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Tan JW, Tan G, Lian X, Chong DKS, Rajalingam P, Dalan R, Mogali SR. Impact of Facilitation on Cognitive Flow in a Novel Diabetes Management Rehearsal Game for Health Professions Education: Mixed Methods, Open-Label, Superiority Randomized Controlled Trial. JMIR Serious Games 2024; 12:e54703. [PMID: 38900700 PMCID: PMC11292155 DOI: 10.2196/54703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/02/2024] [Accepted: 05/31/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Though the prevalence of diabetes is set to increase, most serious game solutions typically target patient self-management and education. Few games target health care professions education, and even fewer consider the factors that may increase their efficacies. The impact of facilitation, a prominent feature of health professions education, is examined in the context of a rehearsal-based diabetes management serious game. OBJECTIVE In this mixed methods, open-label, superiority randomized controlled trial, we compare student performance, attitudes, and perceptions of a rehearsal-based diabetes management game for health care professionals. METHODS Student participants were randomized into 2 groups to play a diabetes management game. The control group played the game alone, and the intervention group played the same game alongside a facilitator tasked to moderate overall challenge levels and address queries. Both groups were administered the Flow Short Scale, a 13-item measure rated on a 7-point Likert scale ranging from 1 ("not at all") to 7 ("very much") immediately after the game. Students were then invited to voluntary focus group discussions to elicit their attitudes and perceptions of the game. Findings were subject to between-group comparisons and inductive thematic analysis respectively. RESULTS A total of 48 (26 control, 22 intervention) clinical-year undergraduates from the Lee Kong Chian School of Medicine in Singapore participated in this study, with 18 continuing to the focus group discussions. Flow Short Scale results indicated the superiority of the intervention group for overall flow (t46=-2.17, P=.04) and the absorption subdomain (t46=-2.6, P=.01). Qualitative results indicated students viewed facilitation as helpful and appropriate, and were able to identify improvable elements of the game's theoretical foundations and overall design. CONCLUSIONS While serious games are efficacious means of rehearsing previously learned knowledge, facilitation allows for their efficiency to be greatly increased. Such increases are likely crucial in the coming years with the increased digitization of health care professions education and the prevalence of diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT05637749; https://www.clinicaltrials.gov/study/NCT05637749.
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Affiliation(s)
- Jun Wen Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Xia Lian
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Darren Kai Siang Chong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Preman Rajalingam
- Institute of Learning, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
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Wang Y, Wang L, Yan J, Yuan X, Lou QQ. Aerobic Training Increases Hippocampal Volume and Protects Cognitive Function for Type 2 Diabetes Patients with Normal Cognition. Exp Clin Endocrinol Diabetes 2023; 131:605-614. [PMID: 37268011 DOI: 10.1055/a-2105-0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To evaluate the effects of aerobic training on hippocampal volume and cognitive function in patients with type 2 diabetes mellitus (T2DM) with normal cognition. MATERIALS AND METHODS One hundred patients with T2DM aged 60-75 years who met inclusion criteria were randomized into the aerobic training group (n=50) and control group (n=50). The aerobic training group received 1 year of aerobic training, while the control group maintained their lifestyle without additional exercise intervention. The primary outcomes were hippocampal volume measured by MRI and Mini-mental State Examination (MMSE) score or Montreal Cognitive Assessment scale (MoCA) scores. RESULTS Eighty-two participants completed the study (aerobic training group, n=40; control group, n=42). There was no significant difference between the two groups at baseline (P>0.05). After one year of moderate aerobic training, increase in total and right hippocampal volume in the aerobic training group were significantly higher than in the control group (P=0.027, P=0.043, respectively). In the aerobic group, total hippocampal volume significantly increased after the intervention compared with baseline (P=0.034). The between-group difference in the change of MMSE and MoCA scores was statistically significant (P=0.015, P=0.027, respectively). Logistic regression showed strong correlations between aerobic training and increase in total hippocampal volume (OR:1.091, [95%CI 0.969, 1.228], P=0.002), improvement of MMSE scores (OR:1.127, [95%CI 1.005, 1.263], P=0.041) or MoCA scores (OR:2.564, [95%CI 2.098.2.973], P=0.045). CONCLUSIONS One-year moderate aerobic training increased total and right hippocampal volume and protected cognitive function for T2DM patients with normal cognition. Early intervention focusing on cognition protection should be considered for T2DM patients in clinical settings.
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Affiliation(s)
- Ying Wang
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan Province, China
| | - Liping Wang
- Department of Geriatrics, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Juan Yan
- Jiangsu college of nursing, Huaian, Jiangsu Province, China
| | - Xiaodan Yuan
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Qing Q Lou
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan Province, China
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Wang H, Tang W, Zhao Y. Acute effects of different exercise forms on executive function and the mechanism of cerebral hemodynamics in hospitalized T2DM patients: a within-subject study. Front Public Health 2023; 11:1165892. [PMID: 37333536 PMCID: PMC10270376 DOI: 10.3389/fpubh.2023.1165892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
Objective This study aimed to investigate the acute effects of aerobic exercise (AE), resistance exercise (RE), and integrated concurrent exercise (ICE; i.e., AE plus RE) on executive function among hospitalized type 2 diabetes mellitus (T2DM) inpatients, and the mechanism of cerebral hemodynamics. Methods A within-subject design was applied in 30 hospitalized patients with T2DM aged between 45 and 70 years in the Jiangsu Geriatric Hospital, China. The participants were asked to take AE, RE, and ICE for 3 days at 48-h intervals. Three executive function (EF) tests, namely, Stroop, More-odd shifting, and 2-back tests, were applied at baseline and after each exercise. The functional near-infrared spectroscopy brain function imaging system was used to collect cerebral hemodynamic data. The one-way repeated measurement ANOVA was used to explore training effects on each test indicator. Results Compared with the baseline data, the EF indicators have been improved after both ICE and RE (p < 0.05). Compared with the AE group, the ICE and RE groups have demonstrated significant improvements in inhibition (ICE: MD = - 162.92 ms; RE: MD = -106.86 ms) and conversion functions (ICE: MD = -111.79 ms; RE: MD = -86.95 ms). Based on the cerebral hemodynamic data, the beta values of brain activation in executive function related brain regions increased after three kinds of exercise, the EF improvements after the ICE showed synchronous activation of blood flow in the dorsolateral prefrontal cortex (DLPFC), the frontal polar (FPA) and orbitofrontal cortex (OFC), the improvement of inhibitory function after RE displayed synchronous activation of DLPFC and FPA, and AE mainly activates DLPFC. The HbO2 concentration in the pars triangularis Broca's area increased significantly after AE, but the EF did not improve significantly. Conclusion The ICE is preferred for the improvements of executive function in T2DM patients, while AE is more conducive to the improvements of refresh function. Moreover, a synergistic mechanism exists between cognitive function and blood flow activation in specific brain regions.
