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1.  Choice of Interactive Dance and Bicycle Games in Overweight and Nonoverweight Youth 
Background:
Interactive video games are a popular alternative to physical activity in youth. One advancement in computer games are interactive games that use physical activity as a game playing controller, combining exercise and entertainment, or exertainment.
Purpose:
This study tested the reinforcing value and activity levels of interactive dance and bicycle race games in 18 overweight and 17 nonoverweight 8- to 12-year-old youth.
Methods:
Reinforcing value was studied using a behavioral choice paradigm that provided children the opportunity to respond on progressive ratio schedules of reinforcement for a choice of either playing the video dance or bicycle game using a handheld video game controller or one of three options: dancing or bicycling alone, dancing or bicycling while watching a video, or playing the interactive dance or bicycle game. Reinforcing value was defined in relationship to the amount of responding children engaged in for either choice.
Results:
Results showed the interactive dance game was more reinforcing than dancing alone or dancing while watching the video (p = .003), but there was no difference across bicycling conditions. Nonoverweight youth were more active when given the opportunity to play the interactive dance game than overweight children (p = .05).
Conclusions:
These results suggest that children may be motivated to be active when given the opportunity to play an interactive dance game.
doi:10.1080/08836610701307835
PMCID: PMC2213751  PMID: 17447864
2.  Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: The electronic games to aid motivation to exercise (eGAME) study 
BMC Public Health  2009;9:146.
Background
Childhood obesity has reached epidemic proportions in developed countries. Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity. Active video games, where players physically interact with images onscreen, may have utility as a novel intervention to increase physical activity and improve body composition in children. The aim of the Electronic Games to Aid Motivation to Exercise (eGAME) study is to determine the effects of an active video game intervention over 6 months on: body mass index (BMI), percent body fat, waist circumference, cardio-respiratory fitness, and physical activity levels in overweight children.
Methods/Design
Three hundred and thirty participants aged 10–14 years will be randomized to receive either an active video game upgrade package or to a control group (no intervention).
Discussion
An overview of the eGAME study is presented, providing an example of a large, pragmatic randomized controlled trial in a community setting. Reflection is offered on key issues encountered during the course of the study. In particular, investigation into the feasibility of the proposed intervention, as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial.
Trial registration
Australian New Zealand Clinical Trials Registry ACTRN12607000632493
doi:10.1186/1471-2458-9-146
PMCID: PMC2696432  PMID: 19450288
3.  A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial 
BMC Geriatrics  2012;12:74.
Background
Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults. This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming. The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults.
Methods
Thirty-one participants (mean age ± SD: 86.2 ± 4.6 years), residents of two Swiss hostels for the aged, were randomly assigned to either the dance group (n = 15) or the control group (n = 16). The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming. The control group performed only the strength and balance exercises during this period. Outcome measures were foot placement accuracy, gait performance under single and dual task conditions, and falls efficacy.
Results
After the intervention between-group comparison revealed significant differences for gait velocity (U = 26, P = .041, r = .45) and for single support time (U = 24, P = .029, r = .48) during the fast walking dual task condition in favor of the dance group. No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy.
Conclusions
There was a significant interaction in favor of the dance video game group for improvements in step time. Significant improved fast walking performance under dual task conditions (velocity, double support time, step length) was observed for the dance video game group only. These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program.
Trial registration
This trial has been registered under ISRCTN05350123 ( http://www.controlled-trials.com)
doi:10.1186/1471-2318-12-74
PMCID: PMC3538689  PMID: 23241332
Dual task; Dance video game; Gait; Older adults; Cognitive-motor intervention
4.  The effect of a cognitive-motor intervention on voluntary step execution under single and dual task conditions in older adults: a randomized controlled pilot study 
Background
This randomized controlled pilot study aimed to explore whether a cognitive-motor exercise program that combines traditional physical exercise with dance video gaming can improve the voluntary stepping responses of older adults under attention demanding dual task conditions.
Methods
Elderly subjects received twice weekly cognitive-motor exercise that included progressive strength and balance training supplemented by dance video gaming for 12 weeks (intervention group). The control group received no specific intervention. Voluntary step execution under single and dual task conditions was recorded at baseline and post intervention (Week 12).
