The effects of a new immersive multidomain training on cognitive, dual-task and physical functions in older adults.

The aim of this study was to assess the potential of multidomain training using Immersive and Interactive Wall Exergames (I2WE) to improve the cognitive and physical functions of older adults. This new generation of exergames offers specific advantageous characteristics (e.g., immersion, virtual cognitive solicitation, high physical stimulation, complex motor skills, multiple social interactions) that could make I2WE an enjoyable multidomain training medium for older adults. A pilot study was set up with 34 participants (M = 69.91 years old). It used the pre-tests - training (3 months, 2 one-hour sessions per week for the 2 groups) - post-tests method to compare: a) the cognitive and the Dual-Task (DT) effects (primary outcomes), b) the physical effects and perceived pleasure (secondary outcomes) between an experimental group following an I2WE program (n = 19) to an active control group performing a Walking and Muscle-Strengthening (WMS) program (n = 15). While visuospatial short-term memory was improved for both groups, only I2WE training enhanced visuospatial working memory, inhibition, and DT. All physical functions, except upper body strength, were enhanced for the 2 groups. The perceived pleasure was higher for the I2WE group than the WMS group. The results of this first study have important clinical implications, showing that I2WE can optimize strategies to improve older adults' physical and cognitive health. Virtual and immersive cognitive stimulation combined with varied physical activity (i.e., aerobic, muscle-strengthening, complex motor skills) appear to be major assets of these new exergames. Moreover, the high level of perceived pleasure to I2WE makes it a promising tool for engaging older adults in sustained multidomain practice.

Influence of Normal Aging and Multisensory Data Fusion on Cybersickness and Postural Adaptation in Immersive Virtual Reality.

Immersive Virtual Reality (VR) systems are expanding as sensorimotor readaptation tools for older adults. However, this purpose may be challenged by cybersickness occurrences possibly caused by sensory conflicts. This study aims to analyze the effects of aging and multisensory data fusion processes in the brain on cybersickness and the adaptation of postural responses when exposed to immersive VR. METHODS: We repeatedly exposed 75 participants, aged 21 to 86, to immersive VR while recording the trajectory of their Center of Pressure (CoP). Participants rated their cybersickness after the first and fifth exposure. RESULTS: The repeated exposures increased cybersickness and allowed for a decrease in postural responses from the second repetition, i.e., increased stability. We did not find any significant correlation between biological age and cybersickness scores. On the contrary, even if some postural responses are age-dependent, a significant postural adaptation occurred independently of age. The CoP trajectory length in the anteroposterior axis and mean velocity were the postural parameters the most affected by age and repetition. CONCLUSIONS: This study suggests that cybersickness and postural adaptation to immersive VR are not age-dependent and that cybersickness is unrelated to a deficit in postural adaptation or age. Age does not seem to influence the properties of multisensory data fusion.

Wireless Lighting System: A New Tool for Assessing Cognitive Functions in the Elderly.

Studies on the effects of aging on cognition have been using the same cognitive tests for decades. A Wireless Lighting System (WLS) could be used to assess cognitive functions in a physically active situation, making the assessment of cognition less isolated and more ecological. This pilot study aimed to evaluate the potential of a WLS for assessing older adults' cognitive functions. It was set up with 15 young (M = 23.47 years old) and 18 older adults (M = 71.44 years old). Their performances were recorded on three WLS tests, designed with the Witty SEM system to assess four main cognitive functions (i.e., inhibition, flexibility, visuospatial short-term and working memory), as well as on three traditional (TRAD) tests (Spatial Span Test, Stroop Test, Trail Making Test). The results show a significant difference between the YOUNG and OLD groups on all WLS test measures (except for WLS flexibility), as well as on all TRAD measures. Additionally, for the OLD group, there were significant correlations between WLS and TRAD test results (r = -0.49 for two measures of inhibition to r = -0.80 for two other measures of inhibition), except for visuospatial short-term memory. However, there was no significant correlation for the YOUNG group (ρ = -0.27 for inhibition to r = 0.45 for visuospatial short-term memory). These WLS tests were valid for assessing the cognitive functions (i.e., flexibility, visuospatial short-term and working memory, inhibition) of older adults and were sensitive to aging.

Tolerance of immersive head-mounted virtual reality among older nursing home residents.