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Affiliation(s)
- Haolin Wang
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
| | - Wei Tang
- Department of Endocrinology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Yanan Zhao
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
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Pennington DL, Reavis JV, Cano MT, Walker E, Batki SL. The Impact of Exercise and Virtual Reality Executive Function Training on Cognition Among Heavy Drinking Veterans With Traumatic Brain Injury: A Pilot Feasibility Study. Front Behav Neurosci 2022; 16:802711. [PMID: 35391785 PMCID: PMC8981916 DOI: 10.3389/fnbeh.2022.802711] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/22/2022] [Indexed: 12/19/2022] Open
Abstract
Executive function (EF) underlies self-control deficits in alcohol use disorder (AUD) and traumatic brain injury (TBI). Cognitive training is a promising adjunctive treatment targeting TBI- and AUD- related cognitive dysfunction. However, major limitations related to compliance and generalizability in the field of cognitive training exist. Physical activity is associated with enhanced cognitive performance across several executive functions and may enhance the benefits of cognitive training. Virtual reality provides multisensory embodied experiences which are likely to engage brain networks more efficiently than standard cognitive training systems, ultimately resulting in greater near- and far-transfer effects. This pilot study aimed to obtain feasibility data and a preliminary assessment of an enriched virtual reality (VR) EF training (EFT) intervention combined with exercise (NCT03786276). Using an 8-week randomized adaptive design study, 30 AUD treatment seeking U.S. Veterans completed nine sessions of exercise-only (n = 15) or gameplay control (n = 15) over 3 weeks, followed by a week-4 repeat assessment in Phase 1. Twenty-three participants completed and moved onto Phase II, where they completed up to nine sessions of VR-EFT plus exercise and completed a week-8 end-of-study assessment. Primary outcomes included feasibility to retain participants, usability, and satisfaction of using VR-EFT. Secondary and exploratory outcomes included within group assessment of change in cognitive function, alcohol use, alcohol craving, and post-concussive symptoms among the three treatment conditions.VR-EFT was feasible with moderate usability and high acceptability ratings.The most common VR-related adverse effect was motion sickness (n = 2/16, 12.5%). The VR-EFT condition was associated with significant improvement in inhibition-switching and visual scanning (both p < 0.05) during Phase II. Exercise-only was associated with significant improvements in cognitive inhibition, cognitive flexibility, reductions in alcohol craving, and number of standard alcohol drinks per week (all p ≤ 0.05). The gaming-control condition was associated with improvement in cognitive flexibility and visuospatial immediate recall (both p < 0.05) during Phase 1. Recruitment and retention of U.S. veterans with AUD and TBI into an exercise plus VR-EFT intervention is feasible, but technological barriers may impact usability. VR-EFT was associated with improvement in executive function domains that were targeted in as little as 3-week and nine sessions of VR-EFT exposure. Results are promising and indicate the need for a larger controlled investigation to assess the efficacy of VR-EFT to enhance treatment outcomes among AUD treatment-seeking U.S. veterans with co-occurring AUD and TBI. Clinical Trial Registration www.ClinicalTrials.gov, Identifier: NCT03786276.
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Affiliation(s)
- David L. Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, United States
| | - Jill V. Reavis
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, United States
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Monique T. Cano
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
| | - Erica Walker
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, United States
| | - Steven L. Batki
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, United States
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Suleiman-Martos N, García-Lara R, Albendín-García L, Romero-Béjar JL, Cañadas-De La Fuente GA, Monsalve-Reyes C, Gomez-Urquiza JL. Effects of active video games on physical function in independent community-dwelling older adults: A systematic review and meta-analysis. J Adv Nurs 2021; 78:1228-1244. [PMID: 34935178 DOI: 10.1111/jan.15138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/25/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023]
Abstract
AIM To analyse the effects of active video games on physical function in independent community-dwelling older adults. DESIGN Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES The CINAHL, LILACS, Medline, Proquest and Scopus databases were consulted, with no restriction by year of publication. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The meta-analysis was performed using RevMan software. RESULTS The analysis included 22 randomized controlled trials with a total of 1208 participants (all ≥55 years old). In our meta-analyses, the effects produced by playing the active video games (mean differences) were statistically significant for the variables Gait speed and Timed up-and-go. The differences between the control and experimental groups were not significant in the following tests: 6-minute walk, 30-second chair stand, balance (measured with the Berg Balance Scale), cadence, grip strength, knee extension strength, 8-Foot Up-and-Go or velocity. CONCLUSIONS Physical exercise from participation in active video games has beneficial effects on two clinical parameters (Gait speed and Timed up-and-go) in independent community-dwelling older adults. However, the effects on other parameters do not differ from those obtained with conventional exercise training. Therefore, the clinical significance of these benefits is limited. IMPACT Older adults usually perform little physical activity. In consequence, researchers have increasingly considered alternatives to traditional forms of exercise. One such is that provided by active video games, which can be a source of stimulation, encouraging adherence and motivation in exercise programmes. Our review shows that active video games can improve gait speed and mobility, but in other respects obtain no differences from conventional exercises. Further tailored randomized clinical trials should be undertaken with diverse populations of older adults to evaluate different physical function variables to determine the most appropriate training approach and its optimal design and duration.
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Affiliation(s)
| | - Rubén García-Lara
- Granada-Northeast Health Management Area, Andalusian Health Service, Granada, Spain
| | - Luis Albendín-García
- Granada-Metropolitano Health District, Andalusian Health Service, Granada, Spain
| | - José L Romero-Béjar
- Statistics and Operational Research Department, University of Granada, Granada, Spain
| | | | - Carolina Monsalve-Reyes
- Social Sciences Department, Catholic University of La Santísima Concepción, Concepción, Chile
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Marinus N, Hansen D, Feys P, Meesen R, Timmermans A, Spildooren J. Cycling: how can we activate care-dependent older adults with a mild cognitive impairment? Disabil Rehabil Assist Technol 2021:1-8. [PMID: 34102092 DOI: 10.1080/17483107.2021.1936665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE In residential care, 50% of older adults are sedentary in most of their time, regardless of the positive impact of physical exercise on health. This study analysed whether television images positively impact the motivation and exercise intensity of cycling exercises of older adults in residential care. METHODS In this randomised controlled cross-over study, 10 residential older adults (mean age 85.0 ± 5.7 years) with Mild Cognitive Impairment (MCI) participated in 3 different cycling exercise interventions (TV off, TV turned on the National Geographic channel (NG) and TV with MemoRide software (Activ84Health®, Leuven, Belgium) (MR) (cybercycling)) compared with a rest condition. RESULTS The participants cycled significantly more distance during NG compared with TVoff (p = 0.024). In comparison to the rest condition, the mean heart rate was significantly higher in all exercise conditions while the maximal heart rate was only higher during NG (p = 0.022). There was no difference in the Borg scale between the different exercise interventions. Interest and enjoyment scored significantly higher during NG (p = 0.014) and MR (p = 0.047) compared to the rest condition and in the NG versus TVoff (p = 0.018). No significant differences were observed in the emotions of the participants. CONCLUSIONS This study has shown indications that the addition of television images may increase the exercise intensity and motivation to exercise in residential older adults with MCI. However, the overall levels of physical activity were insufficient to meet the recommendations for moderate-intense aerobic exercise according to the International Association of Gerontology and Geriatrics and Global Ageing Research Network.Implications for rehabilitationCycling in front of a television increases the exercise volume and motivation to exercise in residential (pre)frail older adults with MCICybercycling had no additional effect in comparison to television images not linked to the exercise.Even with television images (pre)frail older adults with MCI did not meet the recommendations for moderate-intense aerobic exercise for residential older adults according to the IAGG-GARN.
