidence for positive impacts of physical exercise programs on multiple areas of functioning for autistic children and adolescents. Additional research is needed to determine and ensure potential impacts of physical exercise activity programs for important autistic sub-populations, including adults.

Effects of a Session of Exergames and Traditional Games on Inhibitory Control in Children With Autism Spectrum Disorder: Randomized Controlled Crossover Trial

Background

Autism spectrum disorder (ASD) is characterized by deficits in executive functions, such as inhibitory control, which affect behavior and social adaptation. Although physical activity-based interventions, such as exergames, have shown potential to improve these functions, their comparative effects with active traditional games remain underexplored, particularly regarding inhibitory control in children with ASD.

Objective

We aim to analyze the effects of a session of exergames and active traditional games on inhibitory control in children with ASD.

Methods

This randomized controlled crossover trial included 9 male children with ASD (mean age 8.6, SD 1.4 y). Participants completed three 20-minute experimental sessions in random order, with a minimum interval of 48 hours: (1) active traditional games, (2) exergames using Just Dance 2022, and (3) a control session with manual painting activities. Inhibitory control was assessed 5 minutes postsession using a modified flanker task in the E-Prime (version 3.0; Psychological Software Tools Inc) program, recording reaction time (RT) and accuracy in congruent and incongruent phases. Repeated measures ANOVA was used to compare RT and accuracy between experimental and control conditions. Data are presented as means and 95% CIs.

Results

There was a statistically significant effect of condition on RT in the incongruent phase (P=.02). RT in the exergame session (849 ms, 95% CI 642 to 1057) was lower compared to the traditional games (938 ms, 95% CI 684 to 1191; P=.02) and control (969 ms, 95% CI 742, 1196 to P=.01) sessions. No significant differences were observed in RT during the congruent phase or in accuracy across either phase.

Conclusions

A 20-minute session of exergame improved inhibitory control performance in children with ASD compared to active traditional games and painting activities.

The impact of physical exercise interventions on social, behavioral, and motor skills in children with autism: a systematic review and meta-analysis of randomized controlled trials

Background

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social impairments, sensory processing issues, repetitive behavior patterns, motor abnormalities, and executive function impairments.

Objective

To systematically review and meta-analyze the effects of various exercise modalities on flexibility and cognitive control, social skills, behavioral problems, motor skills, and coordination in children with ASD, providing scientific evidence for clinical practice to guide effective exercise interventions for children with ASD.

Methods

Literature searches were conducted in PubMed, EMbase, Cochrane Library, EBSCOhost, and Web of Science databases, covering the period from database inception to February 15, 2024. Inclusion criteria included studies involving children with ASD, any form of exercise intervention, reporting at least one ASD-related outcome, and designed as randomized controlled trials (RCTs) or quasi-experimental studies. Exclusion criteria included reviews, conference abstracts, commentary articles, and studies lacking sufficient statistical data for meta-analysis. Study quality was assessed using the PEDro scale. Effect sizes were calculated using standardized mean differences (SMD). Heterogeneity was assessed with the I 2 statistic. Multiple subgroup analyses were conducted, and publication bias was evaluated using Begg's Test and Egger's Test.

Results

23 RCTs were included in this study, showing positive effects of exercise interventions in various domains.Upper grade students showed significant improvement in flexibility and cognitive control (SMD = -0.282, p = 0.161). Lower grade children showed the most significant improvement in motor skills and coordination (SMD = 0.475, p = 0.043). Preschool children showed significant enhancement in social skills (SMD = 0.312, p = 0.041). Behavioral problems improved significantly across all age groups (SMD = -0.674, p < 0.001). Martial arts and ball games were particularly effective in enhancing these domains, and appropriate periodic exercise interventions effectively improved various abilities in children with ASD. Results varied across different ages and intervention types.

Conclusion

Exercise interventions significantly improve flexibility, cognitive control, motor skills, coordination, social skills, and behavioral problems in children with ASD. This study supports exercise interventions as an effective method to enhance multiple abilities in children with ASD and emphasizes the importance of designing personalized intervention programs tailored to different ages and needs. Future research should focus on larger sample sizes and long-term follow-ups to confirm the sustainability and generalizability of intervention effects.

Effects of traditional Chinese exercises on brain-derived neurotrophic factor in middle-aged and older adults: A systematic review and meta-analysis of randomized controlled trials

Background

Brain-derived neurotrophic factor (BDNF) may help middle-aged and older adults resist age-related neurodegenerative conditions and psychiatric disorders. Recent studies suggested that Traditional Chinese exercises (TCEs) may be a promising strategy to improve the BDNF levels of these populations, while the effectiveness has yet to be definitively confirmed due to the variances in the study designs and observations. Therefore, this systematic review and meta-analysis aimed to examine the effects of TCEs intervention on BDNF in middle-aged and older adults.

Methods

The search was conducted in November 2024 in seven Chinese and English databases. Two reviewers independently reviewed the search results, extracted the data, and assessed the risk of bias and certainty of evidence. Meta-analyses and meta-regressions were performed to determine the overall effect size and the impact of potential moderators.

Results

Ten publications consisting of 543 participants were included. The overall effect size of TCEs on BDNF was large and significant [Hedges'g = 0.82, 95 % CI (0.55, 1.09), p < 0.01]. Subgroup analysis revealed that the effect size was non-significant for participants with mild cognitive impairment (MCI) (p = 0.08), while significant for participants with normal cognitive function (p < 0.01). In the meta-regression, moderators such as the mean age, sex, and baseline BDNF levels of participants, as well as total TCEs time were not associated with outcome variables. The certainty of the evidence was assessed as moderate.

Conclusions

This systematic review and meta-analysis indicates that TCEs intervention could increase the levels of BDNF in middle-aged and older adults with normal cognitive function.

Systematic review registration

www.crd.york.ac.uk/PROSPERO/, identifier: CRD42023484121.

