Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis

Mura, Gioia; Carta, Mauro Giovanni; Sancassiani, Federica; Machado, Sérgio; Prosperini, Luca

doi:10.23736/s1973-9087.17.04680-9

Cited by 111 publications

(67 citation statements)

References 53 publications

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“…88,89 Compared to traditional rehabilitation approaches, exergame-based interventions (which are considered nonimmersive VR systems) were found to improve to a significantly greater extent executive functions and visuospatial perception in adult populations with neurological disabilities and in children with neurodevelopmental disorders. 90 Nevertheless, the effect of nonimmersive VR neurorehabilitation training on HRQoL has so far not been well debated, due to few, low-quality studies of the evidence also confirmed by our findings. 86 Indeed, two meta-analyses on VR-based interventions for specific neurologic disorders reported similar effects on HRQoL for VR and conventional physiotherapy in individuals with Parkinson's disease, 91 together with a lack of scientific evidence for VR-based interventions on HRQoL in poststroke survivors.…”

Section: Discussionsupporting

confidence: 65%

Exergaming for Quality of Life in Persons Living with Chronic Diseases: A Systematic Review and Meta‐analysis

Cugusi

Prosperini

Mura

2020

PM&R

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Objective To evaluate the evidence of effectiveness of exergame‐based rehabilitative interventions on health‐related quality of life (HRQoL) in persons with chronic diseases. Type Systematic review and meta‐analysis. Literature survey Randomized and nonrandomized controlled trials of exergame rehabilitation interventions in populations with chronic diseases reporting HRQoL outcomes were identified by searching PubMed, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, using keywords and MeSH terms for papers published between January 2005 and March 2019. Methodology Risk of bias was assessed by using the PEDro scale. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to score the quality of evidence. Pooled effects were reported as standardized mean differences (SMDs) or weighted mean difference (MDs) and 95% confidence intervals (CIs), using a random‐effects model. Heterogeneity was weighted by inconsistency I2 tests. Synthesis Thirty‐four trials were identified (1594 participants). Overall, the evidence was low quality. Exergames significantly improved HRQoL in populations with chronic diseases, with a small effect size (32 studies; 1544 participants; SMD 0.24; 95% CI 0.1 to 0.4; I2 = 27%) and specifically in people with neurological disorders (20 studies, 956 participants, SMD 0.22; 95% CI 0.2 to 0.4; I2 = 49%), rheumatologic diseases (four studies, 210 participants, SMD 0.39; 95% CI 0.1 to 0.7; I2 = 4%), and cardiorespiratory and chronic metabolic conditions (five studies, 309 participants, SMD 0.23; 95% CI 0.0 to 0.5; I2 = 0%). Exergaming interventions in health care settings demonstrated similarly small but positive effects (22 studies, 905 participants, SMD 0.30; 95% CI 0.1 to 0.5; I2 = 41%), whereas those carried out in home‐based contexts did not. Conclusions Exergame‐based rehabilitative interventions performed in health care settings led to small but statistically significant improvements in HRQoL in persons with chronic diseases.

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Section: Discussionsupporting

confidence: 65%

Exergaming for Quality of Life in Persons Living with Chronic Diseases: A Systematic Review and Meta‐analysis

Cugusi

Prosperini

Mura

2020

PM&R

Self Cite

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“…Interviews showed a strong acceptance of the exergames by patients (even in the first study). The majority would welcome the integration of exergames into their conventional therapy because of their appealing nature and beneficial motor-cognitive training approach [40,106]. The combined training regimen allows for the concurrent processing and synchronization of cognitive and motor stimuli and therefore can trigger brain-body communication.…”

Section: Exergame As An Ms Therapy Toolmentioning

confidence: 99%

“…In recent years, researchers have started to evaluate exergames as a rehabilitation tool for patients with MS. Exergames proved to be an acceptable, feasible, safe, enjoyable, challenging, and self-motivating tool [38][39][40]. Kramer et al [41] concluded that the integration of exergames seemed to have a positive effect on training adherence and therefore could support the efficacy of long-term rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

“…Robinson et al [46] showed that the physical benefits of Nintendo Wii Fit training were comparable with traditional balance training in patients with MS. Furthermore, 2 recent systematic reviews concluded that exergaming enhanced cognitive functioning, in particular decision-making processes (executive functions) and visuospatial perception, in neurological patients who experience stroke, Parkinson disease, MS, or dementia [40,47]. However, many of the results so far stem from commercially available exergame systems (mainly Nintendo Wii and fewer Xbox Kinect and Sony PlayStation) that have not been developed for specific rehabilitation audiences.…”

Section: Introductionmentioning

confidence: 99%

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Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies

Schättin¹,

Häfliger²,

Meyer³

et al. 2021

JMIR Serious Games

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Background Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game–based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. Objective The aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. Methods Focus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience–related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. Results In the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=−2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=−2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. Conclusions The project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS.