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Affiliation(s)
- Nastasia Marinus
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,BIOMED - Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
| | - Dominique Hansen
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,BIOMED - Biomedical Research Center, Hasselt University, Diepenbeek, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Peter Feys
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,BIOMED - Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
| | - Raf Meesen
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joke Spildooren
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Batcir S, Livne Y, Lev Lehman R, Edelman S, Schiller L, Lubovsky O, Shani G, Shapiro A, Melzer I. Development and piloting of a perturbation stationary bicycle robotic system that provides unexpected lateral perturbations during bicycling (the PerStBiRo system). BMC Geriatr 2021; 21:71. [PMID: 33478400 PMCID: PMC7818783 DOI: 10.1186/s12877-021-02015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Balance control, and specifically balance reactive responses that contribute to maintaining balance when balance is lost unexpectedly, is impaired in older people. This leads to an increased fall risk and injurious falls. Improving balance reactive responses is one of the goals in fall-prevention training programs. Perturbation training during standing or treadmill walking that specifically challenges the balance reactive responses has shown very promising results; however, only older people who are able to perform treadmill walking can participate in these training regimes. Thus, we aimed to develop, build, and pilot a mechatronic Perturbation Stationary Bicycle Robotic system (i.e., PerStBiRo) that can challenge balance while sitting on a stationary bicycle, with the aim of improving balance proactive and reactive control. Methods This paper describes the development, and building of the PerStBiRo using stationary bicycles. In addition, we conducted a pilot randomized control trial (RCT) with 13 older people who were allocated to PerStBiRo training (N = 7) versus a control group, riding stationary bicycles (N = 6). The Postural Sway Test, Berg Balance Test (BBS), and 6-min Walk Test were measured before and after 3 months i.e., 20 training sessions. Results The PerStBiRo System provides programmed controlled unannounced lateral balance perturbations during stationary bicycling. Its software is able to identify a trainee’s proactive and reactive balance responses using the Microsoft Kinect™ system. After a perturbation, when identifying a trainee’s trunk and arm reactive balance response, the software controls the motor of the PerStBiRo system to stop the perturbation. The pilot RCT shows that, older people who participated in the PerStBiRo training significantly improved the BBS (54 to 56, p = 0.026) and Postural Sway velocity (20.3 m/s to 18.3 m/s, p = 0.018), while control group subject did not (51.0 vs. 50.5, p = 0.581 and 15 m/s vs. 13.8 m/s, p = 0.893, respectively), 6MWT tended to improve in both groups. Conclusions Our participants were able to perform correct balance proactive and reactive responses, indicating that older people are able to learn balance trunk and arm reactive responses during stationary bicycling. The pilot study shows that these improvements in balance proactive and reactive responses are generalized to performance-based measures of balance (BBS and Postural Sway measures). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02015-1.
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Affiliation(s)
- Shani Batcir
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel
| | - Yaakov Livne
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel
| | - Rotem Lev Lehman
- Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Shmil Edelman
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel
| | - Lavi Schiller
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel
| | - Omri Lubovsky
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Guy Shani
- Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Amir Shapiro
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel.
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel.
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Batcir S, Lubovsky O, Bachner YG, Melzer I. The Effects of Bicycle Simulator Training on Anticipatory and Compensatory Postural Control in Older Adults: Study Protocol for a Single-Blind Randomized Controlled Trial. Front Neurol 2021; 11:614664. [PMID: 33536998 PMCID: PMC7848125 DOI: 10.3389/fneur.2020.614664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Falls are the leading cause of fatal and non-fatal injuries among older adults. Perturbation-Based-Balance Training (PBBT) is a promising approach to reduce fall rates by improving reactive balance responses. PBBT programs are designed for older adults who are able to stand and walk on a motorized treadmill independently. However, frail older adults, whose fall rates are higher, may not have this ability and they cannot participate. Thus, there is a critical need for innovative perturbation exercise programs to improve reactive balance and reduce the fall risks among older adults in a wider range of functioning. Trunk and arms are highly involved in reactive balance reactions. We aim to investigate whether an alternative PBBT program that provides perturbations during hands-free bicycling in a sitting position, geared to improve trunk and arm reactive responses, can be transferred to reduce fall risks and improve balance function among pre-frail older adults. Methods: In a single-blinded randomized-controlled trial, 68 community-dwelling pre-frail older adults are randomly allocated into two intervention groups. The experimental group receives 24-PBBT sessions over 12-weeks that include self-induced internal and machine-induced external unannounced perturbations of balance during hands-free pedaling on a bicycle-simulator system, in combination with cognitive dual-tasks. The control group receives 24 pedaling sessions over 12-weeks by the same bicycle-simulator system under the same cognitive dual-tasks, but without balance perturbations. Participants' reactive and proactive balance functions and gait function are assessed before and after the 12-week intervention period (e.g., balance reactive responses and strategies, voluntary step execution test, postural stability in upright standing, Berg Balance Test, Six-meter walk test, as well as late life function and fear of falling questionnaires). Discussion: This research addresses two key issues in relation to balance re-training: (1) generalization of balance skills acquired through exposure to postural perturbations in a sitting position investigating the ability of pre-frail older adults to improve reactive and proactive balance responses in standing and walking, and (2) the individualization of perturbation training to older adults' neuromotor capacities in order to optimize training responses and their applicability to real-life challenges. Clinical Trial Registration:www.clinicaltrials.gov, NCT03636672 / BARZI0104; Registered: July 22, 2018; Enrolment of the first participant March: 1, 2019. See Supplementary File.