Results
After intervention between-group comparison revealed significant differences for initiation time of forward steps under dual task conditions (U = 9, P = 0.034, r = 0.55) and backward steps under dual task conditions (U = 10, P = 0.045, r = 0.52) in favor of the intervention group, showing altered stepping levels in the intervention group compared to the control group.
Conclusion
A cognitive-motor intervention based on strength and balance exercises with additional dance video gaming is able to improve voluntary step execution under both single and dual task conditions in older adults.
doi:10.2147/CIA.S32558
PMCID: PMC3410679  PMID: 22865999
fall prevention; exercise; dance; video game
5.  Autism and exergaming: effects on repetitive behaviors and cognition 
Autism is a neurodevelopmental disorder that leads to impairment in social skills and delay in language development, and results in repetitive behaviors and restricted interests that impede academic and social involvement. Physical exercise has been shown to decrease repetitive behaviors in autistic children and improve cognitive function across the life-span. Exergaming combines physical and mental exercise simultaneously by linking physical activity movements to video game control and may yield better compliance with exercise. In this investigation, two pilot studies explored the potential behavioral and cognitive benefits of exergaming. In Pilot I, twelve children with autism spectrum disorders completed a control task and an acute bout of Dance Dance Revolution (DDR); in Pilot II, ten additional youths completed an acute bout of cyber cycling. Repetitive behaviors and executive function were measured before and after each activity. Repetitive behaviors significantly decreased, while performance on Digits Backwards improved following the exergaming conditions compared with the control condition. Additional research is needed to replicate these findings, and to explore the application of exergaming for the management of behavioral disturbance and to increase cognitive control in children on the autism spectrum.
doi:10.2147/PRBM.S24016
PMCID: PMC3218790  PMID: 22114543
autism; repetitive behaviors; exergaming; exercise; executive function
6.  Cognitive training with casual video games: points to consider 
Frontiers in Psychology  2014;4:1010.
Brain training programs have proliferated in recent years, with claims that video games or computer-based tasks can broadly enhance cognitive function. However, benefits are commonly seen only in trained tasks. Assessing generalized improvement and practicality of laboratory exercises complicates interpretation and application of findings. In this study, we addressed these issues by using active control groups, training tasks that more closely resemble real-world demands and multiple tests to determine transfer of training. We examined whether casual video games can broadly improve cognition, and selected training games from a study of the relationship between game performance and cognitive abilities. A total of 209 young adults were randomized into a working memory–reasoning group, an adaptive working memory–reasoning group, an active control game group, and a no-contact control group. Before and after 15 h of training, participants completed tests of reasoning, working memory, attention, episodic memory, perceptual speed, and self-report measures of executive function, game experience, perceived improvement, knowledge of brain training research, and game play outside the laboratory. Participants improved on the training games, but transfer to untrained tasks was limited. No group showed gains in reasoning, working memory, episodic memory, or perceptual speed, but the working memory–reasoning groups improved in divided attention, with better performance in an attention-demanding game, a decreased attentional blink and smaller trail-making costs. Perceived improvements did not differ across training groups and those with low reasoning ability at baseline showed larger gains. Although there are important caveats, our study sheds light on the mixed effects in the training and transfer literature and offers a novel and potentially practical training approach. Still, more research is needed to determine the real-world benefits of computer programs such as casual games.
doi:10.3389/fpsyg.2013.01010
PMCID: PMC3882717  PMID: 24432009
attention; working memory; reasoning; fluid intelligence; video games; cognitive training; casual games; transfer of training
7.  Study of Mental Activity and Regular Training (SMART) in at risk individuals: A randomised double blind, sham controlled, longitudinal trial 
BMC Geriatrics  2011;11:19.
