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

      research-article
      , MD 1 , , PhD, Prof Dr 1 , 2 , 3 , , , PhD, Prof Dr 4 , , PhD 5 , , MD 1 , , PhD 1 , , MD 1 , , MD 1 , , MD 1 , , BS 6
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Serious Games
      JMIR Publications
      mild cognitive impairment, dementia, exergaming, physical, cognitive

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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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          Most cited references64

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          Predicting User Intentions: Comparing the Technology Acceptance Model with the Theory of Planned Behavior

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            Prevalence of mild cognitive impairment is higher in men. The Mayo Clinic Study of Aging.

            We investigated the prevalence of mild cognitive impairment (MCI) in Olmsted County, MN, using in-person evaluations and published criteria. We evaluated an age- and sex-stratified random sample of Olmsted County residents who were 70-89 years old on October 1, 2004, using the Clinical Dementia Rating Scale, a neurologic evaluation, and neuropsychological testing to assess 4 cognitive domains: memory, executive function, language, and visuospatial skills. Information for each participant was reviewed by an adjudication panel and a diagnosis of normal cognition, MCI, or dementia was made using published criteria. Among 1,969 subjects without dementia, 329 subjects had MCI, with a prevalence of 16.0% (95% confidence interval [CI] 14.4-17.5) for any MCI, 11.1% (95% CI 9.8-12.3) for amnestic MCI, and 4.9% (95% CI 4.0-5.8) for nonamnestic MCI. The prevalence of MCI increased with age and was higher in men. The prevalence odds ratio (OR) in men was 1.54 (95% CI 1.21-1.96; adjusted for age, education, and nonparticipation). The prevalence was also higher in subjects who never married and in subjects with an APOE epsilon3epsilon4 or epsilon4epsilon4 genotype. MCI prevalence decreased with increasing number of years of education (p for linear trend <0.0001). Our study suggests that approximately 16% of elderly subjects free of dementia are affected by MCI, and amnestic MCI is the most common type. The higher prevalence of MCI in men may suggest that women transition from normal cognition directly to dementia at a later age but more abruptly.
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              Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians.

              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
                Journal
                JMIR Serious Games
                JMIR Serious Games
                JSG
                JMIR Serious Games
                JMIR Publications (Toronto, Canada )
                2291-9279
                Apr-Jun 2020
                30 June 2020
                : 8
                : 2
                : 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
                https://orcid.org/0000-0003-1755-5208
                https://orcid.org/0000-0001-6930-4780
                https://orcid.org/0000-0003-3772-2376
                https://orcid.org/0000-0003-0683-3989
                https://orcid.org/0000-0001-8794-9988
                https://orcid.org/0000-0003-2052-6643
                https://orcid.org/0000-0003-3356-3734
                https://orcid.org/0000-0002-6914-6628
                https://orcid.org/0000-0001-6049-2236
                https://orcid.org/0000-0002-9571-4502
                Article
                v8i2e16841
                10.2196/16841
                7367532
                32602841
                8fa6021f-8543-4a0a-ba65-8a485f0b9b3b
                ©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.

                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
                : 30 October 2019
                : 11 December 2019
                : 19 February 2020
                : 12 April 2020
                Categories
                Review
                Review

                mild cognitive impairment,dementia,exergaming,physical,cognitive

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