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Affiliation(s)
- Shani Batcir
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Omri Lubovsky
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Yaacov G Bachner
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University, Be'er Sheva, Israel
| | - Itshak Melzer
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Carmichael OT, Neiberg RH, Dutton GR, Hayden KM, Horton E, Pi-Sunyer FX, Johnson KC, Rapp SR, Spira AP, Espeland MA. Long-term Change in Physiological Markers and Cognitive Performance in Type 2 Diabetes: The Look AHEAD Study. J Clin Endocrinol Metab 2020; 105:5897494. [PMID: 32845968 PMCID: PMC7566388 DOI: 10.1210/clinem/dgaa591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT The effects of physiological improvements on cognitive function among persons with type 2 diabetes mellitus (T2DM) are not fully understood. OBJECTIVE To determine whether improvements in physiological markers (body weight, blood sugar control, and physical activity) during intensive lifestyle intervention (ILI) are associated with enhancements in cognitive function in older adults with T2DM. DESIGN Multisite randomized controlled trial. SETTING Academic research centers. PATIENTS OR OTHER PARTICIPANTS Participants were aged 45-76 years, with T2DM. INTERVENTION The Action for Health in Diabetes (Look AHEAD) study, a randomized, controlled clinical trial of ILI. MAIN OUTCOME MEASURE Two to 3 cognitive assessments were collected from 1089 participants, the first and last occurring a mean (standard deviation) of 8.6 (1.0) and 11.5 (0.7) years after enrollment. RESULTS Greater improvement in blood sugar control was associated with better cognitive scores (fasting glucose and Rey Auditory Verbal Learning Test [AVLT]: P = 0.0148; fasting glucose and Digit Symbol Coding (DSC): P = 0.0360; HbA1C and DSC: P = 0.0477); but weight loss had mixed associations with cognitive scores (greater body mass index [BMI] reduction and worse AVLT overall: P = 0.0053; and greater BMI reduction and better DSC scores among those overweight but not obese at baseline: P = 0.010). Associations were strongest among those who were overweight (not obese) at baseline, and among those with a history of cardiovascular disease (CVD) at baseline. CONCLUSIONS Improvements in glycemic control, but not necessarily weight status, during ILI may be associated with better subsequent cognitive performance. These associations may differ by adiposity and CVD history.
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Affiliation(s)
- Owen T Carmichael
- Biomedical Imaging Center, Pennington Biomedical Research Center, Baton Rouge, Louisiana
- Correspondence and Reprint Requests: Owen T. Carmichael, PhD, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA. E-mail:
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gareth R Dutton
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathleen M Hayden
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward Horton
- Joslin Diabetes Center, Harvard University, Boston, Massachusetts
| | - F Xavier Pi-Sunyer
- Division of Endocrinology, Obesity/Nutrition Research Center, Columbia University College of Physicians and Surgeons, New York, NY
| | - Karen C Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Stephen R Rapp
- Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Mark A Espeland
- Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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10
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Zhao Q, Zhang Y, Liao X, Wang W. Executive Function and Diabetes: A Clinical Neuropsychology Perspective. Front Psychol 2020; 11:2112. [PMID: 32973635 PMCID: PMC7468478 DOI: 10.3389/fpsyg.2020.02112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/29/2020] [Indexed: 02/05/2023] Open
Abstract
Objective Diabetes is a global public health concern. Management of diabetes depends on successful implementation of strategies to alleviate decline in executive functions (EFs), a characteristic of diabetes progression. In this review, we describe recent research on the relationship between diabetes and EF, summarize the existing evidence, and put forward future research directions and applications. Methods Herein, we provide an overview of recent studies, to elucidate the relationship between DM and EF. We identified new screening objectives, management tools, and intervention targets for diabetes management. We also discuss the implications for clinical practice. Results In both types 1 and 2 diabetes mellitus (DM), hyperglycemia substantially impairs EF in people of all age groups and ethnicities. Hypoglycemia can similarly impair EF. Interestingly, a decline in EF contributes to DM progression. Glucose dysregulation and EF decline exacerbate each other in a vicious cycle: poor blood glucose control, impaired EF, diabetes management task failure, then back to poor blood glucose control. Many pathophysiological indexes (e.g., obesity, metabolic index, inflammatory and immune factors), neuropsychological indexes (e.g., compliance, eating habits, physical exercise, sleep, and depression), and genetic factors are changed by this pathological interaction between DM and EF. These changes can provide insight into the pathophysiological mechanisms of diabetes-related EF decline. Conclusion Further studies, including large-scale prospective and randomized controlled trials, are needed to elucidate the mechanism of the interaction between diabetes and EF and to develop novel strategies for breaking this cycle.
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Affiliation(s)
- Qian Zhao
- International Medical Center/Ward of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- International Medical Center/Ward of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Weiwen Wang
- Department of Neurology, General Hospital of Western Theater Command, Chengdu, China
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11
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Khalili-Mahani N, Assadi A, Li K, Mirgholami M, Rivard ME, Benali H, Sawchuk K, De Schutter B. Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study. JMIR Ment Health 2020; 7:e12388. [PMID: 32213474 PMCID: PMC7146255 DOI: 10.2196/12388] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/20/2019] [Accepted: 12/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants' motivations to adopt these technologies. OBJECTIVE This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework. METHODS A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S1-BrainGame, S2-CarRace, and S3-Exergame). Each session included an identical sequence of activities (t1-Baseline, t2-Picture encode, t3-Play, t4-Stroop test, t5-Play, and t6-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire. RESULTS Session×activity effects were significant on all ambulatory measures (χ210>20; P<.001) other than cortisol (P=.37). Compared with S1 and S2, S3 was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S1, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S3. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (χ21>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group. CONCLUSIONS Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed.
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Affiliation(s)
- Najmeh Khalili-Mahani
- PERFORM Centre, Concordia University, Montreal, QC, Canada.,McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Atousa Assadi
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Kate Li
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | | | | | - Habib Benali
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Kim Sawchuk
- Department of Communications, Concordia University, Montreal, QC, Canada
| | - Bob De Schutter
- Armstrong Institute for Interactive Media Studies, Miami University, Oxford, OH, United States
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12
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Suh J, Choi HS, Kwon A, Chae HW, Eom S, Kim HS. Once-weekly supervised combined training improves neurocognitive and psychobehavioral outcomes in young patients with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2019; 32:1341-1350. [PMID: 31689232 DOI: 10.1515/jpem-2019-0120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/28/2019] [Indexed: 11/15/2022]
Abstract
Background Previous studies investigating the beneficial effects of exercise in type 1 diabetes mellitus (T1DM) are relatively insufficient compared to studies on type 2 diabetes mellitus (T2DM), due to the fear of hypoglycemia. Recently, several researchers have reported that combined aerobic and resistance exercise prevents hypoglycemia during and after exercise. Furthermore, exercise has been shown to have beneficial effects on the psychological status of patients with various diseases. The aim of this study was to evaluate the effect of combined aerobic and resistance exercise in adolescents with T1DM. Methods Thirty-five type 1 diabetic patients were enrolled, and subjects were divided into either an exercise group or a control group. Thirty patients (20 patients in the exercise group, 10 patients in the control group) completed the study. The exercise program was performed for 1 h at a time, once a week, for 12 weeks. Study parameters were evaluated at baseline and 3 months after baseline evaluation. Results Combined aerobic and resistance exercise better controlled the body mass index (BMI), and also improved maximum muscular strength and maximum exercise intensity. On psychological tests, subjects' attention and quality of life showed improving tendency, while their stress and behavioral problems diminished. The number of exercise events increased in the training group, while the daily total insulin dose and glycated hemoglobin (HbA1c) level showed no significant changes. Conclusions A 12-week structured exercise program consisting of aerobic and resistance exercises improves cardiovascular, neurocognitive and psychobehavioral functions, and positively helps lifestyle modification in patients with T1DM.
