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

Effects of Exergame Training on Executive Function and Heart Rate Variability in Middle-Aged and Older Adults: A Randomized Controlled Study

Exergame has become widely popular and offers great levels of cognitive demands, thus may facilitate cognitive benefits. In addition, researchers have proposed that cardiac autonomic function, assessed via heart rate variability (HRV), is associated with cognitive executive function. However, few exergame training studies have investigated this relationship. This study aimed to investigate the effects of 10-week exergame training on executive function and HRV in middle-aged and older adults. Ninety-one participants were randomly assigned to either an exergame training group (63.73 ± 4.48 years) or a control group (62.46 ± 4.77 years). The training program was 50 min per session, twice per week for 10 weeks. The control group was instructed to maintain their usual lifestyle. All participants completed questionnaires and received assessments of executive functions and electrocardiography at baseline and postintervention. Results revealed significant group-by-time interaction effects for the three indices of the digit span test and the total initiation time of the Tower of London task with better postintervention performances achieved by the exergame group. The 6 min walk test also improved significantly in the exergame group but not in the control group. No significant change in HRV was observed for both groups. There were significant correlations between HRV and digit span test scores. Our results suggest that the 10-week exergame training program was effective in improving executive functions of working memory, inhibitory control, and planning ability as well as aerobic fitness in middle-aged and older adults. Moreover, HRV was associated with improved executive function.

Comparison of the Acute Effects of Virtual Reality Exergames and Core Stability Exercises on Cognitive Factors, Pain, and Fear Avoidance Beliefs in People with Chronic Nonspecific Low Back Pain

Objective: In this study, we aimed to investigate and compare the acute effects of exergames (EXG) and core stability exercises (CSEs) on cognitive factors, pain, mood, and fear-avoidance beliefs (FAB) in individuals with chronic low back pain (CLBP). Materials and Methods: In a single-blinded clinical trial, 40 participants with CLBP were randomly assigned to either the EXG group or the CSEs group. The EXG group engaged in a single session of exergames using the Xbox Kinect device, while the CSEs group completed a single session of common core stability exercises. Measurements of attention, working memory, pain intensity, mood states, and FAB were taken before and after each intervention. Results: The results showed that a single session of EXG was significantly more effective than CSEs in improving cognitive reaction time, pain intensity, FAB, and positive mood states (P ≤ 0.05). Additionally, participants reported lower perceived exertion due to exercising following EXG compared with CSEs. Conclusion: EXG may have potential therapeutic advantages over traditional exercise interventions for CLBP.

Computerized cognitive games versus cognitive exergame: the comparison of motor and cognitive functions enhancement in the elderly

BACKGROUND

Considering the importance of cognitive and motor functions of the elderly people, the present study was conducted to evaluate the effectiveness of a cognitive exergame, called Neurolight compared to computerized cognitive games, in enhancing core executive functions and motor performance.

METHODS

A total of 36 individuals in the age range of 60 to 69 years were studied in the form of three groups: The control group continued their daily activities, while the Neurolight group underwent a cognitive-motor training and the Maghzineh performed a computer-based cognitive training program for 24 sessions. Before and after interventions, working memory, inhibitory control, and balance were measured respectively by the N-back, Stroop, and TUG tests.

RESULTS

The results showed that cognitive-motor exercises using Neurolight, for 24 sessions, were able to significantly improve working memory, inhibitory control, and balance in individuals in this age group.

CONCLUSION

This finding supports the other studies suggesting combined cognitive and physical exercises for better effect. Based on its findings, the use of this exercise system can be suggested to coaches and therapists working with the elderly.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

PROSPERO REGISTRATION NUMBER

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

Ten-Minute Physical Activity Breaks Improve Attention and Executive Functions in Healthcare Workers

Occupational health is a major problem in modern work environments. Physical activity breaks (PABs), short exercise periods delivered during working hours, incorporating exergames or outdoor activities, have emerged as a novel approach that could be used to improve work efficiency and workplace wellbeing. Therefore, this study aimed to investigate the impact of PABs on attention levels and executive functions in healthcare workers. A total of 27 healthcare workers (M = 14, W = 13; 49.55 ± 12.46 years), after 4 h of work, randomly performed one of three 10 min conditions weekly in a counterbalanced order: No Physical Activity Break (NPAB); Outdoor Physical Activity Break (OPAB); Physical Activity Break with Exergame (PABEx). After the conditions, executive functions and selective attention were assessed by the Stroop Color and Word Test (SCWT), and the Trail Making A,B test (TMT A,B), respectively. Significant differences between OPAB and NPAB as well as between PABEx and NPAB in the TMT-A test χ2(2) = 44.66 (p < 0.001) and TMT-B test χ2(2) = 48.67 (p < 0.001) were found, respectively. TMT-A and SCWT interference/time scores of the PABEx and OPAB conditions were significantly lower than those of NPAB (p < 0.001). In the SCWT interference/error score, no significant difference was found between the PABEx and NPAB (p > 0.05), but the score was statistically lower in the OPAB condition than PABEx (p = 0.001) and PABEx condition compared to OPAB for TMT-A (p = 0.001). Findings showed that the OPAB and PABEx conditions are effective in improving selective attention and executive functions in healthcare workers. Employers can foster a healthier and more productive workforce by promoting a culture of movement and prioritizing employee health, which in turn can enhance patient care outcomes.