Introduction: Virtual Reality (VR) is a tool that is increasingly used in the aging population. Head-Mounted Displays (HMDs) are stereoscopic vision devices used for immersive VR. Cybersickness is sometimes reported after head-mounted display (HMD) VR exposure. Cybersickness severity and anxiety state reflect VR low tolerance. We aimed to evaluate HMD VR tolerance among older nursing home residents through cybersickness and anxiety state. Methods: A total of 36 participants were included in this preliminary study, 33 of whom (mean age: 89.33 ± 5.48) underwent three individual HMD VR sessions with three different contents. Cybersickness occurrence and severity were scored by the Simulator Sickness Questionnaire (SSQ) after each session. Anxiety state was assessed by the State-Trait Anxiety Inventory form Y-A before and after each session. Anxiety trait (using State-Trait Anxiety Inventory form Y-B) was also evaluated before and after the experiment. In total, 92% (33/36) of patients completed all three sessions, of which 61% (20/33) did not report any cybersickness symptoms (SSQ = 0). Six participants reported significant cybersickness (defined by an SSQ score ⩾10) in at least one session. Discussion: Only two participants stopped the study after the first exposure because of cybersickness. Age, cognitive function, anxiety trait, and well-being were not associated with cybersickness. The mean anxiety state decreased significantly from pre- to post-session. This immersive HMD VR experience was well tolerated among nursing home dwellers. Further larger studies in this population aiming to identify CS determinants are needed in order to use HMD VR on a standard basis.

Factors for optimizing intervention programs for cognition in older adults: the value of exergames.

This review presents factors that could optimize the effectiveness of an intervention program on cognitive health in older adults. Combined, multi-dimensional and interactive programs appear to be relevant. On one hand, for the characteristics to be implemented in the physical dimension of a program, multimodal interventions stimulating the aerobic pathway and muscle strengthening during the solicitation of gross motor activities, seem to be interesting. On the other hand, regarding the cognitive dimension of a program, complex and variable cognitive stimuli appear to hold the greatest promise for generating cognitive benefits and the broadest transfers to untrained tasks. The field of video games also brings interesting enrichment through the gamification of situations and the feeling of immersion. However, some gray areas remain to be clarified, notably the ideal response dose, the balance between physical and cognitive solicitation and the programs' customization.

The User Experience of an Immersive and Interactive Wall Exergame in Older Adults.

Exergames are promising options for modulating the effects of aging on physical and cognitive functions. A new-generation immersive and interactive wall exergame (I2WE) has emerged in recent years, offering users freedom of movement as well as greater and varied interactions with other players, the environment, and the system than traditional games (e.g., Wii™, Kinect). These features could improve the user experience (UX) and thus the engagement and benefits of the intervention for older people. The purpose of this study was to determine whether this kind of exergame could be an effective tool for multidomain training for the elderly. An exploratory study was conducted with 38 healthy older adults who tested a single exergame session to evaluate the UX and the perceived enjoyment, as well as the session's workload and intensity. The results show that I2WE generates moderate-to-high physical intensity, following recommendations for older people, while the perceived exertion is lower. Moreover, it creates a positive UX that correlates with high perceived enjoyment while producing a suitable session's workload. I2WE appears to be an effective tool to promote physical activity while concurrently stimulating cognition in older adults. The intrinsic characteristics (i.e., immersion, combined physical and cognitive activity, interactions, complex motor skills, playfulness, and variety of collective games) give this new type of exergame a promising future. Future studies should be conducted to investigate the effects of an I2WE program on the physical and cognitive functions of older adults.

Is there a relationship between cardiorespiratory fitness and executive performance as function of mental workload in young adults?

In the current study, we have decided to investigate the relationship between cardiorespiratory fitness and executive functions in young adults as a function of mental workload. To achieve our objectives, we have solicited 29 young adults (18-25 years; 12 women) who have first realized the Random Number Generation (RNG) task with two levels of complexity. After each level of complexity, the participants were asked to report on their perceived difficulty. Secondly, participants performed the RABIT® test, during which oxygen consumption was measured through the Metamax 3B-R2. The results showed that executive performance and perceived difficulty deteriorate with increasing task complexity. Additionally, oxygen consumption increased significantly to reach a peak during the hardest phase of the RABIT® test. Finally, as in previous studies, we could not observe a correlation between cardiorespiratory fitness and executive functions. Our findings support the lack of a direct relationship between cardiorespiratory fitness and executive functions. Future studies should explore the relationship between the composite measure of executive function, hemodynamic activity, and cardiorespiratory fitness in healthy youth and their peers with cardiovascular disease. This will examine an indirect effect of Cardiorespiratory fitness (CRF) on Executive functions (EFs) through brain activity.

