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Kantola M, Ilves O, Honkanen S, Hakonen H, Yli-Ikkelä R, Köyhäjoki A, Anttila MR, Rintala A, Korpi H, Sjögren T, Karvanen J, Aartolahti E. The Effects of Virtual Reality Training on Cognition in Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials. J Aging Phys Act 2024; 32:321-349. [PMID: 38242114 DOI: 10.1123/japa.2023-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 01/21/2024]
Abstract
The aim of this systematic review, meta-analysis, and meta-regression was to examine the effects of virtual reality-based training on global cognition and executive function compared with conventional training or information-based treatment in older adults, regardless of cognitive level. A systematic literature search was conducted using four databases. A total of 31 randomized controlled trials were identified. Pooled effect sizes were calculated, the risk of bias was assessed, and evidence was graded. The primary analyses showed a small but statistically significant effect of virtual reality-based training compared with control on global cognition (Hedges' g 0.42, 95% confidence interval [0.17, 0.68], I2 = 70.1%, n = 876, 20 randomized controlled trials, low evidence) and executive function (Hedges' g 0.35, 95% confidence interval [0.06, 0.65], I2 = 68.4%, n = 810, 16 randomized controlled trials, very low evidence). Meta-regression yielded inconclusive results. Virtual reality-based training may be more effective than control in improving cognition in older adults; however, more high-quality studies are needed.
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Affiliation(s)
- Mirjami Kantola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Outi Ilves
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Sports and Rehabilitation, South-Eastern Finland University of Applied Sciences, Savonlinna, Finland
| | - Sari Honkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Harto Hakonen
- Jamk University of Applied Sciences, LIKES, Jyväskylä, Finland
| | - Riku Yli-Ikkelä
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Köyhäjoki
- Central Ostrobothnia Well-Being Service County "Soite", Kokkola, Finland
| | - Marjo-Riitta Anttila
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Aki Rintala
- Physical Activity and Functional Capacity Research Group, Faculty of Health Care and Social Services, LAB University of Applied Sciences, Lahti, Finland
| | - Hilkka Korpi
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Social and Healthcare Unit, Vaasa University of Applied Sciences, Vaasa, Finland
- Well-being and Culture Unit, Oulu University of Applied Sciences, Oulu, Finland
| | - Tuulikki Sjögren
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juha Karvanen
- Faculty of Mathematics and Science, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva Aartolahti
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
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Zukowski LA, Shaikh FD, Haggard AV, Hamel RN. Acute effects of virtual reality treadmill training on gait and cognition in older adults: A randomized controlled trial. PLoS One 2022; 17:e0276989. [PMID: 36322594 PMCID: PMC9629584 DOI: 10.1371/journal.pone.0276989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/17/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Everyday walking often involves walking with divided attention (i.e., dual-tasking). Exercise interventions for older adults should mimic these simultaneous physical and cognitive demands. This proof-of-concept study had a two-fold purpose: 1) identify acute cognitive and gait benefits of a single session of virtual reality treadmill training (VRTT), relative to conventional treadmill training (CTT), and 2) identify differences between those who reduced dual-task costs (i.e., responders) on gait or cognition and those who did not, after the session. METHODS Sixty older adults were randomized to complete a single 30-minute session of VRTT (n = 30, 71.2±6.5 years, 22 females) or CTT (n = 30, 72.0±7.7 years, 21 females). Pre- and post-exercise session, participants performed single-task walking, single-task cognitive, and dual-task walking trials while gait and cognition were recorded. Gait variables were gait speed and gait speed variability. Cognition variables were response reaction time, response accuracy, and cognitive throughput. Dual-task effects (DTE) on gait and cognition variables were also calculated. RESULTS Post-exercise, there were no group differences (all p>0.05). During single- and dual-task trials, both groups walked faster (single-task: F(1, 58) = 9.560, p = 0.003; dual-task: F(1, 58) = 19.228, p<0.001), responded more quickly (single-task: F(1, 58) = 5.054, p = 0.028; dual-task: F(1, 58) = 8.543, p = 0.005), and reduced cognitive throughput (single-task: F(1, 58) = 6.425, p = 0.014; dual-task: F(1, 58) = 28.152, p<0.001). Both groups also exhibited reduced DTE on gait speed (F(1, 58) = 8.066, p = 0.006), response accuracy (F(1, 58) = 4.123, p = 0.047), and cognitive throughput (F(1, 58) = 6.807, p = 0.012). Gait responders and non-responders did not differ (all p>0.05), but cognitive responders completed fewer years of education (t(58) = 2.114, p = 0.039) and better information processing speed (t(58) = -2.265, p = 0.027) than cognitive non-responders. CONCLUSIONS The results indicate that both VRTT and CTT may acutely improve gait and cognition. Therefore, older adults will likely benefit from participating in either type of exercise. The study also provides evidence that baseline cognition can impact training effects on DTE on cognition.