The Effectiveness of Digital Interactive Intervention on Reducing Older Adults' Depressive and Anxiety Symptoms: A Systematic Review and Meta-Analysis

INTRODUCTION

Anxiety and depression are prevalent among older adults, and digital interactive interventions have shown promise in promoting their mental well-being. However, limited research has explored the effects of different types of digital interactive interventions across various devices on anxiety and depression in older adults with different health conditions.

METHODS

A systematic literature review and meta-analysis were conducted using seven selected databases to identify relevant studies up to July 19, 2023. Two reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the Cochrane risk-of-bias tool. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) using a random-effects model.

RESULTS

A total of 20 randomized control trails involving 1,309 older adults fulfilled inclusion criteria. The meta-analysis results demonstrates that the digital interactive intervention technologies had a significance on depression (SMD = -0.656 s, 95% confidence interval [CI] = -0.992 to -0.380, p < 0.001) and anxiety (SMD = -0.381 s, 95% CI = -0.517 to -0.245, p < 0.001). Physical interactive interventions demonstrated a significant effect on depression and anxiety (SMD = -0.711 s, 95% CI = -1.102 to -0.319, p < 0.001) and (SMD = -0.573 s, 95% CI = -0.910 to -0.236, p = 0.001). Similarly, immersive interactive interventions also showed a significant effect on depression and anxiety (SMD = -0.699 s, 95% CI = -1.026 to -0.373, p < 0.001) and (SMD = -0.343 s, 95% CI = -0.493 to -0.194, p < 0.001). Additionally, in the internal medicine group, significant intervention effects were observed for depression (SMD = -0.388, 95% CI = -0.630 to -0.145, p = 0.002) and anxiety (SMD = -0.325, 95% CI = -0.481 to -0.169, p < 0.001). Similarly, in the neurocognitive disorders group, significant intervention effects were found for depression (SMD = -0.702, 95% CI = -0.991 to -0.413, p < 0.001) and anxiety (SMD = -0.790, 95% CI = -1.237 to -0.342, p = 0.001).

CONCLUSION

The results indicated that various digital interactive devices, including physical and immersive interactive devices, have a positive impact on depression and anxiety among older adults. However, mobile games were not effective in addressing depression. Digital interactive technologies did not significantly influence anxiety intervention, except for elderly individuals undergoing surgical procedures. Nevertheless, these interventions effectively addressed depression and anxiety in older individuals with neurocognitive disorders, internal medical issues, and those without health issues.

Virtual reality exergames for improving physical function, cognition and depression among older nursing home residents: A systematic review and meta-analysis

OBJECTIVE

To explore the effectiveness of virtual reality (VR) exergames on physical function, cognition and depression among older nursing home residents.

METHODS

A systematic review and meta-analysis were conducted. The PubMed, Ovid, Embase, Cochrane, CINAHL, and Web of Science databases were searched for relevant studies from inception until June 1, 2023. The reviewers independently completed the study selection, data extraction and quality assessment. Subgroup analyses were conducted to explore the sources of between-study heterogeneity and to determine whether participant or intervention characteristics influenced effect sizes.

RESULTS

Eighteen studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high, and the overall evidence grade was moderate. VR exergames had a large effect on physical function, including mobility [SMD=-0.66, P < 0.001], balance [SMD=0.95, P < 0.001], and lower limb strength [SMD=0.53, P = 0.0009]; and a moderate effect on cognition [SMD=0.48, P = 0.02] and depression [SMD=-0.72, P = 0.03]. Subgroup analyses revealed that a training frequency of 2 sessions per week and coordinating with physiotherapists yielded greater improvements in mobility (P = 0.009; P = 0.0001). VR exergames had especially beneficial effects on balance for physically fit participants (P = 0.03) and on cognition for participants with cognitive impairment (P = 0.01). Additionally, regarding the improvement of depression, commercial VR exergames were superior to self-made systems (P = 0.03).

CONCLUSION

VR exergames can provide a positive impact on physical function, cognition and depression among older nursing home residents. The study also demonstrated the different benefits of exergames between participants who were physically fit and those with cognitive impairment, which is considered as an innovative, cost-efficient and sustainable approach. Specifically, commercial VR exergame programs with a frequency of 2 sessions per week and coordinating with physiotherapists may be the most appropriate and effective option.

Cognitive benefits of the attentional vs exergame training in older adults

OBJECTIVE

The present study aimed at comparing the effectiveness of an Attentional Computerized Cognitive Training and a commercial Exergame Training.

METHODS

Eighty-four healthy older adults took part in the study. They were randomly assigned to one of the following conditions: Attentional Computerized Cognitive Training (ATT-CCT), Exergame Training (EXERG-T), or passive Control Group (CG). Participants assigned to the experimental groups underwent 8 laboratory-based sessions-lasting approximately 45 min each-of the respective training activity. A battery of cognitive tests was assessed before, after, and 3 months following the intervention phase.