Background
The extent to which mental and physical exercise may slow cognitive decline in adults with early signs of cognitive impairment is unknown. This article provides the rationale and methodology of the first trial to investigate the isolated and combined effects of cognitive training (CT) and progressive resistance training (PRT) on general cognitive function and functional independence in older adults with early cognitive impairment: Study of Mental and Regular Training (SMART). Our secondary aim is to quantify the differential adaptations to these interventions in terms of brain morphology and function, cardiovascular and metabolic function, exercise capacity, psychological state and body composition, to identify the potential mechanisms of benefit and broader health status effects.
Methods
SMART is a double-blind randomized, double sham-controlled trial. One hundred and thirty-two community-dwelling volunteers will be recruited. Primary inclusion criteria are: at risk for cognitive decline as defined by neuropsychology assessment, low physical activity levels, stable disease, and age over 55 years. The two active interventions are computerized CT and whole body, high intensity PRT. The two sham interventions are educational videos and seated calisthenics. Participants are randomized into 1 of 4 supervised training groups (2 d/wk × 6 mo) in a fully factorial design. Primary outcomes measured at baseline, 6, and 18 months are the Alzheimer's Disease Assessment Scale (ADAS-Cog), neuropsychological test scores, and Bayer Informant Instrumental Activities of Daily Living (B-IADLs). Secondary outcomes are psychological well-being, quality of life, cardiovascular and musculoskeletal function, body composition, insulin resistance, systemic inflammation and anabolic/neurotrophic hormones, and brain morphology and function via Magnetic Resonance Imaging (MRI) and Spectroscopy (fMRS).
Discussion
SMART will provide a novel evaluation of the immediate and long term benefits of CT, PRT, and combined CT and PRT on global cognitive function and brain morphology, as well as potential underlying mechanisms of adaptation in older adults at risk of further cognitive decline.
Trial Registration
Australia and New Zealand Clinical Trials Register (ANZCTR): ANZCTRN12608000489392
doi:10.1186/1471-2318-11-19
PMCID: PMC3110111  PMID: 21510896
8.  Energy Expenditure and Enjoyment during Video Game Play: Differences by Game Type 
Purpose
Play of physically active video games may be a way to increase physical activity and/or decrease sedentary behavior, but games are not universally active or enjoyable. Active games may differ from traditional games on important attributes, which may affect frequency and intensity of play. The purpose of this study was to investigate differences in energy expenditure and enjoyment across four game types: shooter (played with traditional controllers), band simulation (guitar or drum controller), dance simulation (dance mat controller), and fitness (balance board controller).
Methods
Energy expenditure (metabolic equivalents [METs]) and enjoyment were measured across ten games in 100 young adults aged 18 to 35 (50 females).
Results
All games except shooter games significantly increased energy expenditure over rest (P < .001). Fitness and dance games increased energy expenditure by 322 (mean [SD] 3.10 [0.89] METs) and 298 (2.91 [0.87] METs) percent, which was greater than that produced by band simulation (73%, 1.28 [0.28] METs) and shooter games (23%, 0.91 [0.16] METs). However, enjoyment was higher in band simulation games than in other types (P < .001). Body mass-corrected energy expenditure was greater in normal weight than overweight participants in the two most active game types (P < .001).
Conclusions
Active video games can significantly increase energy expended during screen time, but these games are less enjoyable than other more sedentary games, suggesting that they may be less likely to be played over time. Less active but more enjoyable video games may be a promising method for decreasing sedentary behavior.
doi:10.1249/MSS.0b013e318216ebf3
PMCID: PMC3271952  PMID: 21364477
Young adults; Indirect calorimetry; Electronic games; Overweight; Gender differences
9.  Cognitive enhancement through action video game training: great expectations require greater evidence 
Action video game training may hold promise as a cognitive intervention with the potential to enhance daily functioning and remediate impairments, but this must be more thoroughly evaluated through evidence-based practices. We review current research on the effect of action video game training on visual attention and visuospatial processing, executive functions, and learning and memory. Focusing on studies that utilize strict experimental controls and synthesize behavioral and neurophysiological data, we examine whether there is sufficient evidence to support a causal relationship between action video game training and beneficial changes in cognition. Convergent lines of behavioral and neurophysiological evidence tentatively support the efficacy of training, but the magnitude and specificity of these effects remain obscure. Causal inference is thus far limited by a lack of standardized and well-controlled methodology. Considering future directions, we suggest stringent adherence to evidence-based practices and collaboration modeled after clinical trial networks. Finally, we recommend the exploration of more complex causal models, such as indirect causal relationships and interactions that may be masking true effects.
doi:10.3389/fpsyg.2014.00136
PMCID: PMC3928536  PMID: 24600427
cognition; action video games; cognitive remediation; neurophysiology; cognitive enhancement
10.  Selling points: What cognitive abilities are tapped by casual video games? 
Acta psychologica  2012;142(1):74-86.