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Affiliation(s)
- Lisa A. Zukowski
- Department of Physical Therapy, High Point University, High Point, North Carolina, United States of America
- * E-mail:
| | - Faisal D. Shaikh
- Department of Physical Therapy, High Point University, High Point, North Carolina, United States of America
| | - Alexa V. Haggard
- Department of Physical Therapy, High Point University, High Point, North Carolina, United States of America
| | - Renee N. Hamel
- Department of Physical Therapy, High Point University, High Point, North Carolina, United States of America
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Câmara J, Ferreira L, Faria AL, Vilar M, Bermúdez I Badia S. Feasibility, Acceptability, and Preliminary Impact of Full-Body Interaction on Computerized Cognitive Training Based on Instrumental Activities of Daily Living: A Pilot Randomized Controlled Trial with Chronic Psychiatric Inpatients. Games Health J 2022; 11:435-446. [PMID: 36251861 DOI: 10.1089/g4h.2021.0228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To conduct a pilot randomized control trial to assess the feasibility and acceptability of full-body interaction cognitive training (FBI-CT) inspired by instrumental activities of daily living in chronic psychiatric inpatients and to explore its preliminary impact on cognitive and noncognitive outcomes. Materials and Methods: Twenty psychiatric inpatients met the inclusion criteria and were randomly allocated to the FBI-CT group (n = 10) or the tablet-based CT group (T-CT) (n = 10). Neuropsychological assessments were performed at baseline, postintervention, and 3-month follow-up. Results: Both groups presented high completion rates at postintervention and follow-up. Participants reported high satisfaction following the interventions, with the FBI-CT group exhibiting slightly higher satisfaction. A within-group analysis showed significant improvements in the FBI-CT group for processing speed and sustained attention for short periods (P = 0.012), verbal memory (P = 0.008), semantic fluency (P = 0.027), depressive symptoms (P = 0.008), and quality of life (P = 0.008) at postintervention. At 3-month follow-up, this group maintained verbal memory improvements (P = 0.047) and depressive symptoms amelioration (P = 0.026). The T-CT group revealed significant improvements in sustained attention for long periods (P = 0.020), verbal memory (P = 0.014), and executive functions (P = 0.047) postintervention. A between-group analysis demonstrated that the FBI-CT group exhibited greater improvements in depressive symptoms (P = 0.042). Conclusions: Overall, we found support for the feasibility and acceptability of both training approaches. Our findings show promise regarding the preliminary impact of the FBI-CT intervention, but due to study limitations such as the small sample size, we cannot conclude that FBI-CT is a more effective approach than T-CT for enhancing cognitive and noncognitive outcomes of chronic psychiatric inpatients. Clinical trials (number: NCT05100849).
