Despite the rewards of longevity, a significant societal concern is the exponential increased risk for cognitive decline and dementia that accompanies ageing in adulthood. While not an inevitable consequence ageing, the incidence of dementia increases rapidly after the 6th decade, with approximately 1 in 4 nonagenarians meeting criteria for dementia.
Given the range of possible causes of dementia, the search for a cure remains elusive and medications have little impact on halting or slowing decline. Over the past few decades, researchers have turned attention to behavioral interventions that might slow the rate of cognitive decline and forestall dementia. A compelling body of evidence has been amassed over three decades to demonstrate the benefits of physical exercise for improving brain health in later life and in particular, for preventing, slowing decline, or even improving cognitive function as one ages. Hundreds of high quality studies, including randomized clinical trials, some with neuroimaging and biomarker corroboration, have led to the conclusion that certainly, exercise is one smart thing to do if we wish to stay mentally intact in old age. While not a panacea, it increases the likelihood that we can maintain cognitive functions and remain living independently as long as possible.
Despite the clear research support and lay population acknowledgement that exercise is good for the body and the brain, most of us do not exercise at recommended levels. The American College of Sports Medicine increased recommended exercise levels a few years ago, such that now, all adults, including older adults, are to aim for 45 min of daily exercise, 5-7 days per week, including strenuous exercise. Only 7% of older adults meet even the prior lesser standard, so clearly we have an uphill battle for enlisting exercise as a tool to fight dementia onset.
Considering the difficulty in motivating exercise behavior, researchers in the USA and NUIG have teamed up to examine the possible role of exergaming to engage older adults in exercise and perhaps prevent or curb cognitive decline. A prior study conducted at the Health Aging & Neuropsychology Lab by professors at Union College and Skidmore College in NY (USA) explored the possible cognitive benefits for older adults of using an exergame. The two-year study was funded by the Robert Wood Johnson Foundation and was published in the American Journal of Preventive Medicine (2012). Older adults in the study were randomly assigned to exercise 3-5 sessions of exercise per week on a stationary bike. Half of the riders pedaled the bike in a traditional way, while the other half interacted with a virtual reality scene on a computer screen in front of the bike, steering their way along a scenic tour (e.g., with palm trees, a sunset, or village shops).
A videoclip of a participant pedaling the cybercycle can be viewed here.
Sixty-three participants completed the study and those pedaling the exergame or “cybercycle” had significantly greater cognitive benefit than those pedaling in the traditional way, that is, despite exercising for a similar number of miles and minutes at a similar intensity. This finding led the research team to hypothesize that the interactive combination of physical exercise with mental stimulation led to the increased cognitive benefit.
Follow-up research is underway to examine whether the nature of the “mental exercise” one does while physically exercising, might further enhance the cognitive benefits of exercise. The National Institute on Aging has funded a three-year randomized clinical trial: The Aerobic and Cognitive Exercise Study (ACES), which has opened enrollment at three hospitals in the USA. The focus is on persons with mild cognitive impairment (MCI), but normative individuals are also being invited to participate. A pilot version of the protocol was started two years ago when the PI (Anderson-Hanley) came to NUIG as a Fulbright Scholar and initiated a small scale version of the project in collaboration with Dr. Michael Hogan at NUIG and clinical staff at Galway University Hospital and St. Francis Adult Day Program. In the current protocol, the comparison is between types of exergaming activities, including the interactive tour along scenic bike paths, but also this time comparing a more videogame-like ‘dragon chase’ encounter, requiring effortful processing to steer through a target, find another matching target and thus earn points with a goal of increasing one’s score.
A brief videoclip of the videogame “dragon chase” condition can be viewed here.
Preliminary results from the pilot data collected in the USA and Ireland are being prepared for publication and are promising, indicating that among the twenty older adults completing these two randomized conditions, greater improvements in cognitive function were found in the game-like condition.
Furthermore, in the collaboration with Julia Dimitrova, the team have recently explored the neural and electrophysiological mechanisms underlying the greater cognitive benefits derived from the game-like condition. A study was conducted with 60 healthy older and younger adults to determine the effects of a single session of interactive mental and aerobic exercise when compared to standard aerobic exercise on electrophysiology and neuropsychological performance. Participants were asked to complete a session of 20-minute exercise with electroencephalography (EEG) recording before and after the exercise, which involved riding the “cybercycle”. During the EEG recording, participants completed an executive function task to determine how and whether the session of interactive mental and aerobic exercise would differentially affect their cognitive functioning.
While the researchers did not find greater cognitive benefits after a session of combined interactive mental and aerobic exercise, it was found that exercise in general lead to enhanced performance both cognitively and at a neural level, with participants responding faster and with greater accuracy after both types of exercise. Additionally, the researchers examined how one’s fitness level may affect their ability to complete the exercise and the cognitive task afterwards. Fitness level was determined by a proxy of participants’ BMI (Body Mass Index), as well as their self-reported daily physical activity levels. The researchers found that older adults with greater BMI received less of the same cognitive benefits as their lower BMI counterparts.
Based on these findings, the researchers argue that a long-term intervention of exergaming extending over weeks and months, can lead to different cognitive effects than a single session of exergaming because the longer time frame facilitates familiarity with the different aspects of exergaming, both cognitive and physical. This in turn frees up cognitive resources allowing one to derive greater benefits from the cognitively stimulating portion of the exercise and on any tasks following the exercise. Future research should seek to determine how these two forms of exercise intervention differently affect our brain functioning and whether different forms of exergaming and in different contexts could help to optimize cognitive performance in single bout setting. Indeed, the area of exergaming research is a burgeoning field of exercise research and we can expect many new and exciting developments from this area in the near future.
(Anderson-Hanley & Maloney, 2015)
Interactive Mental and Physical Exercise
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