Digital motor intervention effects on motor performance of individuals with developmental disabilities: a systematic review

BACKGROUND

Individuals (i.e. children/young adults) with developmental disabilities (DDs) and intellectual disabilities (IDs) often display a variety of physical and motor impairments. It is well known that participation in motor activities can positively impact the development of children's cognitive and social skills. Recently, virtual and digital technologies (e.g. video conferencing applications, virtual reality and video gaming) have been increasingly used to promote better physical/motor outcomes. The efficacy of digital technologies in improving motor outcomes for those with DD/ID varies depending on the technology and population, and the comparative effects of various technologies are unknown. The aim of our study is to conduct a systematic review to comprehensively examine the quantitative and qualitative results of current studies reporting the efficacy of digitally based motor interventions on motor outcomes in individuals with DD/ID.

METHODS

Literature published from 1900 to 2024 was searched in four health sciences databases: PubMed, PsycINFO, Scopus and CINAHL. Articles that examined the effects of gross motor/physical activity training using technologies such as exergaming (i.e. exercise through video gaming such as the Wii and Xbox Kinect), virtual reality or telehealth video conferencing applications (i.e. Zoom, Webex or mobile health apps) on the standardised or game-specific gross motor performance of individuals with DD/ID diagnoses that do not typically experience significant walking challenges using experimental or quasi-experimental study designs were included. Thirty relevant articles were retrieved from a search of the databases PubMed (914), PsycINFO (1201), Scopus (1910) and CINAHL (948).

RESULTS

Our quantitative synthesis of this published literature suggests strong and consistent evidence of small-to-large improvements in motor skill performance following digital movement interventions.

CONCLUSIONS

Our review supports the use of digital motor interventions to support motor skill performance in individuals with DD without ID. Digital technologies can provide a more engaging option for therapists to promote motor skill development in individuals with DD or for caregivers to use as an adjunct to skilled therapy.

Benefits of exercise for children and adolescents with autism spectrum disorder: a systematic review and meta-analysis

Background

Numerous experimental studies have shown that exercise can serve as an intervention with beneficial effects on children and adolescents with autism. However, a systematic review on the specific areas affected has not been conducted.

Methods

Preliminary research sources were obtained by searching four databases, and two researchers independently screened the literature that met the study criteria. The study was conducted under the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions.

Results

37 studies were included in the final analysis, of which 9 studies were quantitatively synthesized and 28 studies were qualitatively analyzed. Exercise interventions have positive effects on motor performance, cognitive function, individual and social relationships, behavioral problems, physical health, and brain function in children and adolescents with autism. The results of the meta-analysis indicate that exercise can effectively improve social skills [SMD=-0.53, 95%CI (-0.76, -0.3), P=0.000].

Conclusions

Long-term, regular, chronic exercise is beneficial for children and adolescents with autism, particularly in the area of social skills.

Systematic review registration

https://www.crd.york.ac.uk/prospero PROSPERO, identifier CRD42024554530.

Mechanisms Linking Physical Activity With Mental Health in Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review

INTRODUCTION

Physical activity (PA) is a promising way to improve mental health in children and adolescents with neurodevelopmental disorders (NDDs). However, the underlying mechanisms remain unclear. The current review aimed to explore the potential neurobiological, psychosocial, and behavioral mechanisms between PA interventions and mental health in children and adolescents with NDDs.

METHODS

Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC were searched from inception to June 2023. Randomized controlled trials/quasi-experimental designs applying PA interventions and reporting at least one mental health outcome and at least one potential mechanism in children and adolescents with NDDs were included. The best evidence synthesis rating system was adopted to determine the strength and consistency of potential mechanisms and was performed in 2024.

RESULTS

In total, 45 studies were included, 29 of which were randomized controlled trials and 16 were quasi-experimental, with a total of 1,751 participants. According to the best evidence synthesis rating system, neurobiological (theta activity and P3 amplitude), psychosocial (social skills and social participation), and behavioral (motor skills and sleep) mechanisms were the frequently examined and consistent mechanisms through which PA affected mental health in children and adolescents with NDDs. However, evidence regarding P3 latency, beta activity, and physical self-concept was insufficient.

DISCUSSION

Future PA interventions could consider neurobiological (theta activity and P3 amplitude), psychosocial (social skills and social participation), and behavioral (motor skills and sleep) mechanisms. Alternatively, PA can be developed as an adjunctive approach with interventions that specifically focus on these mechanisms to enhance mental health in children and adolescents with NDDs.

Effects of exercise interventions on brain-derived neurotrophic factor levels in overweight and obesity: A systematic review and meta-analysis

Background

/Objective. An explosion in global obesity epidemic poses threats to the healthcare system by provoking risks of many debilitating diseases, including cognitive dysfunction. Physical activity has been shown to alleviate the deleterious effects of obesity-associated cognitive deficits across the lifespan. Given the strong neuroprotective role of brain-derived neurotrophic factor (BDNF) and exercise training as a known modulator for its elevation, this systematic review sought to examine the strength of the association between exercise and BDNF levels in healthy people with overweight and obesity.

Methods

Six electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Ovid Nursing Database, and SPORTDiscus) were searched from their inceptions through December 2022. The primary outcome of interest was BDNF levels. Interventional studies (randomized and quasi-experimental) with English full text available were included. Risk of bias of the included studies was assessed using the Physiotherapy Evidence Database Scale. Data were extracted for meta-analyses by random-effects models.

Results

Thirteen studies (n = 750), of which 69.2% (9/13) had low risk of bias, were included. In the meta-analysis, exercise interventions had no significant effect on resting BDNF levels (standardized mean difference: -0.30, 95% CI -0.80 to 0.21, P = 0.25). Subgroup analyses also indicated no effects of age and types of control groups being compared on moderating the association.

Conclusion

To further inform the role of BDNF in obesity-related cognitive functioning, rigorous studies with larger samples of participants and raw data available were imperatively deserved.

The benefit of rhythm-based interventions for individuals with autism spectrum disorder: a systematic review and meta-analysis with random controlled trials

Objective

Individuals with autism spectrum disorder (ASD) exhibit impaired behavior synchronization, which is associated with social deficits. Numerous studies have demonstrated that rhythm-based interventions can effectively mitigate social deficits by promoting behavioral synchronization in individuals with ASD. Therefore, a review of the current literature is warranted in this field. The objectives of this review were to explore the effects of rhythm-based interventions on overall social skills and to study the differences in the effects of rhythm-based interventions on specific social skills.

