Does physical exercise improve perceptual skills and visuospatial attention in older adults? A review

Association between Fear of Falling and Visuospatial and Executive Functions in Older Adults with Subjective Cognitive Decline: A Cross-Sectional Study

OBJECTIVES

Fear of falling (FOF) is a common health concern among older adults. Although cognitive impairment (CI) is a risk factor for FOF, the specific cognitive domains associated with FOF remain unclear. This study examined the association between FOF and domain-specific cognitive functions in older adults. We also analyzed whether this association varied based on CI, recent fall experience, or engagement in physical activity.

DESIGN

This was a cross-sectional study analyzing the relationship between FOF and cognitive performance across various domains, with stratifications by CI status, fall history, and physical activity levels.

SETTING AND PARTICIPANTS

The study included 591 older adults with mild CI who visited the Veterans Health Service Medical Center in Korea.

METHODS

Cognitive performance in attention, language, visuospatial, memory, and frontal or executive domains was assessed using the Seoul Neuropsychological Screening Battery-Core. FOF was measured using the Activities-specific Balance Confidence Scale. Covariates, including demographics, physical health, and activity levels, were adjusted in the analyses.

RESULTS

Higher FOF was significantly associated with lower performance in the visuospatial domain [Rey Complex Figure Test (β = 0.04, P = .002)] and the frontal or executive domain [Digit Symbol Coding (β = 0.05, P < .001), Controlled Oral Word Association Test (β = 0.02, P = .041), Trail Making Test (β = 0.06, P < .001), and Color Word Stroop Test (β = 0.04, P < .001)] after adjusting for covariates. The observed association was particularly evident in older adults with CI or those not engaging in moderate physical activity. The association was consistent regardless of fall history in the past year.

CONCLUSIONS AND IMPLICATIONS

High FOF was associated with poor visuospatial and frontal or executive functions. These findings underscore the link between FOF and cognitive function, suggesting that specific cognition in visuospatial and frontal or executive domains may contribute to FOF development.

The Effect of Aerobic Exercise on Visuospatial Attention in Young Adults

Our objective in this study was to investigate the effect of moderate-intensity aerobic exercise on visuospatial attention bias. We examined line bisection performance at rest before exercise and then immediately after exercise in 20 young adults. Pre-exercise, there was a larger leftward bias in subjective midpoint judgment of all participants than post-exercise (p < .001). Thus, leftward error magnitude decreased according to aerobic exercise, as there were rightward shifts after the exercise. The participants' performances were modulated by the hand used to perform manual bisection tasks (p < .02). Participants erred to the left of the true midpoint with the non-dominant hand and to the right of the true midpoint with the dominant hand. The use of the non-dominant hand led to greater leftward error than the errors obtained using the dominant hand, though there was no interaction effect between hand use and effort. These findings suggest that moderate aerobic exercise can benefit visuospatial attention in adults.

The possible positive effects of physical exercise on the global motion perception aging: the cognitive mechanism

Background

Sensitivity to global motion perception (GMP) decreases gradually with age, and the mechanism to effectively alleviate its aging process is still unclear. This study aimed to examine the impact and mechanism of exercise on GMP aging.

Methods

This study adopted the global motion direction discrimination task and used motion coherence thresholds to assess GMP sensitivity. It adopted the perceptual template model (PTM) to fit the GMP processing efficiency.

Results

The threshold for the elderly group with no exercise was higher than that of the elderly group with exercise, while the threshold of the latter was higher than that of the youth group. The results of the model fitting showed that both models, Aa and Af, corresponding to the elderly group with exercise and the elderly group with no exercise, respectively, were the best-fitted models when compared with that of the youth group. Compared to the elderly group with no exercise, models Aa and Af, were the best-fitted models.

Conclusion

These results showed that good exercise habits might have a certain degree of positive effect on GMP aging, by lower their internal additive noise (Aa), and improve the ability to eliminate external noise (Af).

The aging trajectories of brain functional hierarchy and its impact on cognition across the adult lifespan

Introduction

The hierarchical network architecture of the human brain, pivotal to cognition and behavior, can be explored via gradient analysis using restingstate functional MRI data. Although it has been employed to understand brain development and disorders, the impact of aging on this hierarchical architecture and its link to cognitive decline remains elusive.

Methods

This study utilized resting-state functional MRI data from 350 healthy adults (aged 20-85) to investigate the functional hierarchical network using connectome gradient analysis with a cross-age sliding window approach. Gradient-related metrics were estimated and correlated with age to evaluate trajectory of gradient changes across lifespan.