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Affiliation(s)
- Junghwan Suh
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Han Saem Choi
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Soyong Eom
- Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
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13
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Huang KT. Exergaming Executive Functions: An Immersive Virtual Reality-Based Cognitive Training for Adults Aged 50 and Older. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 23:143-149. [PMID: 31794673 DOI: 10.1089/cyber.2019.0269] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Prior research suggests that both exergaming and virtual reality (VR)-based training programs could improve executive functions in older adults. However, few studies investigated whether combining exergaming with VR would be more effective. This study seeks to (a) investigate whether playing exergames in an immersive virtual environment (IVE) would yield differential outcomes in selected executive functions, including inhibition, task switching, and working, and (b) examine the role of feeling of presence as a potential mediator between immersive exergaming and cognitive improvement in specific domains. Thirty-three participants over 50 years of age (mean age = 62) participated in a 4-week training program and were randomly assigned into an IVE and non-IVE to play an exergame (Fruit Ninja) for eight sessions within 4 weeks. The results revealed a significant effect of the IVE on the Stroop Test and Trail Making Test after the 4-week training. Furthermore, the impacts of the IVE exergaming on these two tasks were mediated by the feeling of presence. These findings suggested that the immersive experience of exergaming would elicit the feeling of presence, which later contributes to improved cognitive performances in inhibition and task switching. For the theoretical implications, this study extends previous research by showing that (a) feeling of presence could contribute to older adults' cognitive improvement, and (b) the impacts of immersive exergame training on executive functions vary across individual domains. Additionally, this study provides practical implications such that the design of exergames could emphasize the game features requiring mental simulation, which can serve as a novel strategy for preventing cognitive decline in midlife and old age.
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Affiliation(s)
- Kuo-Ting Huang
- Department of Journalism, Center for Emerging Media Design and Development, Ball State University, Muncie, Indiana
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14
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Sakhare AR, Yang V, Stradford J, Tsang I, Ravichandran R, Pa J. Cycling and Spatial Navigation in an Enriched, Immersive 3D Virtual Park Environment: A Feasibility Study in Younger and Older Adults. Front Aging Neurosci 2019; 11:218. [PMID: 31474851 PMCID: PMC6706817 DOI: 10.3389/fnagi.2019.00218] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/02/2019] [Indexed: 12/20/2022] Open
Abstract
Background Cognitive decline is a significant public health concern in older adults. Identifying new ways to maintain cognitive and brain health throughout the lifespan is of utmost importance. Simultaneous exercise and cognitive engagement has been shown to enhance brain function in animal and human studies. Virtual reality (VR) may be a promising approach for conducting simultaneous exercise and cognitive studies. In this study, we evaluated the feasibility of cycling in a cognitively enriched and immersive spatial navigation VR environment in younger and older adults. Methods A total of 20 younger (25.9 ± 3.7 years) and 20 older (63.6 ± 5.6 years) adults participated in this study. Participants completed four trials (2 learning and 2 recall) of cycling while wearing a head-mounted device (HMD) and navigating a VR park environment. Questionnaires were administered to assess adverse effects, mood, presence, and physical exertion levels associated with cycling in the VR environment. Results A total of 4 subjects withdrew from the study due to adverse effects, yielding a 90% completion rate. Simulator sickness levels were enhanced in both age groups with exposure to the VR environment but were within an acceptable range. Exposure to the virtual environment was associated with high arousal and low stress levels, suggesting a state of excitement, and most participants reported enjoyment of the spatial navigation task and VR environment. No association was found between physical exertion levels and simulator sickness levels. Conclusion This study demonstrates that spatial navigation while cycling is feasible and that older adults report similar experiences to younger adults. VR may be a powerful tool for engaging physical and cognitive activity in older adults with acceptable adverse effects and with reports of enjoyment. Future studies are needed to assess the efficacy of a combined exercise and cognitive VR program as an intervention for promoting healthy brain aging, especially in older adults with increased risk of age-related cognitive decline.
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Affiliation(s)
- Ashwin R Sakhare
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Vincent Yang
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Joy Stradford
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Ivan Tsang
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Roshan Ravichandran
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Judy Pa
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
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15
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Daily Bicycling in Older Adults May be Effective to Reduce Fall Risks-A Case-Control Study. J Aging Phys Act 2018; 26:570-576. [PMID: 29345533 DOI: 10.1123/japa.2017-0263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Older adults gain many health benefits from riding bicycles regularly. We aimed to explore whether older persons who ride bicycles regularly have better balance than controls. Balance control and voluntary stepping were assessed in 20 older adults aged 65-85 years who live in an agricultural community village and who ride bicycles regularly, and 30 age- and gender-matched nonbicycle riders (NBR). Self-reported function and fear of fall were also assessed. Bicycle riders (BR) showed significantly better balance, faster voluntary stepping, and better self-reported advanced lower-extremity function compared with NBR. The results might suggest that bicycling regularly preserves balance control and speed of voluntary stepping in older adults because bicycling might maintain specific balance coordination patterns. The results should be treated with caution as bicycle riders were older adults who selected an active lifestyle (i.e., bicycling as well as living in an agricultural village) that may bias the results.
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16
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Pardue MT, Allen RS. Neuroprotective strategies for retinal disease. Prog Retin Eye Res 2018; 65:50-76. [PMID: 29481975 PMCID: PMC6081194 DOI: 10.1016/j.preteyeres.2018.02.002] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
Diseases that affect the eye, including photoreceptor degeneration, diabetic retinopathy, and glaucoma, affect 11.8 million people in the US, resulting in vision loss and blindness. Loss of sight affects patient quality of life and puts an economic burden both on individuals and the greater healthcare system. Despite the urgent need for treatments, few effective options currently exist in the clinic. Here, we review research on promising neuroprotective strategies that promote neuronal survival with the potential to protect against vision loss and retinal cell death. Due to the large number of neuroprotective strategies, we restricted our review to approaches that we had direct experience with in the laboratory. We focus on drugs that target survival pathways, including bile acids like UDCA and TUDCA, steroid hormones like progesterone, therapies that target retinal dopamine, and neurotrophic factors. In addition, we review rehabilitative methods that increase endogenous repair mechanisms, including exercise and electrical stimulation therapies. For each approach, we provide background on the neuroprotective strategy, including history of use in other diseases; describe potential mechanisms of action; review the body of research performed in the retina thus far, both in animals and in humans; and discuss considerations when translating each treatment to the clinic and to the retina, including which therapies show the most promise for each retinal disease. Despite the high incidence of retinal diseases and the complexity of mechanisms involved, several promising neuroprotective treatments provide hope to prevent blindness. We discuss attractive candidates here with the goal of furthering retinal research in critical areas to rapidly translate neuroprotective strategies into the clinic.