Method

The databases PubMed, Web of Science, Scopus, and Psycinfo were systematically explored until March 2024. A total of eleven research studies, encompassing 408 participants diagnosed with ASD, were incorporated into the meta-analysis. Effect sizes (Hedges' g) were computed for each comparison and amalgamated using random-effects models to evaluate the social skills of individuals with ASD. The methodological quality of each study was evaluated using the Physiotherapy Evidence Database scale(PEDro).

Results

Overall, some valuable observations were made. Rhythm-based interventions had a medium effect on the overall social skills for ASD (Hedges's=0.681; 95%CI[0.075 to 1.286], P  < 0.05). Regarding domain-specific social skills, rhythm-based interventions had a large effect on social interaction (g = 1.299,95% CI [0.508 to 2.091]), a small effect on communication (g = 0.383, 95% CI [0.033 to 0.733], P  < 0.05), and a large effect on emotion (g = 1.752, 95% CI [0.294 to 3.210], P  < 0.05). However, we found a favorable but non-significant effect (g = 0.125, 95% CI [-0.039 to 0.289], P  >  0.05) of rhythm-based interventions on empathy. All study qualities were high (score≥6) using the Physiotherapy Evidence Database (PEDro) scale assessment.

Conclusion

This result indicates the importance of rhythm in the clinical rehabilitation of individuals with ASD. We suggest adding appropriate rhythmic elements to clinical interventions, particularly for individuals with ASD who are less socially competent.

Effects of different exercise interventions on executive function in children with autism spectrum disorder: a network meta-analysis

Background

A large body of research has identified the positive effects of physical activity on children with autism spectrum disorders (ASD). However, the specific benefits of different types of sports on executive functioning in children with ASD remain unclear. The aim of this study was to further analyze the effects of different sports on executive functioning in children with ASD using reticulated meta-analysis and to establish their effectiveness ranking.

Methods

This study conducted a comprehensive online search in Web of Science, PubMed, Cochrane, Embase, and CNKI databases. It included randomized controlled trials and quasi-experimental studies, and synthesized the data using a Bayesian framework.

Results

Several relevant studies were included. The results showed that physical activity significantly improved all three dimensions of executive functioning (inhibitory control, cognitive flexibility, and working memory) in children with ASD. The improvement in cognitive flexibility and inhibitory control both reached a medium effect size. However, the improvement in inhibitory control was better than that in cognitive flexibility, while the improvement in working memory did not reach the level of a medium effect. Mini Basketball was effective in improving inhibitory control and cognitive flexibility, but not working memory. Ping Pong was more effective in cognitive flexibility and working memory, but weaker in inhibitory control. Fixed Bicycle was less effective in all three dimensions. Among other interventions, Learning Bicycles, Animal-assisted therapy, and Exergaming performed better in cognitive flexibility. SPARK, Neiyang Gong, and Martial Arts were also effective in improving inhibitory control. However, SPARK and Fixed Bicycle were not significant in improving working memory.

Conclusion

Physical activity as an intervention can significantly improve the executive function of children with ASD. The intervention effects of different sports on different dimensions of executive function vary. Mini Basketball was outstanding in improving inhibitory control and cognitive flexibility. Ping Pong was effective in improving cognitive flexibility and working memory. Fixed Bicycle was not effective in any dimension.

Effects of Exergaming on executive function and motor ability in children: A systematic review and meta-analysis

This study aimed to evaluate the effectiveness of Exergaming in improving executive function and motor ability across different groups of children and adolescents. We searched several databases, including PsycINFO, Web of Science, Embase, PubMed, SPORT Discus, Scopus, and the Cochrane Central Register of Controlled Trials, for randomized controlled trial (RCT) studies published from inception until November 25, 2023, to identify studies investigating the effect of Exergaming on motor and executive function in children. The protocol was registered with PROSPERO (CRD42023482281). A total of 37 randomized controlled trials were included in this study. Our results indicate that Exergaming can influence children's cognitive flexibility [SMD = 0.34, 95%CI(0.13,0.55), I2 = 0.0%, P = 0.738], inhibition control [SMD = 0.51, 95%CI (0.30,0.72), I2 = 0.0%, P = 0.473], global cognitive [SMD = 0.87, 95%CI (0.50,1.23), I2 = 0.0%, P = 0.974], working memory [SMD = 0.18, 95%CI(-0.16, 0.52), I2 = 46.5%, P = 0.096], gross motor skills [SMD = 0.82, 95%CI (0.30, 1.35), I2 = 79.1%, P<0.001], fine motor skills [SMD = 0.71, 95%CI (0.22,1.21), I2 = 78.7%, P<0.001], balance [SMD = 0.61, 95%CI (0.34, 0.88), I2 = 59.5%, P = 0.001], and cardiorespiratory [SMD = 0.48, 95%CI (0.16, 0.79), I2 = 58.4%, P = 0.019]. While these findings suggest that Exergaming can promote children's cognitive flexibility, inhibitory control, global cognition and motor abilities, the effect on working memory was not statistically significant. Further high-quality randomized controlled trials are warranted to explore the potential benefits of Exergaming for different groups of children, including those with specific needs.

Digital motor intervention effects on physical activity performance of individuals with developmental disabilities: a systematic review

PURPOSE

Post-pandemic, use of digital technologies (e.g., mobile app, Zoom, virtual reality, and videogaming) to promote physical activity (PA) in populations with intellectual and developmental disabilities (IDD) has increased. The efficacy of various digital technologies in promoting PA in individuals with IDD varies. We conducted a systematic review to examine current literature findings on the efficacy of digital PA interventions on PA outcomes in individuals with IDD.

METHODS

Articles published between 1900 and 2024 that examined effects of technology-based PA interventions on PA levels/fitness of individuals with IDD using experimental or quasi-experimental study designs were included. Sixteen articles were retrieved from four health databases PubMed (914), PsycInfo (1201), SCOPUS (1910), and CINAHL (948).

RESULTS

Findings based on 604 participants (Autism: 383; Down Syndrome: 106; Developmental Disability: 83, Developmental Coordination Disorder: 37) provide the most support for exergaming/digital PA intervention benefits for populations with ID, Down Syndrome, and Autism; however, there was limited support for its use in those without ID (e.g., DCD).