Results

The principal gradient (unimodal-to-transmodal) demonstrated a significant non-linear relationship with age, whereas the secondary gradient (visual-to-somatomotor) showed a simple linear decreasing pattern. Among the principal gradient, significant age-related changes were observed in the somatomotor, dorsal attention, limbic and default mode networks. The changes in the gradient scores of both the somatomotor and frontal-parietal networks were associated with greater working memory and visuospatial ability. Gender differences were found in global gradient metrics and gradient scores of somatomotor and default mode networks in the principal gradient, with no interaction with age effect.

Discussion

Our study delves into the aging trajectories of functional connectome gradient and its cognitive impact across the adult lifespan, providing insights for future research into the biological underpinnings of brain function and pathological models of atypical aging processes.

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

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

The Interlinking of Alpha Waves and Visuospatial Cognition in Motor-Based Domains

The manner in which we perceive and respond in accordance to the world is encompassed by our ability to process multimodal input stimuli. In other words, in order to perform any task, especially at a high degree of proficiency, high dependence is placed upon our ability to interact with, interpret, and visualize input stimuli from our environment, known as visuospatial cognition (Chueh et al., 2017). This article will explore and encapsulate the importance of visuospatial cognition, in terms of the link it has with the performance of tasks in various fields, such as artistry, musical performance, and athleticism. Alpha wave investigation will be discussed as a means of both identifying and characterizing the degree of performance within these domains. Findings from this investigation may be used as a modality to optimize performance in the explored domains (e.g., with Neurofeedback techniques). The limitations of using Electroencephalography (EEG) to support the enhancement of this task performance and the recommendations to elicit further research, will also be explored.

Risks and Benefits of Judo Training for Middle-Aged and Older People: A Systematic Review

This systematic overview aimed to review studies investigating the benefits and risks of judo training in older people, and to explore practical methodological applications (Registration ID: CRD42021274825). Searches of EBSCOhost, ISI-WoS, and Scopus databases, with no time restriction up to December 2022, resulted in 23 records meeting the inclusion criteria. A quality assessment was performed through the following tools: ROBINS-I for 10 experimental studies, NIH for 7 observational studies, and AGREE-II for 6 methodological studies. A serious risk of bias emerged for 70% of the experimental studies, whereas 100% of the observational and 67% of the methodological studies presented a “fair” quality. When involving 1392 participants (63 ± 12 years; females: 47%), the studies investigated novice (n = 13), amateur/intermediate (n = 4), expert (n = 4), and unknown (n = 3) level judoka by means of device-based, self-reported, and visual evaluation measures. Mean training encompassed 2 ± 1 sessions. week−1 of 61 ± 17 min for 7 ± 6 months. In relation to judo training exposure and outcomes, three main themes emerged: (i) health (56% of studies; e.g., bones, anthropometry, quality of life); (ii) functional fitness (43%; e.g., balance, strength, walking speed); and iii) psychosocial aspects (43%; e.g., fear of falling, cognition, self-efficacy). Although the included studies presented relevant methodological weaknesses, the data support the positive effects of judo training with advancing age. Future research is needed to help coaches plan judo programs for older people.

Genome-wide association analyses of physical activity and sedentary behavior provide insights into underlying mechanisms and roles in disease prevention

Although physical activity and sedentary behavior are moderately heritable, little is known about the mechanisms that influence these traits. Combining data for up to 703,901 individuals from 51 studies in a multi-ancestry meta-analysis of genome-wide association studies yields 99 loci that associate with self-reported moderate-to-vigorous intensity physical activity during leisure time (MVPA), leisure screen time (LST) and/or sedentary behavior at work. Loci associated with LST are enriched for genes whose expression in skeletal muscle is altered by resistance training. A missense variant in ACTN3 makes the alpha-actinin-3 filaments more flexible, resulting in lower maximal force in isolated type IIA muscle fibers, and possibly protection from exercise-induced muscle damage. Finally, Mendelian randomization analyses show that beneficial effects of lower LST and higher MVPA on several risk factors and diseases are mediated or confounded by body mass index (BMI). Our results provide insights into physical activity mechanisms and its role in disease prevention.

Determining Whether Tai Chi Chuan Is Related to the Updating Function in Older Adults: Differences Between Practitioners and Controls

Background

Tai Chi Chuan (TCC) is an effective method for delaying cognitive decline in older adults. However, in older adults, the association between long-term TCC practice and working memory updating has not been extensively studied.