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Affiliation(s)
- Joana Câmara
- Faculdade de Psicologia e de Ciências de Educação, Universidade de Coimbra, Coimbra, Portugal
- NOVA Laboratory for Computer Science and Informatics, Universidade da Madeira, Funchal, Portugal
| | - Luís Ferreira
- NOVA Laboratory for Computer Science and Informatics, Universidade da Madeira, Funchal, Portugal
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| | - Ana Lúcia Faria
- NOVA Laboratory for Computer Science and Informatics, Universidade da Madeira, Funchal, Portugal
- Escola Superior de Saúde, Universidade da Madeira, Funchal, Portugal
| | - Manuela Vilar
- Faculdade de Psicologia e de Ciências de Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Sergi Bermúdez I Badia
- NOVA Laboratory for Computer Science and Informatics, Universidade da Madeira, Funchal, Portugal
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
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Executive Function Improvement for Children with Autism Spectrum Disorder: A Comparative Study between Virtual Training and Physical Exercise Methods. CHILDREN 2022; 9:children9040507. [PMID: 35455551 PMCID: PMC9029765 DOI: 10.3390/children9040507] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 12/04/2022]
Abstract
This study evaluated and compared the effects of virtual training and physical exercise on the executive function of children with autism spectrum disorder (ASD). After screening, the final analysis of this study was conducted on three groups: a virtual training group (n = 34), a physical exercise group (n = 33), and a control group (n = 33). The experiment was conducted for nine weeks, of which the virtual training group and physical exercise group were conducted three times a week for one hour each time during the first six weeks, while the control group did not conduct virtual training nor physical exercise. During the last three weeks (week 6 to week 9), virtual training and physical exercise were not performed on all three groups. The three main components of executive function (working memory, inhibition, flexibility) of children with ASD were measured before the intervention, after the intervention (week 1 to week 6) and in the last three weeks (week 6 to week 9). The final results are that firstly, the executive function of the virtual training and physical exercise groups were simultaneously improved after the intervention. Secondly, after the intervention stopped, the executive function of the virtual training and physical exercise groups showed a downward trend. Therefore, the study concludes that the application of virtual training and physical exercise can effectively enhance the executive function of children with ASD.
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Liu CL, Cheng FY, Wei MJ, Liao YY. Effects of Exergaming-Based Tai Chi on Cognitive Function and Dual-Task Gait Performance in Older Adults With Mild Cognitive Impairment: A Randomized Control Trial. Front Aging Neurosci 2022; 14:761053. [PMID: 35370622 PMCID: PMC8965318 DOI: 10.3389/fnagi.2022.761053] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/13/2022] [Indexed: 12/31/2022] Open
Abstract
Background Declined cognitive function interferes with dual-task walking ability and may result in falls in older adults with mild cognitive impairment (MCI). The mind-body exercise, Tai Chi (TC), improves cognition and dual-task ability. Exergaming is low-cost, safe, highly scalable, and feasible. Whether the effects of exergaming-based TC is beneficial than traditional TC has not been investigated yet. Objectives The objective of this study was to investigate effects of exergaming-based TC on cognitive function and dual-task walking among older adults with MCI. Methods Fifty patients with MCI were randomly assigned to an exergaming-based TC (EXER-TC) group, a traditional TC (TC) group, or a control group. The EXER-TC and TC groups received 36 training sessions (three, 50-min sessions per week) during a 12-week period. The control group received no intervention and were instructed to maintain their usual daily physical activities. The outcome variables measured included those related to cognitive function, dual-task cost (DTC), and gait performance. Results The EXER-TC and TC groups performed better than the control group on the Chinese version of the Stroop Color and Word Test, the Trail Making Test Parts A and B, the one-back test, gait speed, and DTC of gait speed in cognitive dual-task conditions after training. However, there were no significant differences between the EXER-TC and TC groups. Compared with the control group, only the EXER-TC group experienced beneficial effects for the Montreal Cognitive Assessment. Conclusion EXER-TC was comparable to traditional TC for enhancement of dual-task gait performance and executive function. These results suggested that the EXER-TC approach has potential therapeutic use in older adults with MCI.
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Affiliation(s)
- Chien-Liang Liu
- Department of Neurology, Taipei City Hospital, Taipei, Taiwan
- Dementia Center, Taipei City Hospital, Taipei, Taiwan
- General Education Center, University of Taipei, Taipei, Taiwan
| | - Fang-Yu Cheng
- Institute of Long-Term Care, Mackay Medical College, Taipei, Taiwan
| | - Min-Ju Wei
- Department of Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Ying-Yi Liao
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Science, Taipei, Taiwan
- Department of Teaching and Research, Taipei City Hospital, Taipei, Taiwan
- *Correspondence: Ying-Yi Liao,
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