The idea that video games or computer-based applications can improve cognitive function has led to a proliferation of programs claiming to “train the brain.” However, there is often little scientific basis in the development of commercial training programs, and many research-based programs yield inconsistent or weak results. In this study, we sought to better understand the nature of cognitive abilities tapped by casual video games and thus reflect on their potential as a training tool. A moderately large sample of participants (n=209) played 20 web-based casual games and performed a battery of cognitive tasks. We used cognitive task analysis and multivariate statistical techniques to characterize the relationships between performance metrics. We validated the cognitive abilities measured in the task battery, examined a task analysis-based categorization of the casual games, and then characterized the relationship between game and task performance. We found that games categorized to tap working memory and reasoning were robustly related to performance on working memory and fluid intelligence tasks, with fluid intelligence best predicting scores on working memory and reasoning games. We discuss these results in the context of overlap in cognitive processes engaged by the cognitive tasks and casual games, and within the context of assessing near and far transfer. While this is not a training study, these findings provide a methodology to assess the validity of using certain games as training and assessment devices for specific cognitive abilities, and shed light on the mixed transfer results in the computer-based training literature. Moreover, the results can inform design of a more theoretically-driven and methodologically-sound cognitive training program.
doi:10.1016/j.actpsy.2012.11.009
PMCID: PMC3679476  PMID: 23246789
Working memory; Reasoning; Fluid intelligence; Video games; Cognitive training; Casual games
11.  Brain Training Game Improves Executive Functions and Processing Speed in the Elderly: A Randomized Controlled Trial 
PLoS ONE  2012;7(1):e29676.
Background
The beneficial effects of brain training games are expected to transfer to other cognitive functions, but these beneficial effects are poorly understood. Here we investigate the impact of the brain training game (Brain Age) on cognitive functions in the elderly.
Methods and Results
Thirty-two elderly volunteers were recruited through an advertisement in the local newspaper and randomly assigned to either of two game groups (Brain Age, Tetris). This study was completed by 14 of the 16 members in the Brain Age group and 14 of the 16 members in the Tetris group. To maximize the benefit of the interventions, all participants were non-gamers who reported playing less than one hour of video games per week over the past 2 years. Participants in both the Brain Age and the Tetris groups played their game for about 15 minutes per day, at least 5 days per week, for 4 weeks. Each group played for a total of about 20 days. Measures of the cognitive functions were conducted before and after training. Measures of the cognitive functions fell into four categories (global cognitive status, executive functions, attention, and processing speed). Results showed that the effects of the brain training game were transferred to executive functions and to processing speed. However, the brain training game showed no transfer effect on any global cognitive status nor attention.
Conclusions
Our results showed that playing Brain Age for 4 weeks could lead to improve cognitive functions (executive functions and processing speed) in the elderly. This result indicated that there is a possibility which the elderly could improve executive functions and processing speed in short term training. The results need replication in large samples. Long-term effects and relevance for every-day functioning remain uncertain as yet.
Trial Registration
UMIN Clinical Trial Registry 000002825
doi:10.1371/journal.pone.0029676
PMCID: PMC3256163  PMID: 22253758
12.  Protocol for Fit Bodies, Fine Minds: a randomized controlled trial on the affect of exercise and cognitive training on cognitive functioning in older adults 
BMC Geriatrics  2007;7:23.
Background
Declines in cognitive functioning are a normal part of aging that can affect daily functioning and quality of life. This study will examine the impact of an exercise training program, and a combined exercise and cognitive training program, on the cognitive and physical functioning of older adults.