Objective

This cross-sectional study investigated how updating function operationalized via Reaction Times (RTs) and Accuracy Rates (ARs) of N-Back tasks being measured in a laboratory setting is related to long term practice of TCC.

Methods

Twenty-six healthy elderly people participated in this experiment. According to the duration of time TCC was practiced, 13 subjects in the TCC group had more than 5 years of experience with TCC exercise, and 13 elderly subjects who had not been systematically exposed to mind-body exercise were assigned to the control group. The N-back task was administered to every participant to evaluate the updating function.

Results

The TCC group had faster RTs than the control group (p < 0.05). For the 1-back task, the TCC group showed faster RTs than the control group; for the 2-back task, the TCC group exhibited faster RTs than the control group. The TCC group had higher ARs than the control group (p < 0.05). For the 1-back task, the TCC group showed higher ARs than the control group; for the 2-back task, the TCC group exhibited higher ARs than the control group.

Conclusions

Long-term TCC practitioners exhibit a better updating function as compared to controls who did not practice TCC. Thus, our findings suggest that long-term TCC positively influences the updating function of older adults, making it, in turn, an effective mind-body exercise to maintain specific aspects of cognitive functioning.

The Effects of Combined Cognitive-Physical Interventions on Cognitive Functioning in Healthy Older Adults: A Systematic Review and Multilevel Meta-Analysis

Research has shown that both physical exercise and cognitive training help to maintain cognition in older adults. The question is whether combined training might produce additive effects when the group comparisons are equated in terms of exercise intensity and modality. We conducted a systematic electronic search in MEDLINE, PsycInfo, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify relevant studies published up to February 2021. Seven hundred and eighty-three effect sizes were obtained from 50 published intervention studies, involving 6,164 healthy older adults, and submitted to a three-level meta-analysis. Results showed that combined training produced a small advantage in comparison to single cognitive training on executive functions, whereas both types of training achieved similar effects on attention, memory, language, processing speed, and global cognition. Combined training achieved higher training gains in balance than single physical training, indicating a transfer from cognitive training to balance. Performing cognitive and physical exercise simultaneously, and interactive training (e.g., exergames, square stepping) produced the largest gains in executive functions, speed, and global cognition, as well as the largest improvements in physical functions. Aerobic training was associated with higher effects in attention and fitness, whereas non-aerobic training produced larger effects in global cognition and balance. For all cognitive and physical outcomes, training resulted more advantageous when performed in a social context, even though individual training obtained similar results in balance as group training.

Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier: CRD42020175632.

The Differential Effects of Tai Chi vs. Brisk Walking on Cognitive Function Among Individuals Aged 60 and Greater

Purpose

The aim of this study was to investigate the differential effects of Tai Chi vs. brisk walking on cognitive function among individuals aged 60 and greater.

Patients and Methods

For participant recruitment, a health talk was arranged at two communities in which two different exercise modalities (Tai Chi and brisk walking) were assigned to participants of each community free of charge. The intervention programs lasted 10 weeks, with three 60-min training sessions per week. General cognitive ability and specific cognitive outcomes were measured using the Chinese version of the Montreal Cognitive Assessment (MoCA).

Results

A significant interaction on total scores of the MoCA was observed (F = 11.15, p < 0.05). Post hoc analysis indicated significant improvements on general cognitive performance as measured in performance on the MoCA for both exercise groups at the end of 10 weeks. A significant interaction was only observed on the delayed recall sub-domain (F = 12.93, p < 0.001). Results from post hoc analysis indicate that the Tai Chi group had a significantly better memory performance relative to brisk walking group (p < 0.05). Specifically, significant improvement was observed in Tai Chi group (p < 0.05), but not in the brisk walking group. Both exercise groups demonstrated significant improvements from baseline to Week 10, which emerged in visualspatial ability (p < 0.05) and attention performance (p < 0.001). Lastly, animal naming and orientation significantly benefited from brisk walking (p < 0.05) and Tai Chi training (p < 0.05), respectively.

Conclusion

Tai Chi and brisk walking as the most commonly used, culture-specific mind-body exercise method have been proven to be effective in improving general cognitive performance and specific cognitive domains. Furthermore, differential effects of two different exercise modalities on cognitive domains were observed, which has provided insightful information for customized exercise programs. Finally, aging individuals who are experiencing cognitive decline should either take Tai Chi classes regularly or engage in brisk walking, which could contribute to brain health.

