Exergaming as a Physical Exercise Strategy Reduces Frailty in People With Dementia: A Randomized Controlled Trial

Karssemeijer, Esther G.A.; Bossers, Willem; Aaronson, Justine A.; Sanders, Lianne; Kessels, Roy P. C.; Rikkert, Marcel G M Olde

doi:10.1016/j.jamda.2019.06.026

Cited by 46 publications

(83 citation statements)

References 41 publications

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“…The lack of significant improvements in ADL is in line with a study examining the effects of a Nintendo-Wii bowling game in residents of retirement homes with and without MNCD [50]. In a more recent RCT, no improvements in Katz ADL were found after 12 weeks of cognitive-aerobic bicycle training on a stationary bike in community-dwelling older adults with MNCD [26]. The findings in our study and previous RCTs in MNCD are, however, not consistent with a meta-analysis exploring the efficacy of combined cognitive-physical training in older adults with MCI or MNCD that demonstrated moderate-to-large positive effects on activities of daily living [10].…”

Section: Discussionsupporting

confidence: 71%

“…A previous meta-analysis demonstrated that in residential and community-dwelling older adults with mild cognitive impairment or MNCD, a combination of cognitive and physical training resulted in small-to-medium improvements in global cognitive function and mood and moderate-to-large positive effects on activities of daily living [10]. A randomized controlled trial in outpatients and community patients with MNCD suggested that the group receiving combined cognitive-aerobic bicycle exergame training during 30 to 50 min at three times per week during 12 weeks and the group receiving cycling at the same frequency, intensity, and time without exergaming improved psychomotor speed [25] and reduced frailty [26], as compared to the control group, receiving relaxation and flexibility exercises. However, no differences were observed between the three groups for executive functioning, episodic memory and working memory [25,26].…”

Section: Introductionmentioning

confidence: 99%

“…A randomized controlled trial in outpatients and community patients with MNCD suggested that the group receiving combined cognitive-aerobic bicycle exergame training during 30 to 50 min at three times per week during 12 weeks and the group receiving cycling at the same frequency, intensity, and time without exergaming improved psychomotor speed [25] and reduced frailty [26], as compared to the control group, receiving relaxation and flexibility exercises. However, no differences were observed between the three groups for executive functioning, episodic memory and working memory [25,26].…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

et al. 2021

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Background It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities. Methods Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants’ capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade’s non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (η2p) effect sizes were calculated. Results Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70–91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η2p = 0.41), total SPPB (p < 0.001, η2p = 0.64), SRTT (p<0.001, η2p = 0.51), MoCA (p<0.001, η2p = 0.38), and reductions in CSDD (p<0.001, η2p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η2p = 0.05), DQoL (p = 0.012, η2p = 0.16), and ADL (p = 0.008, η2p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team. Conclusions The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities. Trial registration ClinicalTrials.gov, NCT04436302

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

et al. 2021

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“…The personal costs of dementia and these alarming public health estimates are motivating efforts to identify lifestyle interventions that can slow the progression of ADRD. In addition to focusing on treatment, studies have been targeting prevention of neurodegenerative diseases with the aim of mitigating, delaying or preventing the onset of ADRD [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The Brain in Motion II Study: Study Protocol for a Randomized Controlled Trial of an Aerobic Exercise Intervention for Older Adults at Increased Risk of Dementia

Krüger

Clark²,

Dyck

et al. 2021

Preprint

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Background: There remains no effective intervention capable of reversing most cases of dementia. Current research is focused on prevention, by addressing risk factors that are shared between cardiovascular disease and dementia (e.g., hypertension) before the cognitive, functional, and behavioural symptoms of dementia manifest. A promising preventive treatment is exercise. This study describes the methods of a randomized controlled trial (RCT) that assesses the effects of aerobic exercise and behavioural support interventions in older adults at increased risk of dementia due to genetic and/or cardiovascular risk factors. The specific aims are to determine the effect of aerobic exercise on cognitive performance, explore the biological mechanisms that influence cognitive performance after exercise training, and determine if changes in cerebrovascular physiology and function persist one year after a 6-month aerobic exercise intervention followed by a 1-year behavioural support program (at 18 months).Methods: We will recruit 264 participants (aged 50-80 years) at elevated risk of dementia. Participants will be randomly allocated into one of four treatment arms: (1) aerobic exercise and health behaviour support, (2) aerobic exercise and no health behaviour support, (3) stretching-toning and health behaviour support, and (4) stretching-toning and no health behaviour support. The aerobic exercise intervention will consist of three supervised walking/jogging sessions per week for 6 months whereas the stretching-toning control intervention will consist of three supervised stretching-toning sessions per week also for 6 months. Following the exercise interventions, participants will receive either one year of ongoing telephone behavioural support or no telephone support. The primary outcome is cognition assessed through neuropsychological tests. Secondary outcomes include variety of cerebrovascular/physiological, neuroimaging, sleep, cognitive, other psychological variables and healthcare utilization. The outcome assessments will be conducted at baseline, after the 6-month intervention, and 1 year after the completion of the exercise intervention (at 18 months).Discussion: This study will address knowledge gaps regarding the underlying mechanisms of the pro-cognitive effects of exercise by examining potential mediating factors, including cerebrovascular/physiological, neuroimaging, sleep, and genetic factors that will provide novel biologic evidence on how aerobic exercise can prevent declines in cognition with aging.Trial Registration: ClinicalTrials.gov (NCT03035851, 30 January 2017).

