Simultaneous Exercise and Cognitive Training in Virtual Reality Phase 2 Pilot Study: Impact on Brain Health and Cognition in Older Adults - PubMed (original) (raw)

. 2021 Oct 19;7(2):111-130.

doi: 10.3233/BPL-210126. eCollection 2021.

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Simultaneous Exercise and Cognitive Training in Virtual Reality Phase 2 Pilot Study: Impact on Brain Health and Cognition in Older Adults

Ashwin Sakhare et al. Brain Plast. 2021.

Erratum in

Abstract

Background: Aerobic exercise and environmental enrichment have been shown to enhance brain function. Virtual reality (VR) is a promising method for combining these activities in a meaningful and ecologically valid way.

Objective: The purpose of this Phase 2 pilot study was to calculate relative change and effect sizes to assess the impact of simultaneous exercise and cognitive training in VR on brain health and cognition in older adults.

Methods: Twelve cognitively normal older adults (64.7±8.8 years old, 8 female) participated in a 12-week intervention, 3 sessions/week for 25-50 minutes/session at 50-80% HRmax. Participants cycled on a custom-built stationary exercise bike while wearing a VR head-mounted display and navigating novel virtual environments to train spatial memory. Brain and cognitive changes were assessed using MRI imaging and a cognitive battery.

Results: Medium effect size (ES) improvements in cerebral flow and brain structure were observed. Pulsatility, a measure of peripheral vascular resistance, decreased 10.5% (ES(d) = 0.47). Total grey matter volume increased 0.73% (ES(r) = 0.38), while thickness of the superior parietal lobule, a region associated with spatial orientation, increased 0.44% (ES(r) = 0.30). Visual memory discrimination related to pattern separation showed a large improvement of 68% (ES(η p 2) = 0.43). Cognitive flexibility (Trail Making Test B) (ES(r) = 0.42) and response inhibition (ES(W) = 0.54) showed medium improvements of 14% and 34%, respectively.

Conclusions: Twelve weeks of simultaneous exercise and cognitive training in VR elicits positive changes in brain volume, vascular resistance, memory, and executive function with moderate-to-large effect sizes in our pilot study.

Keywords: Virtual reality; brain health; cognition; older adults; simultaneous exercise and cognitive training.

© 2021 – The authors. Published by IOS Press.

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Conflict of interest statement

The authors have no conflict of interest to report.

Figures

Fig. 1

Fig. 1

Flow diagram summarizing participant eligibility, participation, and attrition.

Fig. 2

Fig. 2

Timeline of assessments and VR training during study.

Fig. 3

Fig. 3

Cognitively challenging gameplay and immersive storylines in VR. (top left) Rescue an animal that has escaped the sanctuary; (top right) Strategic landmarks placed at each intersection and guiding arrow for learning route; (bottom left) Participant cycling on stationary exercise to navigate VR environment; (bottom right) Top-down view of road network. Green dots denote participant’s path, red dot indicates starting point, and purple dot indicates destination.

Fig. 4

Fig. 4

(A) Cognitive flexibility, as measured by TMT-B, improved pre- to post-intervention. (B) Inhibitory control, as measured by Flanker, improved across each of the 4 timepoints. (C) Visual discrimination related to pattern separation, as measured by MST, improved pre- to post-intervention. Effect sizes are shown in the bottom or top right corner of each boxplot.

Fig. 5

Fig. 5

Whole brain volume (A), superior parietal lobule thickness (B), and middle frontal gyrus thickness (C) increased pre- to post-intervention. Effect sizes are shown in the bottom right corner of each boxplot.

Fig. 6

Fig. 6

(A) Lower arterial pulsatility suggests reduced peripheral vascular resistance. (B) Higher cranio-caudal peak CSF flow through C2-C3 SS suggests improved circulation. Effect sizes are shown in the bottom right corner of each boxplot.

Fig. 7

Fig. 7

(A) Exertion levels, defined as percentage of HR max, per week. Solid line indicates target exertion based on aerobic exercise schedule. (B) Time spent cycling per week. Solid line indicates target volume based on aerobic exercise schedule.

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