Physical Activity Is Associated with Improved Visuomotor Processing in Older Adults with Moderate and Advanced Glaucomatous Visual Field Defect: A Cross-Sectional Study

Glaucoma affects a wide spectrum of daily essential activities in older adults. This study examined whether older adults with moderate and advanced stages of glaucoma exhibit differences in visuomotor task performance compared with age- and gender-matched ophthalmologically healthy control subjects and estimated the effects of physical activity (PA) levels, age, and severity of visual impairment on patients' visuomotor task performance. Sixty older adults with moderate glaucoma, advanced glaucoma, and normal sight participated in the study. Visuomotor processing was assessed using laboratory-based simple and complex visuomotor reaction tasks. Monocular Humphrey Visual Field and binocular Humphrey Esterman Visual Field tests were used to estimate visual field defect severity. The International Physical Activity Questionnaire was used to assess PA levels. Participants with glaucoma had poorer scores in visuomotor tasks compared to participants with normal sight. Glaucoma patients' PA levels, age, and binocular visual field defect explained 54% of the variation in complex reaction time. Low PA levels were identified as a risk factor for visuomotor processing decline. Compensatory mechanisms to improve the efficiency of visual field scanning in patients with more severe visual field defects may exist.

The effects of age and physical exercise on multimodal signal responses: Implications for semi-autonomous vehicle takeover requests

The present study examined whether the non-chronological age factor, engagement in physical exercise, affected responses to multimodal (combinations of visual, auditory, and/or tactile) signals differently between younger and older adults in complex environments. Forty-eight younger and older adults were divided into exercise and non-exercise groups, and rode in a simulated Level 3 autonomous vehicle under four different task conditions (baseline, video watching, headway estimation, and video-headway combination), while being asked to respond to various multimodal warning signals. Overall, bi- and trimodal warnings had faster response times for both age groups across driving conditions, but was more pronounced for older adults. Engagement in physical exercise was associated with smaller maximum braking force for younger participants only, and also corresponded to longer average fixation durations, compared to the non-exercise group. Findings from this research can help to guide decisions about the design of warning and information systems for semi-autonomous vehicles.

Does Acute Exercise Stress Affect Postural Stability and Cognitive Function in Subjects with Chronic Ankle Instability?

Altered postural control in people with chronic ankle instability (CAI) may be attributed to deficits that are associated with neurocognitive function. Acute training is another factor that may negatively affect postural control and increase the risk of ankle sprain. The purpose of this investigation was to determine the effect of acute exercise on postural stability and cognitive function among patients with CAI. Fifteen patients with CAI (aged 21.5 ± 2.0 years) and 15 healthy controls (aged 20.3 ± 1.7 years) completed a single-limb stance postural control test and a battery of computer-based cognitive tests before and after acute exercise. The overall stability index (OSI) was used as a measure of postural stability. The cognitive domains tested were global cognitive score, executive function, attention, visual-spatial perception, information processing, and fine motor control. Subjects in both groups had similar OSI scores, with a trend for reduced stability in the CAI after the exercise protocol (p = 0.053). There were no differences between the groups in all cognitive domains before or after exercise. Following exercise, the domains of overall cognitive score, visual-spatial perception, and information processing speed improved in both groups (p = 0.003, p = 0.033, p = 0.001; respectively). These findings should be considered with caution due to the heterogeneity of the CAI population.

Physical activity and aerobic fitness show different associations with brain processes underlying anticipatory selective visuospatial attention in adolescents

Current knowledge about the underlying brain processes of exercise-related benefits on executive functions and the specific contributions of physical activity and aerobic fitness during adolescence is inconclusive. We explored whether and how physical activity and aerobic fitness are associated with the oscillatory dynamics underlying anticipatory spatial attention. We studied whether the link between physical exercise level and cognitive control in adolescents is mediated by task-related oscillatory activity. Magnetoencephalographic alpha oscillations during a modified Posner's cueing paradigm were measured in 59 adolescents (37 females and 22 males, 12-17 years). Accelerometer-measured physical activity and aerobic fitness (20-m shuttle run test) were used to divide the sample into higher- and lower-performing groups. The interhemispheric alpha asymmetry during selective attention was larger in the high than in the low physical activity group, but there was no difference between the high and low aerobic fitness groups. Exploratory mediation analysis suggested that anticipatory interhemispheric asymmetry mediates the association between physical activity status and drift rate in the selective attention task. Higher physical activity was related to increased cue-induced asymmetry, which in turn was associated with less efficient processing of information. Behaviorally, more physically active males showed stronger dependence on the cue, while more fit females showed more efficient processing of information. Our findings suggest that physical activity may be associated with a neural marker of anticipatory attention in adolescents. These findings might help to explain the varying results regarding the association of physical activity and aerobic fitness with attention and inhibition in adolescents.

