Effect of exergaming versus combined exercise on cognitive function and brain activation in frail older adults: A randomized controlled trial.

BACKGROUND Cognitive impairment is prevalent among frail older adults. Traditional exercise and exergaming positively affect cognition in healthy older people. However, few studies have investigated the effects of exergaming on cognition and brain activation in frail older adults. OBJECTIVE This study compared the effect of Kinect based exergaming (EXER) and combined physical exercise (CPE) training on cognitive function and brain activation in frail older adults in Taiwan. We hypothesized that EXER would be superior to CPE in this population. METHODS We randomized 46 community-dwelling frail older adults to the EXER or CPE group for 36 sessions (three 60-min training sessions per week) over 12 weeks. Outcome measures for cognitive function included global cognition measured by the Montreal Cognitive Assessment, executive function measured by the Executive Interview 25, verbal memory measured by the Chinese version of the California Verbal Learning Test, attention measured by the Stroop Color and Word Test and Trail Making Test (part B), and working memory measured by spatial n-back tests. Prefrontal cortex activation during the global cognition test was documented with functional near-infrared spectroscopy (fNIRS). RESULTS Both groups improved significantly in global cognition (p<0.05), executive function (p<0.05), and attention (p<0.05) after the 12-week intervention. The group×time interaction indicated that EXER training significantly enhanced global cognition more than CPE training (F(1,44)=5.277, p=0.026). Moreover, only the EXER group showed significant improvements in verbal (p<0.05) and working (p<0.05) memory after the intervention. The fNIRS hemodynamics data revealed decreased activation in prefrontal cortices of both groups (p<0.05) during the post-training cognitive assessment, thereby suggesting greater neural efficiency; however, we found no significant group difference. CONCLUSION In frail older adults, exergaming and CPE could improve cognitive function, most likely by increasing neural efficiency. Moreover, exergaming may be superior to CPE, particularly in improving global cognition.