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Affiliation(s)
- Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA; Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA, 30332, USA.
| | - Rachael S Allen
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
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17
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Allen RS, Hanif AM, Gogniat MA, Prall BC, Haider R, Aung MH, Prunty MC, Mees LM, Coulter MM, Motz CT, Boatright JH, Pardue MT. TrkB signalling pathway mediates the protective effects of exercise in the diabetic rat retina. Eur J Neurosci 2018. [PMID: 29537701 DOI: 10.1111/ejn.13909] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetic retinopathy is a leading cause of vision loss. Treatment options for early retinopathy are sparse. Exercise protects dying photoreceptors in models of retinal degeneration, thereby preserving vision. We tested the protective effects of exercise on retinal and cognitive deficits in a type 1 diabetes model and determined whether the TrkB pathway mediates this effect. Hyperglycaemia was induced in Long Evans rats via streptozotocin injection (STZ; 100 mg/kg). Following confirmed hyperglycaemia, both control and diabetic rats underwent treadmill exercise for 30 min, 5 days/week at 0 m/min (inactive groups) or 15 m/min (active groups) for 8 weeks. A TrkB receptor antagonist (ANA-12), or vehicle, was injected 2.5 h before exercise training. We measured spatial frequency and contrast sensitivity using optokinetic tracking biweekly post-STZ; retinal function using electroretinography at 4 and 8 weeks; and cognitive function and exploratory behaviour using Y-maze at 8 weeks. Retinal neurotrophin-4 was measured using ELISA. Compared with non-diabetic controls, diabetic rats showed significantly reduced spatial frequency and contrast sensitivity, delayed electroretinogram oscillatory potential and flicker implicit times and reduced cognitive function and exploratory behaviour. Exercise interventions significantly delayed the appearance of all deficits, except for exploratory behaviour. Treatment with ANA-12 significantly reduced this protection, suggesting a TrkB-mediated mechanism. Despite this, no changes in retinal neurotrohin-4 were observed with diabetes or exercise. Exercise protected against early visual and cognitive dysfunction in diabetic rats, suggesting that exercise interventions started after hyperglycaemia diagnosis may be a beneficial treatment. The translational potential is high, given that exercise treatment is non-invasive, patient controlled and inexpensive.
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Affiliation(s)
- Rachael S Allen
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Adam M Hanif
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
| | - Marissa A Gogniat
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA.,Department of Ophthalmology, Emory University, Atlanta, GA, USA
| | - Brian C Prall
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA.,Department of Ophthalmology, Emory University, Atlanta, GA, USA.,Neuroscience Program, Emory University, Atlanta, GA, USA
| | - Raza Haider
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
| | - Moe H Aung
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA.,Department of Ophthalmology, Emory University, Atlanta, GA, USA.,Neuroscience Program, Emory University, Atlanta, GA, USA
| | - Megan C Prunty
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
| | - Lukas M Mees
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA.,Department of Ophthalmology, Emory University, Atlanta, GA, USA
| | - Monica M Coulter
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
| | - Cara T Motz
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
| | - Jeffrey H Boatright
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA.,Department of Ophthalmology, Emory University, Atlanta, GA, USA.,Neuroscience Program, Emory University, Atlanta, GA, USA
| | - Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Neuroscience Program, Emory University, Atlanta, GA, USA
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18
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Douris PC, Handrakis JP, Apergis D, Mangus RB, Patel R, Limtao J, Platonova S, Gregorio A, Luty E. The Effects of Aerobic Exercise and Gaming on Cognitive Performance. J Hum Kinet 2018; 61:73-83. [PMID: 29599861 PMCID: PMC5873338 DOI: 10.1515/hukin-2017-0134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The purpose of our study was to investigate the effects of video gaming, aerobic exercise (biking), and the combination of these two activities on the domains of cognitive performance: selective attention, processing speed, and executive functioning. The study was a randomized clinical trial with 40 subjects (mean age 23.7 ± 1.8 years) randomized to one of four thirty-minute conditions: video gaming, biking, simultaneous gaming and biking, and a control condition. Cognitive performance was measured pre and post condition using the Stroop test and Trails B test. A mixed design was utilized. While video gaming, biking, simultaneous gaming and biking conditions improved selective attention and processing speed (p < 0.05), only the bike condition improved the highest order of cognitive performance, executive function (p < 0.01). There were no changes in cognitive performance for the control condition. Previous studies have shown that if tasks approach the limits of attentional capacity there is an increase in the overall chance for errors, known as the dual-task deficit. Simultaneous biking and gaming may have surpassed attentional capacity limits, ultimately increasing errors during the executive function tests of our cognitive performance battery. The results suggest that the fatiguing effects of a combined physically and mentally challenging task that extends after the exercise cessation may overcome the eventual beneficial cognitive effects derived from the physical exercise.
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Affiliation(s)
- Peter C Douris
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - John P Handrakis
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Demitra Apergis
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Robert B Mangus
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Rima Patel
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Jessica Limtao
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Svetlana Platonova
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Aladino Gregorio
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Elliot Luty
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
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19
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Shellington EM, Reichert SM, Heath M, Gill DP, Shigematsu R, Petrella RJ. Results From a Feasibility Study of Square-Stepping Exercise in Older Adults With Type 2 Diabetes and Self-Reported Cognitive Complaints to Improve Global Cognitive Functioning. Can J Diabetes 2018; 42:603-612.e1. [PMID: 29884522 DOI: 10.1016/j.jcjd.2018.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/06/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Adults with type 2 diabetes mellitus have an increased risk for dementia. Therefore, we proposed an intervention called the Square-stepping exercise (SSE) program to mitigate this risk. Our primary aim was to determine the feasibility of SSE in adults with type 2 diabetes and self-reported cognitive complaints. Our secondary aim was to determine whether 24 weeks of SSE improved cognition. Our tertiary aim was to determine whether SSE improved antisaccade reaction time, which is a measure of executive-related oculomotor control. METHODS Adults >49 years with type 2 diabetes and self-reported cognitive complaints were randomized to an SSE group (2×/week for 24 weeks of SSE) or a control group. Feasibility was assessed by recruitment and attendance. Participants were assessed at baseline, after 12 weeks and after 24 weeks for global cognitive function, memory, planning, reasoning and concentration via a computer-based cognitive battery (Cambridge Brain Sciences) and antisaccade reaction time (at baseline and 24 weeks). RESULTS Participants in the SSE group were (mean [SD]): 65.9 (5.2) years old; 33% female; body mass index 33.3 kg/m2 (4.8) (n=12). Participants in the control group were 71.2 (6.9) years old; 31% female; body mass index 31.9 kg/m2 (4.6) (n=13). Over 24 weeks, attendance was 70.2% (SD 17.2) for 4/12 participants. There were 4 withdrawals and 1 adverse event. There were no differences in global cognitive functioning. The SSE group improved in planning domain change scores between 12 and 24 weeks (F=5.8, p=0.03, ηp2=0.28) compared to controls. In the SSE group, we found a nonsignificant improvement in antisaccade reaction time of 38 ms (SD 16), n=2, compared to 9 ms (SD 45) in the control group, n=8. CONCLUSIONS SSE should be evaluated further to improve its feasibility in older adults with type 2 diabetes. This study provides preliminary evidence that SSE improves executive function in adults with type 2 diabetes and self-reported cognitive complaints.