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“…Exergames, which require physical effort and are controlled by (whole) body movements ( Oh and Yang, 2010 ), have been promoted as suitable tools for providing attractive and effective training alternatives or supplements by the interdisciplinary research and development (R&D) community. In more than 10 years, R&D work has proved that exergames have the potential to be training tools that are both effective (i.e., increasing physical-cognitive fitness, endurance, strength, and coordination) ( Staiano and Calvert, 2011a , b ; Sween et al, 2014 ; Best, 2015 ; Benzing et al, 2016 ; Kari, 2017 ; Mura et al, 2018 ; Stojan and Voelcker-Rehage, 2019 ; Xiong et al, 2019 ) and attractive (e.g., increasing training adherence, motivation, flow, and engagement) ( McRae et al, 2012 ; Valenzuela et al, 2018 ; Martin-Niedecken et al, 2019b ; Tondello et al, 2019 ). Furthremore, exergamging promotes physical activity and training in different target populations ( Lu et al, 2013 ; Kappen et al, 2019 ; Martin-Niedecken and Schättin, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Comparing the Impact of Heart Rate-Based In-Game Adaptations in an Exergame-Based Functional High-Intensity Interval Training on Training Intensity and Experience in Healthy Young Adults

2021

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Physical inactivity remains one of the biggest societal challenges of the 21st century. The gaming industry and the fitness sector have responded to this alarming fact with game-based or gamified training scenarios and thus established the promising trend of exergaming. Exergames—games played with the (whole) body as physical input—have been extolled as potential attractive and effective training tools. Simultaneously, researchers and designers are still exploring new approaches to exploit the full potential of this innovative and enjoyable training method. One way to boost the attractiveness and effectiveness of an exergame is to individualize it with game adaptations. A physiological parameter that is often used to balance the physical challenge and intensity of exergames to the player’s fitness skills is the heart rate (HR). Therefore, researchers and designers often rely on age-based, maximum HR (HRmax) formulas originating from performance diagnostics. In combination with the player’s assessed real-time HR during an exergame session, the pre-determined HRmax is used to adapt the game’s challenge to reach a pre-defined HR and physical intensity level (in-exergame adaptations), respectively. Although the validity and reliability of these age-based HRmax formulas were proven in heterogeneous target populations, their use is still often criticized as HR is an individual parameter that is affected by various internal and external factors. So far, no study has investigated whether the formula-based pre-calculated HRmax compared to a standardized individually pre-assessed HRmax elicits different training intensities, training experiences, and flow feelings in an exergame. Therefore, we compared both variants for in-exergame adaptation with the ExerCube – a functional high-intensity interval training exergame – in healthy young adults. Comparing the results of the two conditions, no significant differences were found for HR parameters and perceived physical and cognitive exertion, nor for overall flow feelings and physical activity enjoyment. Thus, the formula-based in-exergame adaptation approach was suitable in the presented study population, and the ExerCube provided an equally reliable in-exergame adaptation and comparable exergame play experiences. We discuss our findings in the context of related work on exergame adaptation approaches and draw out some implications for future adaptive exergame design and research topics.

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Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis

Abstract: The final version may contain major or minor changes.Subscription: Information about subscribing to Minerva Medica journals is online at: http://www.minervamedica.it/en/how-to-order-journals.php Reprints and permissions: For information about reprints and permissions send an email to:

Cited by 111 publications

References 53 publications

Exergaming for Quality of Life in Persons Living with Chronic Diseases: A Systematic Review and Meta‐analysis

Exergaming for Quality of Life in Persons Living with Chronic Diseases: A Systematic Review and Meta‐analysis

Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies

Comparing the Impact of Heart Rate-Based In-Game Adaptations in an Exergame-Based Functional High-Intensity Interval Training on Training Intensity and Experience in Healthy Young Adults

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