Methods/Design
Fit Bodies, Fine Minds is a randomized, controlled trial. Community-dwelling adults, aged between 65 and 75 years, are randomly allocated to one of three groups for 16 weeks. The exercise-only group do three 60-minute exercise sessions per week. The exercise and cognitive training group do two 60-minute exercise sessions and one 60-minute cognitive training session per week. A no-training control group is contacted every 4 weeks. Measures of cognitive functioning, physical fitness and psychological well-being are taken at baseline (0 weeks), post-test (16 weeks) and 6-month follop (40 weeks). Qualitative responses to the program are taken at post-test.
Discussion
With an increasingly aged population, interventions to improve the functioning and quality of life of older adults are particularly important. Exercise training, either alone or in combination with cognitive training, may be an effective means of optimizing cognitive functioning in older adults. This study will add to the growing evidence base on the effectiveness of these interventions.
Trial Registration
Australian Clinical Trials Register: ACTRN012607000151437
doi:10.1186/1471-2318-7-23
PMCID: PMC2094709  PMID: 17915035
13.  Attitudes of Postmenopausal Women toward Interactive Video Dance for Exercise 
Journal of Women's Health  2009;18(8):1239-1243.
Abstract
Aims
Although physical activity (PA) is universally recommended, most adults are not regular exercisers. Interactive video dance is a novel form of PA in widespread use among young adults, but interest among adults is not known. Postmenopausal women are an appropriate target for interventions to promote PA because they have an increased risk of health problems related to sedentary behavior. We explored perceived advantages and disadvantages of video dance as a personal exercise option in postmenopausal women.
Methods
Forty sedentary postmenopausal women (mean age ± SD 57 ± 5 years), were oriented in eight small groups to interactive video dance, which uses a force-sensing pad with directional panels: the player steps on the panels in response to arrows scrolling on a screen, synchronized to music. Perceived advantages and disadvantages were elicited through a nominal group technique (NGT) process.
Results
Participants generated 113 advantages and 71 disadvantages. The most frequently cited advantages were “it's fun” and “improves coordination” (seven of eight groups), the fact that challenge encourages progress (five of eight groups), the potential for weight loss (four of eight groups), and the flexibility of exercise conditions (three of eight groups). Concerns were the potentially long and frustrating learning process, cost (six of eight groups), and possible technical issues (two of eight groups).
Conclusions
The recreational nature of interactive dance exercise was widely appealing to postmenopausal women and might help promote adherence to PA. Initial support to learn basic technical and movement skills may be needed.
doi:10.1089/jwh.2008.1176
PMCID: PMC2825684  PMID: 19630550
14.  Impact of an Active Video Game on Healthy Children’s Physical Activity 
Pediatrics  2012;129(3):e636-e642.
OBJECTIVE:
This naturalistic study tests whether children receiving a new (to them) active video game spontaneously engage in more physical activity than those receiving an inactive video game, and whether the effect would be greater among children in unsafe neighborhoods, who might not be allowed to play outside.
METHODS:
Participants were children 9 to 12 years of age, with a BMI >50th percentile, but <99th percentile; none of these children a medical condition that would preclude physical activity or playing video games. A randomized clinical trial assigned children to receiving 2 active or 2 inactive video games, the peripherals necessary to run the games, and a Wii console. Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment. Neighborhood safety was assessed with a 12 item validated questionnaire.
RESULTS:
There was no evidence that children receiving the active video games were more active in general, or at anytime, than children receiving the inactive video games. The outcomes were not moderated by parent perceived neighborhood safety, child BMI z score, or other demographic characteristics.
CONCLUSIONS:
These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children.
doi:10.1542/peds.2011-2050
PMCID: PMC3289528  PMID: 22371457
exergames; Wii
15.  A Rehabilitation Tool Designed for Intensive Web-Based Cognitive Training: Description and Usability Study 
JMIR Research Protocols  2013;2(2):e59.