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Affiliation(s)
- Erin M Shellington
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Sonja M Reichert
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Dawn P Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | - Robert J Petrella
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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20
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Mohammadi S, Mokhtarinia HR, Jafarpisheh AS, Kasaeian A, Osqueizadeh R. Investigating the Effects of Different Working Postures on Cognitive Performance. JOURNAL OF REHABILITATION 2018. [DOI: 10.21859/jrehab.18.4.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Podolski N, Brixius K, Predel HG, Brinkmann C. Effects of Regular Physical Activity on the Cognitive Performance of Type 2 Diabetic Patients: A Systematic Review. Metab Syndr Relat Disord 2017; 15:481-493. [PMID: 29160740 DOI: 10.1089/met.2017.0120] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cognitive decline has been shown to be associated with long-term type 2 diabetes mellitus (T2DM). This review analyzes the present literature to ascertain the role of regular physical activity (PA) for the functioning of the diabetic brain. METHODS PubMed was systematically searched for relevant publications up to July 2017. RESULTS Four cross-sectional, one longitudinal observational, and nine interventional studies with a total of ∼7000 T2DM subjects are included in this review. Some significant positive relationships between the PA level of T2DM patients and their performance in several cognitive tests are reported in the cross-sectional studies. The longitudinal observational study implies a higher risk for developing dementia/mild cognitive impairment in T2DM patients with low PA behavior. Some significantly improved cognitive test results are reported for T2DM patients following physical training (PT) in six interventional studies. The quality of most of the training studies is low due to small sample sizes and/or missing control groups. DISCUSSION PT may potentially contribute to improving the cognitive performance in T2DM patients. Additional high-quality studies with standardized cognitive assessments are needed to further determine the dose-effect relationships between PA and cognitive performance in T2DM patients.
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Affiliation(s)
- Natalie Podolski
- 1 Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne , Cologne, Germany
| | - Klara Brixius
- 1 Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne , Cologne, Germany
| | - Hans G Predel
- 2 Department of Preventive and Rehabilitative Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne , Cologne, Germany
| | - Christian Brinkmann
- 2 Department of Preventive and Rehabilitative Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne , Cologne, Germany .,3 IST University of Applied Sciences , Düsseldorf, Germany
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Cognitive behavioral therapy (CBT) for preventing Alzheimer's disease. Behav Brain Res 2017; 334:163-177. [PMID: 28743599 DOI: 10.1016/j.bbr.2017.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 12/13/2022]
Abstract
This review provides the rationale for implementing cognitive behavioral therapy (CBT) for the prevention of Alzheimer's disease (AD). There are known risk factors associated with the development of AD, some of which may be ameliorated with CBT. We posit that treating the risk factors of inactivity, poor diet, hyposmia and anosmia, sleep disorders and lack of regularly engaged challenging cognitive activity will modify the physiology of the brain sufficiently to avoid the accumulation of excess proteins, including amyloid beta, causal events in the development of AD. Further, the successful treatment of the listed risk factors is well within our technology to do so and, even further, it is cost effective. Also, there is considerable scientific literature to support the proposition that, if implemented by well-established practices, CBT will be effective and will be engaged by those of retirement age. That is, we present a biologically informed CBT for the prevention of the development of AD, i.e., an aspect of applied behavioral neuroscience.
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Russell BA, Summers MJ, Tranent PJ, Palmer MA, Cooley PD, Pedersen SJ. A randomised control trial of the cognitive effects of working in a seated as opposed to a standing position in office workers. ERGONOMICS 2016; 59:737-744. [PMID: 26413774 DOI: 10.1080/00140139.2015.1094579] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
Abstract
Sedentary behaviour is increasing and has been identified as a potential significant health risk, particularly for desk-based employees. The development of sit-stand workstations in the workplace is one approach to reduce sedentary behaviour. However, there is uncertainty about the effects of sit-stand workstations on cognitive functioning. A sample of 36 university staff participated in a within-subjects randomised control trial examining the effect of sitting vs. standing for one hour per day for five consecutive days on attention, information processing speed, short-term memory, working memory and task efficiency. The results of the study showed no statistically significant difference in cognitive performance or work efficiency between the sitting and standing conditions, with all effect sizes being small to very small (all ds < .2). This result suggests that the use of sit-stand workstations is not associated with a reduction in cognitive performance. Practitioner Summary: Although it has been reported that the use of sit-stand desks may help offset adverse health effects of prolonged sitting, there is scant evidence about changes in productivity. This randomised control study showed that there was no difference between sitting and standing for one hour on cognitive function or task efficiency in university staff.
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Affiliation(s)
- Bridget A Russell
- a School of Medicine (Psychology) , University of Tasmania , Launceston , Australia
| | - Mathew J Summers
- b Wicking Dementia Research & Education Centre , University of Tasmania , Hobart , Australia
- c School of Social Sciences , University of the Sunshine Coast , Queensland , Australia
| | - Peter J Tranent
- a School of Medicine (Psychology) , University of Tasmania , Launceston , Australia
| | - Matthew A Palmer
- a School of Medicine (Psychology) , University of Tasmania , Launceston , Australia
| | - P Dean Cooley
- d University of Tasmania Active Work Laboratory, Faculty of Education , University of Tasmania , Launceston , Australia
| | - Scott J Pedersen
- d University of Tasmania Active Work Laboratory, Faculty of Education , University of Tasmania , Launceston , Australia
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Bantoft C, Summers MJ, Tranent PJ, Palmer MA, Cooley PD, Pedersen SJ. Effect of Standing or Walking at a Workstation on Cognitive Function: A Randomized Counterbalanced Trial. HUMAN FACTORS 2016; 58:140-149. [PMID: 26408647 DOI: 10.1177/0018720815605446] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 08/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE In the present study, we examined the effect of working while seated, while standing, or while walking on measures of short-term memory, working memory, selective and sustained attention, and information-processing speed. BACKGROUND The advent of computer-based technology has revolutionized the adult workplace, such that average adult full-time employees spend the majority of their working day seated. Prolonged sitting is associated with increasing obesity and chronic health conditions in children and adults. One possible intervention to reduce the negative health impacts of the modern office environment involves modifying the workplace to increase incidental activity and exercise during the workday. Although modifications, such as sit-stand desks, have been shown to improve physiological function, there is mixed information regarding the impact of such office modification on individual cognitive performance and thereby the efficiency of the work environment. METHOD In a fully counterbalanced randomized control trial, we assessed the cognitive performance of 45 undergraduate students for up to a 1-hr period in each condition. RESULTS The results indicate that there is no significant change in the measures used to assess cognitive performance associated with working while seated, while standing, or while walking at low intensity. CONCLUSION These results indicate that cognitive performance is not degraded with short-term use of alternate workstations.
