Exergaming and Older Adult Cognition: A Cluster Randomized Clinical Trial

Anderson-Hanley, Cay; Arciero, Paul J.; Brickman, Adam M.; Nimon, Joseph P.; Okuma, Naoko; Westen, Sarah C.; Merz, Molly E.; Pence, Brandt D.; Woods, Jeffrey A.; Kramer, Arthur F.; Zimmerman, Earl A.

doi:10.1016/j.amepre.2011.10.016

« Previous Next »American Journal of Preventive Medicine
Volume 42, Issue 2 , Pages 109-119, February 2012

Exergaming and Older Adult Cognition:

A Cluster Randomized Clinical Trial

Cay Anderson-Hanley, PhD
- Healthy Aging and Neuropsychology Lab, Department of Psychology, Union College, Schenectady, New York
- Health and Exercise Sciences Department, Skidmore College, Saratoga Springs, New York
- Address correspondence to: Cay Anderson-Hanley, PhD, Department of Psychology, Union College, 807 Union Street, Schenectady NY 12308
Paul J. Arciero, DPE
- Healthy Aging and Neuropsychology Lab, Department of Psychology, Union College, Schenectady, New York
- Health and Exercise Sciences Department, Skidmore College, Saratoga Springs, New York
Adam M. Brickman, PhD
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York
Joseph P. Nimon, BS
- Healthy Aging and Neuropsychology Lab, Department of Psychology, Union College, Schenectady, New York
Naoko Okuma, BS
- Health and Exercise Sciences Department, Skidmore College, Saratoga Springs, New York
Sarah C. Westen, BS
- Healthy Aging and Neuropsychology Lab, Department of Psychology, Union College, Schenectady, New York
Molly E. Merz, BS
- Healthy Aging and Neuropsychology Lab, Department of Psychology, Union College, Schenectady, New York
Brandt D. Pence, BA
- Department of Kinesiology, University of llinois, Urbana-Champaign, llinois
Jeffrey A. Woods, PhD
- Department of Kinesiology, University of llinois, Urbana-Champaign, llinois
Arthur F. Kramer, PhD
- Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana-Champaign, Illinois
Earl A. Zimmerman, MD
- Albany Medical Center, Department of Neurology, Albany, New York

Background

Dementia cases may reach 100 million by 2050. Interventions are sought to curb or prevent cognitive decline. Exercise yields cognitive benefits, but few older adults exercise. Virtual reality–enhanced exercise or “exergames” may elicit greater participation.

Purpose

To test the following hypotheses: (1) stationary cycling with virtual reality tours (“cybercycle”) will enhance executive function and clinical status more than traditional exercise; (2) exercise effort will explain improvement; and (3) brain-derived neurotrophic growth factor (BDNF) will increase.

Design

Multi-site cluster randomized clinical trial (RCT) of the impact of 3 months of cybercycling versus traditional exercise, on cognitive function in older adults. Data were collected in 2008–2010; analyses were conducted in 2010–2011.

Setting/participants

102 older adults from eight retirement communities enrolled; 79 were randomized and 63 completed.

Interventions

A recumbent stationary ergometer was utilized; virtual reality tours and competitors were enabled on the cybercycle.

Main outcome measures

Executive function (Color Trails Difference, Stroop C, Digits Backward); clinical status (mild cognitive impairment; MCI); exercise effort/fitness; and plasma BDNF.

Results

Intent-to-treat analyses, controlling for age, education, and cluster randomization, revealed a significant group X time interaction for composite executive function (p=0.002). Cybercycling yielded a medium effect over traditional exercise (d=0.50). Cybercyclists had a 23% relative risk reduction in clinical progression to MCI. Exercise effort and fitness were comparable, suggesting another underlying mechanism. A significant group X time interaction for BDNF (p=0.05) indicated enhanced neuroplasticity among cybercyclists.

Conclusions

Cybercycling older adults achieved better cognitive function than traditional exercisers, for the same effort, suggesting that simultaneous cognitive and physical exercise has greater potential for preventing cognitive decline.