CONCLUSION

Digital technology is an effective tool to promote improvements in PA/fitness, motor, cardiovascular performance in individuals with ID. Future studies need to build on this evidence to support the use of PA outcomes in individuals with different IDD diagnoses.

Virtual reality as a telerehabilitation strategy for people with autism spectrum disorder during the COVID-19 quarantine scenario: physical activity, motor performance and enjoyment

PURPOSE

People with autism spectrum disorder could benefit from physical activity during the pandemic and COVID-19 restrictions, mainly to maintain adequate physical activity. We aimed to evaluate the feasibility, enjoyment, and potential effect of telerehabilitation using a serious game named 'MoveHero'.

MATERIALS AND METHODS

Registered in Clinical Trials (NCT04402034). We adopted a remotely run Telerehabilitation research design with 44 participants recruited: 22 People with ASD people and 22 non-ASD individuals.

RESULTS

All participants safely participated, 100% adherence to sessions, ∼60% enjoying the task, and significantly improved performance, with better performance for the NA group at most practice moments.

CONCLUSIONS

Our findings support both how to implement a gaming intervention and the need to investigate the efficacy of serious games to motivate moderate intensity physical activity in people with ASD.

Two Physiotherapy Methods to Improve the Physical Condition of Children with Autism Spectrum Disorder

This study presents two simple physiotherapy programs that were implemented for five weeks and showed positive changes in balance, coordination, and motor skills in kindergarteners with ASD. Physiotherapy programs in a gym and games on a smart board with balance plates and an unstable base were applied to improve the physical condition of children with ASD. Thirty children with ASD (4-6 years old) attending special needs kindergarten were enrolled in the study. Three tests were used to assess participants' physical condition before and after the study: the modified Berg Balance Scale, the Imbalance Coordination Sample, and the Bruininks-Oseretsky Motor Proficiency Test (BOTMP). The resulting mean change, calculated from each group's scores, shows that the participants who received physical therapy sessions at the smart board had the greatest change of 1.58 points. It shows that the opportunity to play games on a smart board motivates children with ASD to work harder; therefore, it is a simple and easy way to engage children in different types of physical exercise. A slightly smaller change of 1.51 was obtained in the group that received gym sessions. However, working in the gym was more psychologically challenging for the children with ASD due to their lack of desire and motivation. Both methods are relatively simple and easy to apply at home; therefore, parents can make a significant contribution to improving children's physical condition and that can be an effective tool to assist these individuals with activities in daily life.

Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies

Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.

The effects of physical activity on pediatric eyes: A systematic review and meta-analysis

INTRODUCTION

Examining the retina represents a non-invasive method to evaluate abnormalities pertaining to the nervous and cardiovascular systems. Evidence indicates that physical activity is a non-pharmacological intervention to enhance the nervous and cardiovascular systems. However, little is unknown about its effects on ocular characteristics in children and adolescents. The purpose of this study was to examine the effects of physical activity interventions on ocular characteristics in children and adolescents.

METHOD

The electronic bases Web of Science, Embase, Cochrane Library, PubMed, SPORTDiscus, CINAHL, and ERIC were searched from inception to May 2023. Incorporated were randomized controlled trials or quasi-experimental designs that had implemented acute or chronic physical activity interventions among children and adolescents to evaluate various eye-related attributes via clinical examinations or surveys. Two authors independently performed the data extraction and risk of bias assessment, utilizing the Physiotherapy Evidence Database checklist.

RESULTS

A total of 474 articles were identified, of which eight articles underwent a systematic review, and six were chosen for meta-analysis. Chronic physical activity interventions positively impacted central retinal artery equivalent (CRAE) with a small to moderate effect (SMD = 0.21; 95% CI 0.04 to 0.39, p = 0.034, I2 = 0%) and central retinal venular equivalent (CRVE) with a small effect (SMD = 0.098; 95% CI 0.08 to 0.11; p = 0.008, I2 = 0%). Intraocular pressure, kinetic visual acuity, and eye strain also improved significantly after physical activity interventions.

DISCUSSION

Participating in chronic physical activity programs appear to impact children and adolescents' eye-related attributes positively.

[Motor intervention strategies on postural control in children and youth with autism spectrum disorder: A systematic review]

Autism spectrum disorder (ASD) has varied characteristics with an impact at the social, communicative and sensorimotor (SM) level. An SM feature is postural control (PC) problems. There are various motor intervention strategies (MIS), but the benefit over LC is something that has been analyzed less extensively. The objective was to describe the MIS and its results on the PC of children and adolescents with ASD. A search of PubMed, Scopus, Web of Science and Cochrane was performed. A total of eight articles met the eligibility criteria. All MIS showed beneficial results on the improvement of PC. The MIS were of a varied nature (dance practice, personalized physical activity, video games, Tai Chi Chuan, Taekwondo and virtual reality). It is necessary to improve the designs and consider the risks of bias, since they limit the scope of the results.

Children with Autism Spectrum Disorder Exhibit Elevated Physical Activity and Reduced Sedentary Behavior

According to previous research, individuals with autism spectrum disorder (ASD) have lower levels of physical activity than their typically developed (TD) counterparts. There have been conflicting reports about physical activity (PA) levels in people with ASD. Given the conflicting evidence, further investigation is required. We believe that evaluating PA in individuals with ASD is critical in order to offer PA intervention plans aiming at increasing their health-related physical fitness on a daily, systematic, and individualized basis. In the current study, an ActiGraph monitor (GT3X+) was used to accurately measure PA and sedentary activity in 21 children with autism aged 6.43 ± 2.29 years and 30 TD children aged 7.2 ± 3.14 years. Our data indicated that while the light and moderate activity counts were not significantly different between the two groups, the vigorous activity was significantly higher in ASD compared to TD. This finding was attributed to ASD characteristic stereotypy and self-stimulating behaviors. The significantly higher vigorous PA is discussed in relation to altered neurochemistry, oxidative stress, and neuroinflammation as etiological mechanisms in ASD. This research provides a better understanding of the status of PA participation in individuals with ASD.

