September 23, 2019
By Scott Baltic
NEW YORK (Reuters Health) - People with dementia who trained on stationary bicycles in front of video screens showing images of a familiar town had improved frailty levels after 12 weeks, researchers in the Netherlands have found.
The "exergame," however, did not yield improvements in physical functioning, level of physical activity or activities of daily living, the research team reports in the Journal of the American Medical Directors Association, online August 10.
Coauthor Dr. Marcel Olde Rikkert of Radboud University Medical Center, in Nijmegen, told Reuters Health by email that staff at the community centers where the trial was done "were pleasantly surprised by the fun and quality of life the exergame with cycling paths through familiar towns gave their guests."
He said the exergame itself is inexpensive, costing only a few hundred dollars for the initial set-up.
He and his colleagues note in their report that people with dementia are "physically frailer than their healthy peers, with a reduction in lean mass and increased risk of sarcopenia. Also, they are more sedentary and participate less in regular physical exercise."
Physical activity can "benefit physical functioning, cognition, daily functioning, and well-being in older people with dementia," they continue, but efforts to promote physical exercise in this group often stall because of poor adherence.
For the current study, the team randomized 115 individuals with dementia to exergame training, aerobic training or an active-control intervention.
Participants were recruited through memory centers and day-care centers and ads in local newspapers. All had clinically confirmed mild to moderate dementia, and were at least 60 years old, with a mean age of 79.
Each group received three training sessions a week for 12 weeks. The exergame group's aerobic goal was to cycle for 30 to 50 minutes per session and ultimately to achieve an intensity of 65% to 75% of heart rate reserve after 12 weeks.
The cognitive component involved following one of several routes through a digital environment (often a city familiar to the participant). The cognitive difficulty increased through seven successive training levels. Participants received feedback on their scores at the end of each session. If a participant scored well enough on the cognitive activity, they could proceed to the next level.
The aerobic-training group rode a stationary bicycle without a digital environment, and the active-control group undertook 30-minute sessions of relaxation and flexibility exercises.
Adherence was 87.3% in the exergame group, 81.1% in the aerobic-training group (P=0.05) and 85.4% in the control group.
At 12 weeks, the exergame group saw a significant reduction in scores on the Evaluative Frailty Index for Physical Activity compared with the control group, though the effect size was only small to moderate. The exergame group and the aerobic training group did not differ significantly.
Dr. Veronika van der Wardt of the Division of Rehabilitation, Ageing and Well-being at the University of Nottingham, UK, who was not involved in the study, called it "an excellent contribution to explore motivation and adherence in people with dementia."
She noted that while the level of staff support needed for the exergame was high, earlier research has shown that such highly supervised exercise sessions "can be cost-effective in people with dementia, as they reduce the costs of social and health services."
Dr. Franka Meiland of Amsterdam University Medical Center, who is currently involved in a study of exergaming but did not take part in the current research, echoed van der Wardt's comments.
"Exergaming might be a bit more expensive than other exercise activities, but it is probably more fun to do and may yield promising results, as this study showed," she told Reuters Health by email.
The study did not have commercial funding, and the researchers reported no conflicts of interest.
J Am Med Dir Assoc 2019 .
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