Background
Cognitive deficits are among the most disabling of neurological diseases and have a serious impact on the quality of life of patients and families. Cognitive training has been proven successful in improving or compensating for neuropsychological deficits after acute brain injury, but its efficacy highly depends on the intensity of treatment over an extended period of time. Therefore, cognitive training indicates expensive human resources and renders the rehabilitation process vulnerable to physical and economic barriers for the majority of patients.
Objective
The aim of this study was to develop and test a new Web-based rehabilitation tool that provides intensive cognitive training at home under clinical prescription and monitoring, at affordable costs.
Methods
From a pool of 60 original exercises, designed and used over the past 10 years for cognitive training at our center, we developed 27 exercises on a computer game format, with automatic increase or decrease of difficulty levels. These exercises were assembled in a clean, user-friendly design and covered various cognitive domains such as attention (n=4), memory (n=11), language (n=3), calculus (n=3), praxis (n=2), and executive functions (n=3). A Web 2.0 platform was also designed to provide medical prescription of cognitive training sessions, performed at the patient’s home. These sessions included continuous monitoring of compliance, performance, and evolution; algorithms for automatic adjustment and long-term learning through use, and database recording of all activities. The end-user interaction test included 80 patients from our memory clinic from several groups including subjective memory complaints (n=20), traumatic brain injury (n=20), stroke and other static brain lesions (n=20), and mild Alzheimer’s disease (n=20). During a 1-hour session, patients and their relatives were taught to use the system and allowed to practice using it. At the end of the session, they were asked to complete a questionnaire.
Results
A total of 48/80 patients (60%) attended the training session. The mean age of the patients was 60 years (SD 13.3, range 41-78), and the mean level of formal education was 6 years (range 4-16). Of all the participants, 32/48 patients (66%) have previously used a computer. All patients and their relatives made a positive evaluation of the cognitive training tool. Only 2/48 patients (4%) were not interested in performing the exercises at home; 19/48 patients (39%) mentioned the need for further coaching from a relative or health care professional. The patients who mentioned difficulties in performing the exercises have not used the computer earlier.
Conclusions
This new Web-based system was very well accepted by patients and their relatives, who showed high levels of motivation to use it on a daily basis at home. The simplicity of its use and comfort were especially outlined. This tool will have an important effect on human resource management, in increasing the patient access to specialized health care and improving the quality and national health system costs of rehabilitation programs.
doi:10.2196/resprot.2899
PMCID: PMC3869046  PMID: 24334248
cognitive training; cognitive deficits; neurorehabilitation; Web-based applications; eHealth systems; usability test
16.  Promotion of the mind through exercise (PROMoTE): a proof-of-concept randomized controlled trial of aerobic exercise training in older adults with vascular cognitive impairment 
BMC Neurology  2010;10:14.
Background
Sub-cortical vascular ischaemia is the second most common etiology contributing to cognitive impairment in older adults, and is frequently under-diagnosed and under-treated. Although evidence is mounting that exercise has benefits for cognitive function among seniors, very few randomized controlled trials of exercise have been conducted in populations at high-risk for progression to dementia. Aerobic-based exercise training may be of specific benefit in delaying the progression of cognitive decline among seniors with vascular cognitive impairment by reducing key vascular risk factors associated with metabolic syndrome. Thus, we aim to carry out a proof-of-concept single-blinded randomized controlled trial primarily designed to provide preliminary evidence of efficacy aerobic-based exercise training program on cognitive and everyday function among older adults with mild sub-cortical ischaemic vascular cognitive impairment.
Methods/Design
A proof-of-concept single-blinded randomized trial comparing a six-month, thrice-weekly, aerobic-based exercise training group with usual care on cognitive and everyday function. Seventy older adults who meet the diagnostic criteria for sub-cortical ischaemic vascular cognitive impairment as outlined by Erkinjuntti and colleagues will be recruited from a memory clinic of a metropolitan hospital. The aerobic-based exercise training will last for 6 months. Participants will be followed for an additional six months after the cessation of exercise training.