Effects of a Coordinative Ability Training Program on Adolescents' Cognitive Functioning

The purpose of this randomized controlled study was to investigate the effects of a 12-week coordinative ability training program on adolescents’ cognitive functioning, using evaluation tests of visuospatial perception, attention, and working memory. We randomly assigned 60 public school students (14–15 years) to either an experimental coordinative abilities training (∼40 min twice/week) group (n = 30) or a control group (n = 30) who received general psycho-physical wellness training (∼40 min., twice a week). At baseline and after training we used two standardized motor tests and a single cognitive measure (Corsi’s Block-tapping test) to assess students’ visuospatial perception, attention, and working memory. We found a significant Time x Group interaction for the Throwing and Catching Test and Corsi’s Block-Tapping test, reflecting a meaningful experimental group improvement (p < 0.001), and there were no significant pre-post changes found in the control group. Thus, a 12-week program of coordinative abilities was able to improve not only coordination skills but aspects of cognitive functioning relevant to academic achievement.

Using "Enzan No Metsuke" (Gazing at the Far Mountain) as a Visual Search Strategy in Kendo

In Kendo (Japanese fencing), “Enzan no Metsuke” is an important Waza (technique) that is applied by expert Kendo fighters. It involves looking at the opponent's eyes with “a gaze toward the far mountain,” taking in not only the opponent's face but also his or her whole body. Over the last few decades, a considerable number of studies on visual search behaviors in sport have been conducted. Yet, there are few articles that examine visual search behaviors in combat sports, such as martial arts. This study aimed to analyze the visual search strategies used by expert Kendo fighters through sparring practices to discuss what “Enzan no Metsuke” is under experimental, but natural (in situ), conditions. Ten experts, 10 novices, and one Shihan (a master of Kendo) participated in this study. The fighters wore a mobile eye tracker and faced a real opponent. They were instructed to do the following in five different sessions: prepare themselves, practice their offense and defense techniques, and fight in a real Shiai (match). The results indicated differences in the visual search strategies between the Shihan, experts, and novices. The Shihan and experts fixated on their opponent's eyes or head region most of the time and adopted a visual search strategy involving fewer fixations of longer duration. Conversely, novices set their eyes mainly on the opponent's Shinai (sword). Only the Shihan always looked at the opponent's eyes, even during the preparation, offense, and defense sessions. Shihan and experts set their “visual pivot” on the opponent's eyes quietly, even when the opponent tried to attack with the Shinai. Novices, however, moved their eyes up and down based on the influence of their opponent's movements. As these results indicate, novices tried to search for detailed information about their opponent and processed visual information depending on their focal vision, whereas Shihan and experts absorbed information not from their opponent's eyes but from their entire body by utilizing their peripheral vision; this means that Shihan and experts could see an opening or opportunity and react instantaneously by using “Enzan no Metsuke.”

Exercise mode and attentional networks in older adults: a cross-sectional study

Background

Previous studies have indicated that physical exercise enhances attentional function; however, the relationship between exercise mode and attentional networks has not been clarified for older adults (>60 years old). This study aimed to investigate the relationship between attentional networks and different exercise modes in older adults.

Methods

Two hundred and fifty-nine participants aged between 60 to 81 years were enrolled and classified into three groups (closed-skill group, open-skill group, or sedentary control group) using an exercise-related questionnaire. All participants completed an attention network test (ANT), which measured executive control, orienting, and alerting networks.

Results

The open-skill group had significantly higher executive network efficiency compared to the closed-skill (p < 0.01) and sedentary (p < 0.01) groups. The closed-skill group had significantly higher values compared to the sedentary control group (p < 0.05). Differences were not detected among groups for alerting and orienting networks (p > 0.05). The open-skill group had significantly higher values compared to the sedentary control group regarding proportion score of executive network (p < 0.01). In comparison, no significant differences were detected among groups for proportion scores of alerting and orienting networks.

Conclusion

This study extends current knowledge by demonstrating that open-skill exercises selectively enhance the executive control of attentional networks in older adults. Open-skill exercises combines physical exercise and cognitive training, potentially representing a more effective exercise mode to maintain or enhance attentional function in older adults.