Mini-Review of Studies Testing the Cardiorespiratory Hypothesis With Near-Infrared Spectroscopy (NIRS): Overview and Perspectives.

The cardiorespiratory hypothesis (CH) is one of the hypotheses used by researchers to explain the relationship between cardiorespiratory fitness and cognitive performance during executive functions. Despite the indubitable beneficial effect of training on brain blood flow and function that may explain the link between physical fitness and cognition and the recognition of the near-infrared spectroscopy (NIRS) as a reliable tool for measuring brain oxygenation, few studies investigated the CH with NIRS. It is still not well understood whether an increase in brain flow by training is translated into an increase in cerebral oxygenation. Thus, the objective of this mini-review was to summarize main results of studies that investigated the CH using the NIRS and to propose future research directions.

Effect of Exergaming on Physical Fitness, Functional Mobility, and Cognitive Functioning in Adults With Down Syndrome.

This study examined whether exergames could improve physical, functional, and cognitive functions in people with Down syndrome. Twelve adults with DS, aged over 35 (M = 50.35, SD = 7.45), were randomly assigned to a Wii-based program (n = 6) or a control group (n = 6), and completed physical (Chair Stand Test, 6-Minute Walk Test), functional (TUG, TUDS), and cognitive tests (Corsi, Barrage tests). The experimental group completed a 12-week Wii-based program. There was high intervention adherence and, compared with the control group, greater improvements were observed in the Wii-based exercise intervention group in physical fitness and functional outcomes (p < .05), with no changes in cognitive outcomes.

Motor-cognitive dual-task performance of older women evaluated using Wii Balance Board.

BACKGROUND: Single- and dual-tasks are influenced by age-related impaired postural balance. Aim of this study was to analyze the Center of Pressure (CoP) oscillation during static balance in the presence or absence of cognitive task on older women. METHODS: Thirty-one healthy older women were assessed in a stand quiet position with open/closed eyes (single-task, OE and CE) and with cognitive task (dual-task, DT) through Wii Balance Board. Sway area, total displacement and CoP oscillation (CO) based on the number of times that CoP traveled through anteroposterior and mediolateral directions. Friedman test was used to compare OE, CE and DT. Dual-task interference percentage was used to quantify the cognitive load on balance whereas Spearman correlation coefficient was used to assess the association of cognitive domains and CO. RESULTS: The CO was significantly higher in DT than in single-tasks and participants were unable to maintain their limits of stability in mediolateral direction. The cost of DT interference was 30.5%, which is partially explained by the deviation of attention from postural control to spatial and temporal orientation. CONCLUSION: Our findings show that cognitive load during DT impairs balance in mediolateral direction, thus indicating the use of WBB to assess cognitive interference on postural control.

Virtual Reality-Based Exercise with Exergames as Medicine in Different Contexts: A Short Review.

There is enough evidence that, nowadays, the sedentary lifestyle is one of the major health problems worldwide, linked to many chronic diseases, including mental comorbidities, systemic hypertension, metabolic dysregulation, and cancer. Although health societies recommend engagement to physical activities, there is an overwhelming number of people remaining sedentary, even knowing the health benefits of regular exercises. One of the main factors that justifies this scenario is the lack of motivation, which is a barrier to people intended to start new habits for health. Considering this previous information, new alternatives for exercises may help people engage in a healthier lifestyle. Technology has contributed to this with devices that allow movements based on virtual reality approaches, including the exergames. These are games available even in commercial devices, as video-games, that allow people to work with different physical components. Furthermore, exergames add cognitive gain through its dual-task characteristic. Moreover, due to the combination of these benefits, they are feasible to acquire, and easy to use. Exergames are not only a potential strategy to reduce sedentary lifestyle but also a good method to improve health gains and rehabilitation in different populations and pathological conditions: older adults, stroke survivors, and Parkinson's disease. In this review, we aim to demonstrate some conditions that literature supports the intervention with exergames due to its physical and cognitive benefits. Furthermore, at the end of this review, we also explore the neurobiological mechanisms behind virtual-reality based exercises.