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“…Predictors of exercise adherence were grouped into the following clusters: demographic, psychological, program-related, medical condition severity, comorbidities, and other. Demographic factors were evaluated by 13 studies(25, 28-32, 35, 36, 38, 40, 41, 43, 44) (Table 2), psychological factors by 14 studies(22, 24, 25, 27-31, 34, 36, 38, 40, 41, 43, 44) (Table 3), program-related factors by 7 studies,(22,26,29,33,35,37,39) medical condition severity by 11 studies,(24, 28-31, 38, 40-44) comorbidities by 8 studies(24,25,27,32,36,40,41,43) and other predictors by 5 studies (22,31,35,42,43). Similar factors were investigated between exercise indications (seeSupplementary Tables S3, S4, S5; Additional Files 3, 4, 5), however more functional measures to quantify lung function were used as potential predictors of adherence among pulmonary rehabilitation studies, while more disease characteristics and history measures were used among cardiac rehabilitation studies.…”

mentioning

confidence: 99%

Predictors of Adherence to Prescribed Exercise Programs for Older Adults With Medical or Surgical Indications for Exercise: a Systematic Review

Shaw

Pilon

Vierula

et al. 2020

Preprint

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BACKGROUND AND OBJECTIVES: Prescribed exercise to treat medical conditions and to prepare for surgery is a promising intervention to prevent adverse health outcomes for older adults; however, adherence to exercise programs may be low. Our objective was to identify and grade the quality of predictors of adherence to prescribed exercise in older adults. METHODS: Prospective experimental studies were identified using a peer-reviewed search strategy applied to MEDLINE, EMBASE, Cochrane and CINAHL from inception until October 6, 2020. Following independent and duplicate review of titles, abstracts and full texts, we included prospective studies with an average population age >65 years, where exercise was formally prescribed for a medical or surgical condition. We excluded studies where exercise was prescribed for a chronic musculoskeletal condition. Risk of bias was assessed using the Quality in Prognostic studies tool or Cochrane risk of bias tool, as appropriate. Predictors of adherence were identified, pooled, and graded for quality using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for predictor studies.RESULTS: We included 19 observational studies and 4 randomized controlled trials (n=5785) Indications for exercise included cardiac (n=6), pulmonary rehabilitation (n=7), or other (n=10; surgical, medical, and neurologic). Of the 10 studies that reported adherence as the percent of prescribed sessions completed, average adherence was 80% (range 60%-98%; standard deviation (SD) 11%). Of the 10 studies that reported adherence as a categorical threshold demarking adherent vs not adherent, average adherence was 57.5% (range 21%-83%; SD 21%). Moderate-quality evidence suggested that positive predictors of adherence were self-efficacy and good self-rated mental health; negative predictors were depression (high quality) and distance from the exercise facility. Moderate-quality evidence suggested that comorbidity and age were not predictive of adherence.CONCLUSIONS: These findings can inform design of future exercise programs as well as identification of individuals who may require extra support to benefit from prescribed exercise.SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018108242

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Exergaming as a Physical Exercise Strategy Reduces Frailty in People With Dementia: A Randomized Controlled Trial

Cited by 46 publications

References 41 publications

The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

The Brain in Motion II Study: Study Protocol for a Randomized Controlled Trial of an Aerobic Exercise Intervention for Older Adults at Increased Risk of Dementia

Predictors of Adherence to Prescribed Exercise Programs for Older Adults With Medical or Surgical Indications for Exercise: a Systematic Review

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