Effects of Mind-Body Exercises on Cognitive Function in Older Adults: A Meta-Analysis

BACKGROUND/OBJECTIVES

Mind-body exercise has positive effects on cognitive performance, according to clinical observation and experts' recommendations. However, its potential benefits for the cognitive function of aging adults are uncertain and still lack systematic estimations. Therefore, we conducted a systematic review and meta-analysis to evaluate the overall efficacy and effectiveness of mind-body exercises for cognitive performance in aging individuals with or without cognitive impairment.

DESIGN

A systematic review and meta-analysis.

SETTING AND PARTICIPANTS

We searched related trials through June 2018 from four databases: Medline, Embase, PsycINFO (all via Ovid), and the Cochrane Library/Central Register of Controlled Trials.

MEASUREMENTS

Methodological quality was assessed using the Cochrane Risk of Bias Tool. A meta-analysis of comparative effects was performed using Review Manager v.5.3 software, and publication bias was examined using Egger's test.

RESULTS

A total of 32 randomized controlled trials with 3624 participants were ultimately included in this meta-analysis. The results revealed that mind-body exercises as a whole had benefits in improving global cognition compared with that of the control group (mean difference [MD] = 0.92; 95% confidence interval [CI] = 0.33-1.51; p = .002) and were more effective than control interventions in promoting cognitive flexibility (MD = -8.80; 95% CI = -15.22 to -2.38; p = .007), working memory (MD = 0.32; 95% CI = 0.01-0.64; p = .05), verbal fluency (standardized mean difference [SMD] = 0.27; 95% CI = 0.09-0.45; p = .003), and learning (SMD = 0.24; 95% CI = 0.10-0.39; p = .001) on cognitively intact or impaired older adults. In dose-subgroup analysis, only moderate exercise intensity (60-120 min per week) significantly increased global cognition scores compared with those of the control group (MD = 1.15; 95% CI = 0.34-1.97; p = .006).

CONCLUSION

Mind-body exercises, especially tai chi and dance mind-body exercise, are beneficial for improving global cognition, cognitive flexibility, working memory, verbal fluency, and learning in cognitively intact or impaired older adults. Moderate intensity is recommended as the optimal dose for older adults. J Am Geriatr Soc 67:749-758, 2019.

Effects of physical, virtual reality-based, and brain exercise on physical, cognition, and preference in older persons: a randomized controlled trial

Background

Physical exercise (PE), virtual reality-based exercise (VRE), and brain exercise (BE) can influence physical and cognitive conditions in older persons. However, it is not known which of the three types of exercises provide the best effects on physical and cognitive status, and which exercise is preferred by older persons. This study compared the effects of PE, VRE, and BE on balance, muscle strength, cognition, and fall concern. In addition, exercise effort perception and contentment in older persons was evaluated.

Methods

Eighty-four older persons (n = 84) were randomly selected for PE, VRE, BE, and control groups. The exercise groups received 8-week training, whereas the control group did not. Balance was assessed by Berg Balance Scale (BBS) and Timed Up and Go test (TUG), muscle strength by 5 Times Sit to Stand (5TSTS) and left and right hand grip strength (HGS), cognition by Montreal Cognitive Assessment (MoCA) and Timed Up and Go test Cognition (TUG-cog), fall concern by Fall Efficacy Scale International (FES-I), exercise effort perception by Borg category ratio scale (Borg CR-10), and exercise contentment by a questionnaire.

Results

After exercise, PE significantly enhanced TUG and 5TSTS to a greater extent than VRE (TUG; p = 0.004, 5TSTS; p = 0.027) and BE (TUG; p = 0,012, 5TSTS; p < 0.001). VRE significantly improved MoCA (p < 0.001) and FES-I (p = 0.036) compared to PE, and 5TSTS (p < 0.001) and FES-I (p = 0.011) were improved relative to BE. MoCA was significantly enhanced by BE compared to PE (p < 0.001) and both MoCA and TUG-cog were improved compared to VRE (p = 0.04). PE and VRE significantly (p < 0.001) increased Borg CR-10 in all exercise sessions, whereas BE showed a significant improvement (p < 0.001) in the first 4 sessions. Participants had a significantly greater satisfaction with BE than controls (p = 0.006), and enjoyed VRE and BE more than PE (p < 0.001). Subjects in all exercise groups exhibited benefits compared to the control group (p < 0.001).

Conclusions

PE provided the best results in physical tests, VRE produced measurable improvements in physical and cognition scores, while BE enhanced cognition ability in older persons. Older persons preferred VRE and BE compared to PE. Both exercises are suggested to older persons to improve physical and cognitive conditions.