Is the "lactormone" a key-factor for exercise-related neuroplasticity? A hypothesis based on an alternative lactate neurobiological pathway.

For many years lactate was seen as a metabolite from glucose metabolism. However, since the last century researchers have shown that this molecule has an important role on liver, muscle, and brain metabolism. Lactate traffics along whole body mediating many biological processes depending on specific situations. For example, glucose is the main substrate used during exercise but lactate released by striated skeletal muscle is used by own muscle as secondary fuel. On the other hand, neuronal firing in the brain is almost totally lactate-dependent. In addition, lactate has an important role on BDNF-mediated neuroplasticity. As this molecule has a pleiotropic role in the body, it was called as "lactormone" in 2009. Here we show basic concepts on peripheral and central metabolism and discuss neurobiological pathways of lactate, including an alternative hypothesis on lactate released during exercise.

Cognitive Training Game Versus Action Videogame: Effects on Cognitive Functions in Older Adults.

OBJECTIVE: The purpose of the study was to compare a cognitive training game, Kawashima Brain Training (KBT), and an action videogame, Super Mario Bros (SMB), in their effects on cognitive function in older adults. MATERIALS AND METHODS: Thirty-six older adults were randomly assigned to the KBT group, the SMB group, or the no-training no-contact control group. All participants completed several cognitive tests [matrix reasoning, Stroop, Trail Making Test, digit symbol substitution test (DSST), Corsi clock, spatial relation, and number comparison]. Then, participants in the game groups were instructed to play the videogame (KBT or SMB) for 1 hour, thrice per week, during 2 months, for a total training time of 24 hours. When the twenty-four 1-hour game sessions were complete, the three groups again completed the cognitive tests. RESULTS: Analysis of variances on each of the cognitive measures and Tukey's post hoc tests showed that the matrix reasoning change score was significantly greater in both game groups than in the control group. The Stroop test change was significantly greater in the KBT group than in control and SMB groups. The DSST, Corsi block test, spatial relations test, and number comparison test showed significantly greater change in the SMB group than in the control group with KBT intermediate. CONCLUSION: The scope of benefits of SMB training seems broader than those from the KBT program. The intrinsic characteristics of SMB and KBT games may well be partly responsible for these differences.

French validation of the modified-falls efficacy scale (M-FES Fr).

INTRODUCTION: Among the tools assessing fall related self-efficacy, the Modified-Falls Efficacy Scale (M-FES) seems to be a comprehensive and sensitive scale. However, no validated French version exists to this day. OBJECTIVE: This study aims to translate the M-FES and validate this French translation (M-FES Fr). METHOD: The validation steps used to translate and validate the M-FES Fr were i) forward - backward translation, ii) examination of the internal structure and reliability, iii) evaluation of the convergent validity. In this study, 310 French-speaking older adults (56 geriatric patients and 254 community-dwelling older adults) completed the M-FES Fr. Among the community-dwelling older adults, 67 fallers and 70 non-fallers were also asked to complete questionnaires related to variables such as health, fear of falling, and physical activity levels. RESULTS: A two-factor solution (indoor vs outdoor activities) was suggested, which accounted for 68.1% of the total variance. Reliability estimates for both factors were good (Cronbach α > 0.94, ICC > .93). Significant differences between geriatric patients and community-dwelling older adults and between fallers and non-fallers were highlighted. Furthermore, the M-FES Fr scores were significantly linked to various risk factors for falling. CONCLUSION: The M-FES Fr has psychometric properties which are similar to those found in the original version, including reliability and validity. This questionnaire will enable French-speaking researchers and health professionals to work with the same concepts as those used in other languages. Notably, the M-FES Fr could be used in the development and evaluation of intervention strategies in the prevention of falls.

Training the elderly in pedestrian safety: Transfer effect between two virtual reality simulation devices.