Effect of exercise interventions on brain-derived neurotrophic factor expression in people with overweight and obesity: protocol for a systematic review and meta-analysis

INTRODUCTION

Epidemic obesity ('globobesity') has led to a considerable rise in the prevalence and incidence of many disabling conditions, including cognitive dysfunction. Recent evidence has suggested that habitual exercise can alleviate the deleterious effects of obesity on cognitive functioning across the lifespan. Given that there is a potential link among obesity, exercise, cognitive health and brain-derived neurotrophic factor (BDNF), this systematic review aims to critically appraise interventional trials on exercise and BDNF and to estimate the pooled effect of exercise training on BDNF levels among healthy individuals with overweight and obesity.

METHODS AND ANALYSIS

Six electronic databases-PubMed, MEDLINE, EMBASE, Web of Science, Ovid Nursing Database and SPORTDiscus-will be searched from their inception through December 2022. Only interventional studies, including randomised controlled trials and quasi-experimental studies, with full text available and reported in English will be included. The primary outcomes will be changes in BDNF levels among healthy subjects with overweight and obesity following either acute or chronic bouts of exercise interventions. Two reviewers will independently conduct data extraction and risk of bias assessment for included trials using the Physiotherapy Evidence Database Scale. We will produce a narrative synthesis, with findings categorised by sex, age groups and types of exercise training. Data will be extracted and pooled for meta-analyses using random-effects models.

ETHICS AND DISSEMINATION

No formal ethical approval is required for this systematic review. The findings of this review will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42023414868.

Effects of Cooperative, Competitive, and Solitary Exergames on Cognition and Anxiety Levels in Children with Developmental Disabilities

Objective: Exergames are playing an important role in person-centered therapy, health care services, and in the rehabilitation field. This study aimed to compare the effects of cooperative, competitive, and solitary exergames on cognition and anxiety levels in children with developmental disabilities (DD). Materials and Methods: This study was a randomized controlled trial pretest-posttest including 36 children with DD who were allocated to the cooperative exergame group (CGG), competitive exergame group (CmGG), and solitary exergame group (SGG). The exergame program was performed two times a week for 8 weeks and the outcome measurements were conducted before and after the program. A paired sample t-test and one-way analysis of variance (ANOVA) were used to analyze the changes within and between the groups. Results: The result indicated a significant improvement in memory, attention, and visual perception in all groups; the CGG and CmGG showed a high increase in attention compared with the SGG. However, only the CGG presented a significant improvement in the language subscale. In terms of anxiety, only the CGG presented substantial improvements in all anxiety subscales. The CmGG showed improvement in social phobia and the SGG in physical injury fears, social phobia, and general anxiety fears. Conclusion: The findings suggest that cooperative and competitive exergames may be used to effectively improve cognitive functions; cooperative exergames can be applied as the most effective method to reduce anxiety compared with the other game types for children with DD.

GamerFit-ASD beta test: adapting an evidence-based exergaming and telehealth coaching intervention for autistic youth

Background

Health disparities faced by autistic youth are exacerbated by inadequate physical activity (PA) and sleep, whereas healthy PA and sleep may improve mood and function. Adaptive Game Squad (AGS) is an evidence-based telehealth coaching and exergaming intervention to improve PA and sleep for adolescents with diverse neurodevelopmental and psychiatric conditions. This study aimed to adapt AGS for autistic youth ages 10-15 years; beta-test the modified intervention for feasibility, accessibility, and engagement; and further refine the intervention for a larger planned demonstration pilot.

Methods

Interdisciplinary experts adapted AGS to create GamerFit-ASD, a 12-week intervention that included a progressive exergame schedule, Fitbit step-tracking, weekly health coaching, and health tip/exercise videos. For beta testing, the intervention was shortened to a 4-week trial with 5 parent/child dyads. Children completed exit surveys and parents and children were interviewed about intervention feasibility, accessibility, and engagement. Exit survey data were summarized with descriptive statistics. Qualitative data were analyzed using a modified grounded-theory approach.

Results

All participants (n = 5; ages 10-14 years) attended all 4 planned coaching sessions and completed an average of 9 of 12 planned exergame challenges for a weekly average of 50 min. All participants reported enjoying coaching sessions, 4 of 5 reported enjoying exergames, and 3 of 5 reported enjoying on-demand exercise videos. In interviews, children generally reported finding participation feasible, exergaming challenges active and fun, and coaches friendly and helpful. Parents reported high feasibility of supporting their children's involvement and valued child goal-setting and intervention flexibility; however, some found telehealth sessions overly scripted. Several adaptations to coaching scripts, coach training, and parent materials were made for the larger demonstration pilot, including changes to reduce scriptedness of coaching sessions, to provide parents with more information specific to autism, and to make video content more appropriate to children's needs/preferences.

Discussion

A telehealth coaching and exergaming intervention appears feasible, accessible, and engaging for autistic youth aged 10-15. Future studies with larger, more diverse samples, longer study durations and/or follow-up periods, and more rigorous study designs are needed to advance understanding of the appropriateness and effectiveness of this type of intervention for this population.

Physical Activity Interventions for Improving Cognitive Functions in Children With Autism Spectrum Disorder: Protocol for a Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects millions of children worldwide, with a current prevalence of approximately 1 in 54 children in the United States. Although the precise mechanisms underlying ASD remain unclear, research has shown that early intervention can have a significant impact on cognitive development and outcomes in children with ASD. Physical activity interventions have emerged as a promising intervention for children with ASD, but the efficacy of different types of interventions remains unclear.

OBJECTIVE

This study protocol aims to update the knowledge on extant literature and explore the efficacy of physical activity intervention strategies on cognitive functions in children with ASD.

METHODS

A systematic review and network meta-analysis (NMA) will be conducted following the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols for Network Meta-Analyses) statement. A total of 9 bibliographic databases (APA PsycInfo, CENTRAL, Dimensions, ERIC, MEDLINE Complete, PubMed, Scopus, SPORTDiscus, and Web of Science) will be systematically searched to screen eligible articles based on a series of inclusion and exclusion criteria. A study will be considered for inclusion if it is not classified as a systematic review with or without meta-analysis, was published from inception to present, includes children aged 0 to 12 years with ASD, quantitively measures cognitive outcomes, and examines treatment comprising at least 1 physical activity intervention strategy. The internal validity and quality of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework. Statistical analyses will be performed in the RStudio software (version 3.6; RStudio Inc) with the BUGSnet package and the Comprehensive Meta-Analysis software (version 3.3; Biostat Inc). The results of our NMA will be illustrated through network diagrams accompanied by geometry and league tables. Further, to rank the interventions based on their efficacy, we will use the surface under the cumulative ranking curve.