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Affiliation(s)
| | | | - Peter J Tranent
- University of Tasmania, Launceston, AustraliaUniversity of the Sunshine Coast, Queensland, AustraliaUniversity of Tasmania, Launceston, Australia
| | - Matthew A Palmer
- University of Tasmania, Launceston, AustraliaUniversity of the Sunshine Coast, Queensland, AustraliaUniversity of Tasmania, Launceston, Australia
| | - P Dean Cooley
- University of Tasmania, Launceston, AustraliaUniversity of the Sunshine Coast, Queensland, AustraliaUniversity of Tasmania, Launceston, Australia
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Theng YL, Lee JWY, Patinadan PV, Foo SSB. The Use of Videogames, Gamification, and Virtual Environments in the Self-Management of Diabetes: A Systematic Review of Evidence. Games Health J 2015; 4:352-61. [PMID: 26287926 DOI: 10.1089/g4h.2014.0114] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The use of videogames in healthcare interventions is gaining popularity, but there is still a gap in the understanding on how these types of interventions are used for the management of diabetes. The purpose of this review is to examine published research on the use of videogames for diabetes management. With the increased use of mobile technology, the review was expanded to understand whether games, gamification, and virtual environments can be used for diabetes self-management. Out of the 307 articles identified, only 10 articles met the inclusion criteria of the study. The duration of most studies was short, with small sample sizes. All interventions targeted behavioral changes examining risk reduction of diabetes-related risk and promotion of healthy behavior among study participants. Videogames appeared to be helpful tools for education in some interventions, whereas gamification and virtual environments increased extrinsic motivation and provided positive reinforcement. This review concludes by discussing the potential of using videogames and gamification for the self-management of diabetes.
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Affiliation(s)
- Yin-Leng Theng
- 1 Wee Kim Wee School of Communication and Information, Nanyang Technological University , Singapore
| | - Jason W Y Lee
- 2 Centre of Social Media Innovations for Communities, Nanyang Technological University , Singapore
| | - Paul V Patinadan
- 2 Centre of Social Media Innovations for Communities, Nanyang Technological University , Singapore
| | - Schubert S B Foo
- 2 Centre of Social Media Innovations for Communities, Nanyang Technological University , Singapore
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Tate DF, Lyons EJ, Valle CG. High-tech tools for exercise motivation: use and role of technologies such as the internet, mobile applications, social media, and video games. Diabetes Spectr 2015; 28:45-54. [PMID: 25717278 PMCID: PMC4334081 DOI: 10.2337/diaspect.28.1.45] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IN BRIEF The majority of patients with type 2 diabetes are not active at recommended levels, and many do not have access to behavior change programs to support lifestyle change. Thus, tools and programs designed to promote the adoption and maintenance of physical activity using technology may be helpful. This article reviews the evidence regarding the use of technology tools such as the Internet, mobile applications, social media, and video games and provides suggestions for evaluating the potential benefit of such tools for behavior change.
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Affiliation(s)
- Deborah F. Tate
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Elizabeth J. Lyons
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Carmina G. Valle
- Cancer Health Disparities Training Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CHapel Hill, NC
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Galioto R, King WC, Bond DS, Spitznagel MB, Strain G, Devlin M, Cohen R, Crosby RD, Mitchell JE, Gunstad J. Physical activity and cognitive function in bariatric surgery candidates. Int J Neurosci 2014; 124:912-8. [DOI: 10.3109/00207454.2014.895344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kempf K, Martin S. Autonomous exercise game use improves metabolic control and quality of life in type 2 diabetes patients - a randomized controlled trial. BMC Endocr Disord 2013; 13:57. [PMID: 24321337 PMCID: PMC3880220 DOI: 10.1186/1472-6823-13-57] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 10/15/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Lifestyle intervention in type 2 diabetes mellitus (T2DM) is effective but needs a special local setting and is costly. Therefore, in a randomized-controlled trial we tested the hypothesis that the autonomous use of the interactive exercise game Wii Fit Plus over a period of 12 weeks improves metabolic control, with HbA1c reduction as the primary outcome, and weight loss, reduction of cardiometabolic risk factors, physical activity and quality of life (secondary outcomes) in T2DM patients. METHODS Participants (n = 220) were randomized into an intervention and a control group. The intervention group was provided with a Wii console, a balance board and the exercise game Wii Fit Plus for 12 weeks. The control group remained under routine care and received the items 12 weeks later. At baseline and after 12 weeks (and for the control group additionally after 12 weeks of intervention) the participants' health parameters, medication, physical activity and validated questionnaires for quality of life (PAID, SF12, WHO-5, CES-D) were requested and compared in a complete case analysis using the Mann-Whitney test and the Wilcoxon signed rank test. RESULTS 80% of participants completed the 12-week study. Patients in the intervention group significantly improved HbA1c (from 7.1 ± 1.3% to 6.8 ± 0.9%; -0.3 ± 1.1%; p = 0.0002) in comparison to the control group (from 6.8 ± 0.9% to 6.7 ± 0.7%; -0.1 ± 0.5%) and also significantly reduced fasting blood glucose (from 135.8 ± 38.9 mg/dl to 126.6 ± 36.6 mg/dl; p = 0.04), weight (from 97.6 ± 19.2 kg to 96.3 ± 18.7 kg; p < 0.001) and body mass index (from 34.1 ± 6.5 kg/m2 to 33.5 ± 6.5 kg/m2; p < 0.001). Daily physical activity increased significantly (p < 0.001). Diabetes-dependent impairment, mental health, subjective wellbeing and quality of life also improved significantly, and the number of patients with depression decreased. Similar improvements were seen in the control group after exercise game intervention. CONCLUSIONS In this trial a low-threshold intervention with the interactive exercise game Wii Fit Plus was able to motivate T2DM patients to improve physical activity, glucometabolic control and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT01735643.
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Affiliation(s)
- Kerstin Kempf
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Hohensandweg 37, 40591 Düsseldorf, Germany
| | - Stephan Martin
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Hohensandweg 37, 40591 Düsseldorf, Germany
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Abstract
The July 2012 issue of the Journal of Diabetes Science and Technology includes a special symposium called "Serious Games for Diabetes, Obesity, and Healthy Lifestyle." As part of the symposium, this article focuses on health behavior change video games that are designed to improve and support players' diabetes self-management. Other symposium articles include one that recommends theory-based approaches to the design of health games and identifies areas in which additional research is needed, followed by five research articles presenting studies of the design and effectiveness of games and game technologies that require physical activity in order to play. This article briefly describes 14 diabetes self-management video games, and, when available, cites research findings on their effectiveness. The games were found by searching the Health Games Research online searchable database, three bibliographic databases (ACM Digital Library, PubMed, and Social Sciences Databases of CSA Illumina), and the Google search engine, using the search terms "diabetes" and "game." Games were selected if they addressed diabetes self-management skills.
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Affiliation(s)
- Debra A Lieberman
- Department of Communication, University of California, Santa Barbara, Santa Barbara, California 93106-4020, USA.
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