Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review

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Abstract

Background

Individuals with mild cognitive impairment and dementia have impaired physical and cognitive functions, leading to a reduced quality of life compared with those without such impairment. Exergaming, which is defined as a combination of exercise and gaming, is an innovative, fun, and relatively safe way to exercise in a virtual reality or gaming environment. Therefore, exergaming may help people living with mild cognitive impairment or dementia to overcome obstacles that they may experience regarding regular exercise and activities.

Objective

The aim of this systematic review was to review studies on exergaming interventions administered to elderly individuals with mild cognitive impairment and dementia, and to summarize the results related to physical and cognitive functions such as balance, gait, executive function, and episodic memory.

Methods

We searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, Amed, and Nursing Database for articles published from the inception of the respective databases to January 2019. We included all clinical trials of exergaming interventions in individuals with mild cognitive impairment and dementia for review. The risk of bias was independently evaluated by two reviewers using the Cochrane Collaboration and Risk of Bias in Non-randomized Studies of Interventions tools.

Results

Ten studies involving 702 participants were included for review. There was consistent evidence from 7 studies with a low risk of bias showing statistically significant effects of exergaming on cognitive functioning in people with mild cognitive impairment and dementia. With respect to physical function, 3 of 5 full-scale studies found positive results, and the intensity of most games was classified as moderate.

Conclusions

Overall, exergaming is an innovative tool for improving physical and cognitive function in people with mild cognitive impairment or dementia, although there is high heterogeneity among studies in terms of the duration, frequency, and gaming platform used. The quality of the included articles was moderate to high. More high-quality studies with more accurate outcome indicators are needed for further exploration and validation of the benefits of exergaming for this population.

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Approximately two thirds of stroke survivors continue to experience motor deficits of the arm resulting in diminished quality of life. Conventional rehabilitation provides modest and sometimes delayed effects. Virtual reality (VR) technology is a novel adjunctive therapy that could be applied in neurorehabilitation. We performed a meta-analysis to determine the added benefit of VR technology on arm motor recovery after stroke. We searched Medline, EMBASE, and Cochrane literature from 1966 to July 2010 with the terms "stroke," "virtual reality," and "upper arm/extremity." We evaluated the effect of VR on motor function improvement after stroke. From the 35 studies identified, 12 met the inclusion/exclusion criteria totaling 195 participants. Among them, there were 5 randomized clinical trials and 7 observational studies with a pre-/postintervention design. Interventions were delivered within 4 to 6 weeks in 9 of the studies and within 2 to 3 weeks in the remaining 3. Eleven of 12 studies showed a significant benefit toward VR for the selected outcomes. In the pooled analysis of all 5 randomized controlled trials, the effect of VR on motor impairment (Fugl-Meyer) was OR=4.89 (95% CI, 1.31 to 18.3). No significant difference was observed for Box and Block Test or motor function. Among observational studies, there was a 14.7% (95% CI, 8.7%-23.6%) improvement in motor impairment and a 20.1% (95% CI, 11.0%-33.8%) improvement in motor function after VR. VR and video game applications are novel and potentially useful technologies that can be combined with conventional rehabilitation for upper arm improvement after stroke.

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Author and article information

Contributors

Hui Feng:

ORCID: https://orcid.org/0000-0001-6930-4780

Xiangya School of NursingCentral South UniversityNo. 172 Tongzipo RoadChangshaChina86 82650292feng.hui@csu.edu.cn

Journal

Journal ID (nlm-ta): JMIR Serious Games

Journal ID (iso-abbrev): JMIR Serious Games

Journal ID (publisher-id): JSG

Title: JMIR Serious Games

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-9279

Publication date Collection: Apr-Jun 2020

Publication date (Electronic): 30 June 2020

Volume: 8

Issue: 2

Electronic Location Identifier: e16841

Affiliations

[1 ] Xiangya School of Nursing Central South University Changsha China

[2 ] Xiangya-Oceanwide Health Management Research Institute Central South University Changsha China

[3 ] National Clinical Research Center for Geriatric Disorders Xiangya Hospital Changsha China

[4 ] Xiangya School of Public Health Central South University Changsha China

[5 ] School of Nursing University of Texas Health Science Center San Antonio, TX United States

[6 ] Henan Children's Hospital Zhengzhou China

Author notes

Corresponding Author: Hui Feng feng.hui@ 123456csu.edu.cn

Author information

Yinan Zhao https://orcid.org/0000-0003-1755-5208

Hui Feng https://orcid.org/0000-0001-6930-4780

Xinyin Wu https://orcid.org/0000-0003-3772-2376

Yan Du https://orcid.org/0000-0003-0683-3989

Xiufen Yang https://orcid.org/0000-0001-8794-9988

Mingyue Hu https://orcid.org/0000-0003-2052-6643

Hongting Ning https://orcid.org/0000-0003-3356-3734

Lulu Liao https://orcid.org/0000-0002-6914-6628

Huijing Chen https://orcid.org/0000-0001-6049-2236

Yishan Zhao https://orcid.org/0000-0002-9571-4502

Article

Publisher ID: v8i2e16841

DOI: 10.2196/16841

PMC ID: 7367532

PubMed ID: 32602841

SO-VID: 8fa6021f-8543-4a0a-ba65-8a485f0b9b3b

Copyright © ©Yinan Zhao, Hui Feng, Xinyin Wu, Yan Du, Xiufen Yang, Mingyue Hu, Hongting Ning, Lulu Liao, Huijing Chen, Yishan Zhao. Originally published in JMIR Serious Games (http://games.jmir.org), 30.06.2020.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org, as well as this copyright and license information must be included.

History

Date received : 30 October 2019

Date revision requested : 11 December 2019

Date revision received : 19 February 2020

Date accepted : 12 April 2020

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