RESULTS

Our preliminary search identified 3778 potentially relevant studies. The screening of the studies based on the inclusion and exclusion criteria is ongoing, and we anticipate that the final number of eligible studies will be in the range of 30 to 50.

CONCLUSIONS

This study will provide a comprehensive review of the literature on physical activity interventions for children with ASD and will use NMA to compare the efficacy of different types of interventions on cognitive outcomes. Our findings will have important implications for clinical practice and future research in this area and will contribute to the growing body of evidence supporting the use of physical activity interventions as a key component of early intervention for children with ASD.

TRIAL REGISTRATION

PROSPERO CRD42021279054; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=279054.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40383.

The Effect of Meditation-Based Mind-Body Interventions on Symptoms and Executive Function in People With ADHD: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

This study aims to perform a systematic review and meta-analysis of the effect of MBIs (Mindfulness, Tai Chi, Yoga, and Qigong) on symptoms and executive function (EF) in ADHD.

METHOD

PubMed, Web of Science, the Cochrane Library, PsycINFO, CINAHL, Embase, and CNKI databases were searched to collect randomized controlled trials (RCTs) on the effects of MBIs on symptoms and EF in ADHD. Data extraction and methodological quality evaluation were conducted by two researchers, and a meta-analysis was conducted by Stata SE.

RESULTS

The pooled meta-analyses of MBIs revealed a positive and small effect on inattention (g = -0.26), hyperactivity/impulsivity (g = -0.19), and EF (g = -0.35).

CONCLUSION

Results suggest that MBIs have a significant improvement relative to the control condition. Although some results show that symptoms are affected by age, interventions, and total time of moderators, while EF is not affected by age and measurement, it needs to be supported by more research evidence. (J. of Att. Dis. XXXX; XX(X) XX-XX).

Effects of Virtual Reality-Based Exercise on Physical Fitness in People with Intellectual Disability: A Systematic Review of Randomized Controlled Trials

It is unclear whether virtual reality (VR)-based exercise can improve physical fitness in people with intellectual disability (ID). This systematic review therefore aimed to synthesize existing evidence regarding the efficacy of VR-based exercise on physical fitness in people with ID. Eligible articles were searched through six major electronic databases from inception until August 15, 2022. Returned studies were screened through predefined inclusion and exclusion criteria. Data from the included studies were then extracted and synthesized. A total of 13 randomized controlled trials were included and 12 of them were found to have good research quality. Different physical fitness outcomes were evaluated: (1) muscular fitness (d = 0.05-2.12; proportion of effect = 5/6), (2) cardiorespiratory fitness (d = 0.12-0.67; proportion of effect = 5/5), (3) flexibility (d = 0.81; proportion of effect = 1/2), (4) body composition (d = 0.10; proportion of effect = 2/3), (5) balance (d = 0.23-1.65; proportion of effect = 6/7), (6) coordination (d = 0.19-0.48; proportion of effect = 2/3), (7) speed and agility (d = 0.13-0.46; proportion of effect = 4/4), and (8) overall motor proficiency (d = 0.02-1.08; proportion of effect = 1/3). While there was some preliminary evidence showing that VR-based exercise could improve muscular fitness, cardiorespiratory fitness, balance, and speed and agility in individuals with ID, other outcomes showed less conclusive or limited positive evidence. Overall, additional studies are needed to understand the benefits of VR-based exercise on physical fitness in people with ID.

Is active video gaming associated with improvements in social behaviors in children with neurodevelopmental disorders: a systematic review

Active video gaming (AVG) is a way that children with neurodevelopmental disorders can participate in social play and could be associated with improvements in social behaviors. However, limited research has investigated if AVG is associated with improvements in social behaviors in children and adolescents with neurodevelopmental disorders. A systematic literature search was conducted in Medline, Embase, Psycinfo, Cinahl, and Eric, Web of Science, and Scopus. Three main concepts were searched: exergaming, neurodevelopmental disorders, and social behaviors. Keywords and subject headings were used for each concept. 3080 articles were identified in the initial search in 2019; in January 2021, 167 additional articles were identified. Of these, 8 studies with 242 children with autism spectrum disorder, cerebral palsy, or developmental coordination disorder were included in this review. Six studies reported that participation in AVG was associated with improved social functioning, social interaction, emotional well-being, and social/emotional skills in children with ASD, CP, and DCD. In contrast, two studies that included children diagnosed with ASD did not find any association between AVG participation and social behaviors. The findings of this systematic review suggest that participation in an AVG intervention may be associated with improved social behaviors in children and adolescents with ASD, CP, and DCD. However, due to the limited number of studies included, this finding must be interpreted with caution. Future research is needed that examines the treatment fidelity of AVG in improving social behavior skills in children with neurodevelopmental disorders and the generalizability of these skills to real-life social situations.

Combining physical and virtual worlds for motor-cognitive training interventions: Position paper with guidelines on technology classification in movement-related research

Efficient movements require intact motor and cognitive function. There is a growing literature on motor-cognitive interventions to improve the overall quality of life of healthy or diseased older people. For such interventions, novel technological advances are crucial not only in terms of motivation but also to improve the user experience in a multi-stimuli world, usually offered as a mixture of real and virtual environments. This article provides a classification system for movement-related research dealing with motor-cognitive interventions performed in different extents of a virtual environment. The classification is divided into three categories: (a) type of digital device with the associated degree of immersiveness provided; (b) presence or absence of a human-computer interaction; and (c) activity engagement during training, defined by activity >1.5 Metabolic Equivalent of task. Since virtual reality (VR) often categorizes different technologies under the same term, we propose a taxonomy of digital devices ranging from computer monitors and projectors to head-mounted VR technology. All immersive technologies that have developed rapidly in recent years are grouped under the umbrella term Extended Reality (XR). These include augmented reality (AR), mixed reality (MR), and VR, as well as all technologies that have yet to be developed. This technology has potential not only for gaming and entertainment, but also for research, motor-cognitive training programs, rehabilitation, telemedicine, etc. This position paper provides definitions, recommendations, and guidelines for future movement-related interventions based on digital devices, human-computer interactions, and physical engagement to use terms more consistently and contribute to a clearer understanding of their implications.