OBJECTIVES: A virtual-reality training program has been developed to help older pedestrians make safer street-crossing decisions in two-way traffic situations. The aim was to develop a small-scale affordable and transportable simulation device that allowed transferring effects to a full-scale device involving actual walking. METHODS: 20 younger adults and 40 older participants first participated in a pre-test phase to assess their street crossings using both full-scale and small-scale simulation devices. Then, a trained older group (20 participants) completed two 1.5-h training sessions with the small-scale device, whereas an older control group received no training (19 participants). Thereafter, the 39 older trained and untrained participants took part in a 1.5-h post-test phase again with both devices. RESULTS: Pre-test phase results suggested significant differences between both devices in the group of older participants only. Unlike younger participants, older participants accepted more often to cross and had more collisions on the small-scale simulation device than on the full-scale one. Post-test phase results showed that training older participants on the small-scale device allowed a significant global decrease in the percentage of accepted crossings and collisions on both simulation devices. But specific improvements regarding the way participants took into account the speed of approaching cars and vehicles in the far lane were notable only on the full-scale simulation device. DISCUSSION: The findings suggest that the small-scale simulation device triggers a greater number of unsafe decisions compared to a full-scale one that allows actual crossings. But findings reveal that such a small-scale simulation device could be a good means to improve the safety of street-crossing decisions and behaviors among older pedestrians, suggesting a transfer of learning effect between the two simulation devices, from training people with a miniature device to measuring their specific progress with a full-scale one.

The braking force in walking: age-related differences and improvement in older adults with exergame training.

The purposes of this present research were, in the first study, to determine whether age impacts a measure of postural control (the braking force in walking) and, in a second study, to determine whether exergame training in physically-simulated sport activity would show transfer, increasing the braking force in walking and also improving balance assessed by clinical measures, functional fitness, and health-related quality of life in older adults. For the second study, the authors developed an active video game training program (using the Wii system) with a pretest-training-posttest design comparing an experimental group (24 1-hr sessions of training) with a control group. Participants completed a battery comprising balance (braking force in short and normal step conditions), functional fitness (Senior Fitness Test), and health-related quality of life (SF-36). Results show that 12 weeks of video game-based exercise program training improved the braking force in the normal step condition, along with the functional fitness of lower limb strength, cardiovascular endurance, and motor agility, as measured by the Senior Fitness Test. Only the global mental dimension of the SF-36 was sensitive to exergame practice. Exergames appear to be an effective way to train postural control in older adults. Because of the multimodal nature of the activity, exergames provide an effective tool for remediation of age-related problems.

[The effects of video games on cognitive aging]. / Effets de la pratique des jeux vidéo sur le vieillissement cognitif.

Advancing age is associated with cognitive decline, which, however, remains a very heterogeneous phenomenon. Indeed, several extrinsic factors seem to modulate the effect of aging on cognition. Recently, several studies have provided evidence that the practice of video games could engender many benefits by favoring the maintenance of cognitive vitality in the elderly. This review of the literature aims to establish a precise inventory of the relations between the various types of video games and cognitive aging, including both sedentary video games (i.e., classics as well as brain training) and active video games (i.e., exergames). The largest benefits seem to be provided by exergames which combine game play with significant physical exercise. This article also tries to define the determinants of the training programs which could be responsible for the observed improvements.

Effects of interactive physical-activity video-game training on physical and cognitive function in older adults.

The purpose of the present study was to assess the potential of exergame training based on physically simulated sport play as a mode of physical activity that could have cognitive benefits for older adults. If exergame play has the cognitive benefits of conventional physical activity and also has the intrinsic attractiveness of video games, then it might be a very effective way to induce desirable lifestyle changes in older adults. To examine this issue, the authors developed an active video game training program using a pretest-training-posttest design comparing an experimental group (24 × 1 hr of training) with a control group without treatment. Participants completed a battery of neuropsychological tests, assessing executive control, visuospatial functions, and processing speed, to measure the cognitive impact of the program. They were also given a battery of functional fitness tests to measure the physical impact of the program. The trainees improved significantly in measures of game performance. They also improved significantly more than the control participants in measures of physical function and cognitive measures of executive control and processing speed, but not on visuospatial measures. It was encouraging to observe that, engagement in physically simulated sport games yielded benefits to cognitive and physical skills that are directly involved in functional abilities older adults need in everyday living (e.g., Hultsch, Hertzog, Small, & Dixon, 1999).