RESULTS

The results showed that just the ATT-CCT improved participants' performance, specifically within attention, processing speed, verbal learning and memory. While both intervention groups revealed improved memory self-perception and decreased self-reported absent-mindedness, only the benefits following the ATT-CCT proved to be stable over time.

CONCLUSIONS

The results suggested that our ATT-CCT may be an effective tool for enhancing cognitive abilities in older healthy adults.

Exergames improve cognitive function in older adults and their possible mechanisms: A systematic review

Objective

The degree of aging in China is deepening, leading to cognitive decline and seriously affecting the health status of the elderly. This article explores the benefits of exergames in improving cognitive function in older adults through a literature review, with aim of contributing to the development of healthy aging.

Methods

Using PubMed, Web of Science, CNKI, dimensional spectrum, search for research papers from 2005 to April 2023 by using keywords such as a somatosensory game, cognitive function, execute function, working memory, aged and suppression control. PEDro Scale was used to check the quality of the literature.

Results

A total of 16 papers were included in the review. Exergames improve the executive function of the elderly and support the relationship between exergames and cognitive performance in older adults. From a mechanistic perspective, somatosensory play promotes signal transduction of brain neurotrophin, thereby protecting the structure and function of neurons in specific brain regions and delays the decline of executive function in older adults as much as possible.

Conclusions

It is recommended to use exergames as an intervention measure for the physical and mental health preservation of older adults. Suggest adopting personalised exergames in the future to explore the impact of cognitive and physical functions in elderly people, as well as measurable changes in brain structure.

Neural and behavioral evidence supporting the relationship between habitual exercise and working memory precision in healthy young adults

Introduction

Working memory (WM) is a well-known fundamental ability related to various high-level cognitive functions, such as executive functioning, decision-making, and problem-solving. Although previous studies have posited that chronic exercise may improve cognitive functions, its underlying neural mechanisms and whether habitual exercise is associated with individual WM ability remain unclear.

Methods

In the current study, 36 participants reported their habitual physical activity through the International Physical Activity Questionnaire (IPAQ). In addition to assessments of intelligence quotient (IQ), WM storage capacity (K score), and visuomotor coordination capacity, electroencephalogram (EEG) signals were recorded while the participants performed a WM precision task fusing conventional visual and motor retrospective cue (retro-cue) WM tasks.

Results

We found that greater amounts of and higher frequencies of vigorous-intensity exercise were highly correlated with smaller recall errors in the WM precision task. Contralateral delay activity (CDA), a well-known WM-related event-related potential (ERP) component evoked by the valid retro-cue, predicted individual behavioral recall error. Participants who met the medium or high level of IPAQ criteria (the regular exercise group) showed smaller behavioral recall error and larger CDA than participants who did not meet the criteria (the irregular exercise group). The two groups did not differ in other assessments, such as IQ, WM storage capacity, and visuomotor coordination ability.

Discussion

Habitual exercise was specifically correlated with individual differences in WM precision, rather than IQ, WM storage capacity, and visuomotor coordination ability, suggesting potential mechanisms of how modulations of chronic exercise improve cognition through visual and/or motor WM precision.

A novel balance training approach: Biomechanical study of virtual reality-based skateboarding

Introduction: The use of virtual reality (VR) technology in training and rehabilitation gained increasing attention in recent years due to its potential to provide immersive and interactive experiences. We developed a novel VR-based balance training, VR-skateboarding, for improving balance. It is important to investigate the biomechanical aspects of this training, as it would have benefited both health professionals and software engineers. Aims: This study aimed to compare the biomechanical characteristics of VR-skateboarding with those of walking. Materials and Methods: Twenty young participants (10 males and 10 females) were recruited. Participants underwent VR-skateboarding and walking at the comfortable walking speed, with the treadmill set at the same speed for both tasks. The motion capture system and electromyography were used to determine joint kinematics and muscle activity of the trunk and legs, respectively. The force platform was also used to collect the ground reaction force. Results: Participants demonstrated increased trunk flexion angles and muscle activity of trunk extensor during VR-skateboarding than during walking (p < 0.01). For the supporting leg, participants' joint angles of hip flexion and ankle dorsiflexion, as well as muscle activity of knee extensor, were higher during VR-skateboarding than during walking (p < 0.01). For the moving leg, only hip flexion increased in VR-skateboarding when compared to walking (p < 0.01). Furthermore, participants increased weight distribution in the supporting leg during VR-skateboarding (p < 0.01). Conclusion: VR-skateboarding is a novel VR-based balance training that has been found to improve balance through increased trunk and hip flexion, facilitated knee extensor muscles, and increased weight distribution on the supporting leg compared to walking. These differences in biomechanical characteristics have potential clinical implications for both health professionals and software engineers. Health professionals may consider incorporating VR-skateboarding into training protocols to improve balance, while software engineers may use this information to design new features in VR systems. Our study suggests that the impact of VR-skateboarding particularly manifest when focusing on the supporting leg.