The quality of life of people with ASD through physical activity and sports

Among the factors that influence the quality of life of people with Autism Spectrum Disorder (ASD), physical activity and sport are key dimensions of physical well-being. Few studies take into account the perspectives of people with ASD in order to understand the extent of physical well-being and their subjective perception of it. The development of a system of quality of life indicators related to physical activity and sport for people with ASD and their analysis is the aim of this study, providing guidelines for improvement. A study was carried out with a sample of 276 people, professionals (n = 143), family members (n = 73) and people with ASD (n = 60). The people with ASD in the sample belonged to three age categories: children aged 8-12 years, adolescents aged 12-18 years and adults over 18 years. The research team used a qualitative methodology in the collection of information. They adapted three questionnaires, with validated quality of life scales, to guide the interviews and also applied them in the design of the focus group protocols. Subsequently, the research team analysed the information collected in the focus groups with families and professionals using a DELPHI method. A system for coding the responses and qualitative analysis of the responses was also prepared for the analysis of the data by the research team. Finally, the information obtained was compared with a group of representative experts. The results concluded with the elaboration of a system of quality of life indicators related to the dimension of physical well-being, as well as guidelines and proposals that bring together the perspectives of people with ASD in relation to the practice of sport and physical activity. There is a need to increase the practice of sport among people with ASD in order to promote their health, social participation and personal satisfaction. It is concluded that it is not possible to obtain a broad picture of the quality of life of people with ASD and their families due to lack of information. However, the method and the results obtained represent a first approach at national level to increase knowledge about the quality of life of people with ASD.

Winning The Game Against Depression: A Systematic Review of Video Games for the Treatment of Depressive Disorders

PURPOSE OF REVIEW

To review the evidence about video game-based therapeutic intervention for people diagnosed with depressive disorders.

RECENT FINDINGS

Psychotherapy has been proved to reduce depressive symptoms and is a key element in the treatment of depressive disorders. However, geographical, economical and stigmatized concerns are barriers to access to psychotherapy. New technologies and videos games can overcome some of these barriers by providing teleconferencing evidence-based therapy as time as they may offer an interactive entertainment. Overall, video game-based interventions were useful and effective in reducing symptoms of depressive disorders. Seven of the studies were published in the last 5 years, which reflects the increased research interest in video game-based interventions for depression. Overall, when adherence was reported, rates of acceptability and feasibility were high.

Exercise-Based Interventions Aimed at Improving Balance in Children with Autism Spectrum Disorder: A Meta-Analysis

Children with Autism Spectrum Disorder (ASD) often have deficits in motor skills, especially balance. This article presents a meta-analytic review of 15 intervention studies that aimed to improve balance in children and adolescents with ASD. Across these studies, there were 195 participants with ASD for whom pre-intervention and post-intervention balance scores were available. We measured the standardized mean difference (Hedges' g) between their pre-intervention and post-intervention balance scores and found a large, positive effect from these balance interventions (standardized mean difference-1.82 (95% CI [1.34, 2.29])). Various balance intervention procedures were shown to be very efficacious for children and adolescents with ASD. Clearly, balance is a motor skill that is very susceptible to intervention efforts. We also provided recommendations to researchers regarding what information to include when conducting intervention studies.

Influence of Autism and Other Neurodevelopmental Disorders on Cognitive and Symptom Profiles: Considerations for Baseline Sport Concussion Assessment

OBJECTIVE

The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivity disorder (ADHD) and learning disorders (LD) have demonstrated effects on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) performance. No current research has directly examined whether autism spectrum disorder (ASD) has similar effects. The current study compared ImPACT cognitive and symptom profiles in athletes with self-reported ASD to other NDs and healthy controls using case-control matching.

METHOD

The current study compared ImPACT baselines of high school athletes with ASD to athletes with other NDs (ADHD, LD, and co-occurring ADHD/LD) and healthy controls on cognitive composites and symptom reporting. Participants included 435 athletes (87 controls, 87 with ASD, 87 with ADHD, 87 with LD, and 87 with ADHD/LD) selected from a larger naturalistic sample. Athletes were matched to the ASD group based on age, sex, and sport using randomized case-matched selection from the larger database.

RESULTS

Results revealed that athletes with ASD performed more poorly than healthy controls on the Visual Motor Speed composite. No differences were found for Post-concussion Symptom Scale (PCSS) domain scores. Differences in cognitive and symptom profiles among the athletes with other NDs were also found.

CONCLUSIONS

Results elucidate patterns of baseline performance for athletes with ASD, demonstrating that there may not be significant differences between ASD and healthy controls on four of the five ImPACT composites, and no symptom reporting differences. Cognitive and symptom differences found for other NDs should be considered when interpreting baseline performance and for making return-to-play decisions in the absence of baseline assessment.

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

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

The Effects of Exercise Interventions on Executive Functions in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review and Meta-analysis

BACKGROUND

Both chronic and acute exercise interventions have reported positive effects on executive functions (EFs) in general populations. However, data on changes in EFs in children and adolescents with autism spectrum disorder (ASD) in response to exercise interventions are still unclear.

OBJECTIVE

This systematic review and meta-analysis aimed to synthesize available empirical studies concerning the effects of exercise interventions on EFs in children and adolescents with ASD.

METHODS

In accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, the electronic databases CINAHL Complete (via EBSCOhost), SPORTDiscus with Full Text (via EBSCOhost), MEDLINE (via EBSCOhost), Web of Science, ProQuest, and Education Resources Information Center (ERIC; via EBSCOhost) were searched from inception to January 2021. Two authors independently extracted data and conducted a risk-of-bias analysis using the Physiotherapy Evidence Database scale. Randomized controlled trials/quasi-experimental designs that used acute or chronic exercise interventions and assessed EFs through neurocognitive tasks or questionnaires among children and adolescents with ASD were included. In total, 259 articles were identified, of which 15 full texts were independently assessed for eligibility by two authors. In total, 14 articles underwent systematic review, and seven were selected for meta-analysis.

RESULTS

Overall, chronic exercise interventions had a small to moderate positive effect on overall EFs in children and adolescents with ASD (g = 0.342; 95% confidence interval [CI] 0.084-0.600; p < 0.01). Regarding domain-specific EFs, chronic exercise interventions had a small to moderate positive effect on cognitive flexibility (g = 0.312; 95% CI 0.053-0.570; p < 0.01) and inhibitory control (g = 0.492; 95% CI 0.188-0.796; p < 0.01). However, our review found a non-significant effect size (g = 0.212; 95% CI - 0.088 to 0.512) on working memory.

CONCLUSIONS

Chronic exercise interventions appear to have beneficial effects on overall EFs in children and adolescents with ASD, particularly in relation to cognitive flexibility and inhibitory control.

The impact of exercise interventions concerning executive functions of children and adolescents with attention-deficit/hyperactive disorder: a systematic review and meta-analysis

Background

Previous studies found that exercise interventions have positive effects on executive functions of the general population. However, studies seldom target executive functions of children and adolescents with attention-deficit hyperactivity disorder (ADHD). This study aimed to synthesise empirical studies regarding the effects of exercise interventions on executive functions of children and adolescents with ADHD.

Methods

A systematic search of the relevant literature was conducted in March 2020 through six electronic databases: CINAHL Complete, Eric, MEDLINE, PsychINFO, SPORTDiscus with Full Text, and Web of Science. Randomised controlled trials/quasi-experimental designs that applied exercise interventions and assessed executive functions through neurocognitive tasks among children and adolescents with ADHD were included. Altogether, 314 studies were identified, from which 31 full texts were independently assessed by two authors for eligibility. Finally, 21 studies underwent systematic reviews and 15 were selected for meta-analysis. Data extraction procedures and risk of bias analysis were conducted by two independent authors using the Physiotherapy Evidence Database (PEDro) scale.

Results

The findings indicated that exercise interventions improved overall executive functions of children and adolescents with ADHD (SMD = 0.611, 95% CI [0.386 to 0.836], p < 0.01). Exercise interventions had a moderate-to-large positive effect on inhibitory control (g = 0.761, 95% CI [0.376 to 1.146], p < 0.01) and cognitive flexibility (g = 0.780, 95% CI [0.331 to 1.228], p < 0.001). Likewise, during the subgroup analysis, intervention intensity and sessions of exercise (acute vs chronic) significantly moderated exercise intervention rather than intervention type.

Conclusions

Chronic sessions of exercise interventions with moderate intensity should be incorporated as treatment for children with ADHD to promote executive functions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01135-6.

Video Games for the Treatment of Autism Spectrum Disorder: A Systematic Review

Video games are a promising area of intervention for children diagnosed with Autism Spectrum Disorders (ASD). However, reviews on this topic are scarce. This review on studies exploring video games for the treatment of ASD followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and its protocol was registered in PROSPERO. PubMed, PsycInfo, Embase, WebOfScience and clinicaltrials.gov databases were searched. Twenty-four articles were included in the review. Video game-based interventions were effective for alleviating ASD symptoms, albeit with small effect sizes. High rates of acceptability and adherence to treatment were obtained. Conclusion: Video games are a promising area for improving the treatment of children with ASD. Exploring commercial video games is one of the lines for future research.

The Effects of Physical Activity and Exergaming on Motor Skills and Executive Functions in Children with Autism Spectrum Disorder

Objective: This study aims at investigating the effects of two types of interventions, Sports, Play and Active Recreation for Kids (SPARK) and exergaming (Kinect), on motor skills (MS) and executive functions (EF) in children with autism spectrum disorder (ASD). Materials and Methods: Sixty children, aged 6-10 years were randomly assigned to SPARK (n = 20), Kinect (n = 20), or a control group (n = 20). Children's MS and EF were assessed before and after the intervention. The SPARK and Kinect groups participated in an 8-week intervention; the control group received treatment as usual. Intention-to-treat repeated-measures ANOVA was used to examine the effects of the intervention. Results: For MS, a significant group X time interaction was observed for aiming and catching skills [F(2, 53) = 4.12, P < 0.05]; the SPARK group improved significantly from pre- to post-test compared with the other groups. For EF, a main effect of group was found for correct responses [F(2, 53) = 5.43, P < 0.01]. The Kinect group showed more correct responses than the SPARK and control groups. A main effect of time was significant for conceptual responses [F(1, 53) = 10.61, P < 0.01] and perseverative errors [F(1, 53) = 14.31, P < 0.01]. Conclusion: This study suggests that structured physical activity (PA) interventions that target specific MS improve motor function in children with ASD and exergaming could be effective for improving EF. Future research is needed to untangle the interaction between the type of exercise, traditional PA versus exergaming, and the dose associated with improvements in MS and EF in children with ASD.

Virtual reality in psychiatric disorders: A systematic review of reviews

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

Therapeutic and Preventive Use of Video Games in Child and Adolescent Psychiatry: A Systematic Review

BACKGROUND

Over the past decade, the use of commercial video games and serious games has developed in child and adolescent psychiatry. These games may become relevant alternatives or adjuncts to traditional psychotherapy, providing that their effectiveness is properly established. The purpose of this literature review was to evaluate the effectiveness of serious games and commercial video games in the treatment or prevention of psychiatric disorders in children and adolescents.

METHODS

Medline's database was used to search articles published between January 2012 and July 2019. The following keywords were used for this search: "Video games" OR "Active video game" OR "serious gaming" OR "Serious game" OR "Exergame" AND "Child mental disorder" OR "Adolescent" OR "Child" AND "Therapy" OR "Prevention". Only comparative studies which targeted interventions on children and adolescents suffering from psychiatric disorders were included.

RESULTS

Twenty-two studies, focusing on a wide range of psychiatric conditions, met our inclusion criteria's: 14 evaluated serious games and 8 commercial games. All studies were randomized controlled trials but only two studies compared the intervention game to psychotherapeutic gold standard; other studies used a no-intervention control group or an alternative game as the control group. Eighteen studies reported significant improvements on the symptoms and test scores targeted.

CONCLUSION

Serious games and commercially available video games can be an effective trajectory for psychotherapy in child and adolescent psychiatry. However, there is a lack of longitudinal studies which assess the sustained effects of these games, and standards for proper evaluation of their effectiveness are missing.