Discussion
This research will be an important first step in quantifying the effect of an exercise intervention on cognitive and daily function among seniors with sub-cortical ischaemic vascular cognitive impairment, a recognized risk state for progression to dementia. Exercise has the potential to be an effective, inexpensive, and accessible intervention strategy with minimal adverse effects. Reducing the rate of cognitive decline among seniors with sub-cortical ischaemic vascular cognitive impairment could preserve independent functioning and health related quality of life in this population. This, in turn, could lead to reduced health care resource utilization costs and avoidance of early institutional care.
Trial Registration
ClinicalTrials.gov Protocol Registration System: NCT01027858.
doi:10.1186/1471-2377-10-14
PMCID: PMC2830197  PMID: 20158920
17.  Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial 
BMC Public Health  2013;13:477.
Background
Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people.
Methods/design
A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed.
Discussion
This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise.
Trial registration
Australian New Zealand Clinical Trials Registry ACTRN12612000889853
The trial is now in progress with 12 villages already have been randomised.
doi:10.1186/1471-2458-13-477
PMCID: PMC3691670  PMID: 23675705
18.  Feasibility and Pilot Efficacy Results from the Multi-site Cognitive Remediation in the Schizophrenia Trials Network (CRSTN) Study 
The Journal of clinical psychiatry  2012;73(7):1016-1022.
Background
The true benefit of pharmacological intervention to improve cognition in schizophrenia may not be evident without regular cognitive enrichment. Clinical trials assessing the neurocognitive effects of new medications may require engagement in cognitive remediation exercises to stimulate the benefit potential. However, the feasibility of large-scale multi-site studies using cognitive remediation at clinical trials sites has not been established.
Methods
Patients with DSM-IV schizophrenia from nine sites were randomized to a cognitive remediation condition that included the Posit Science Brain Fitness auditory training program with weekly NEAR ‘bridging groups,’ or a control condition of computer games and weekly healthy lifestyles groups. Patients were expected to complete 3–5 one-hour sessions weekly for 40 sessions or 12 weeks, whichever came first.
Results
The primary outcomes were feasibility results as measured by rate of enrollment, retention, and completion rate of primary outcome measures. Within the 3-month enrollment period, 53 of a projected 54 patients were enrolled and 47 completed the study. Thirty-one patients completed all 40 sessions and all patients completed all primary outcome measures. Preliminary efficacy results indicated that after 20 sessions, patients in the cognitive remediation condition demonstrated mean MCCB composite score improvements that were 3.7 (95% CI: 7.34, 0.05) T-score points greater than in patients in the computer games control group (F=4.16, df=1,46, p=0.047). At the end of treatment, a trend favoring cognitive remediation was not statistically significant (F=2.26, df=1,47, p=0.14).
Discussion
Multi-site clinical trials of cognitive remediation using the Posit Science auditory training program with the NEAR method of weekly bridging groups in traditional clinical sites appear feasible.
doi:10.4088/JCP.11m07100
PMCID: PMC3746329  PMID: 22687548
19.  The motivation to be sedentary predicts weight change when sedentary behaviors are reduced 
Background
Obesity is correlated with a sedentary lifestyle, and the motivation to be active or sedentary is correlated with obesity. The present study tests the hypothesis that the motivation to be active or sedentary is correlated with weight change when children reduce their sedentary behavior.
Methods
The motivation to be active or sedentary, changes in weight, and accelerometer assessed physical activity were collected for 55 families with overweight/obese children who participated in a nine-week field study to examine behavior and weight change as a function of reducing sedentary behavior. Children were studied in three 3-week phases, baseline, reduce targeted sedentary behaviors by 25% and reduce targeted sedentary behaviors by 50%. The targeted sedentary behaviors included television, video game playing, video watching, and computer use.
Results
The reinforcing value of sedentary behavior but not physical activity, was correlated with weight change, as losing weight was associated with lower reinforcing value of sedentary behaviors. Reducing sedentary behavior was not associated with a significant change in objectively measured physical activity, suggesting the main way in which reducing sedentary behavior influenced weight change is by complementary changes in energy intake. Estimated energy intake supported the hypothesis that reducing sedentary behaviors influences weight by reducing energy intake.
Conclusions
These data show that the motivation to be sedentary limits the effects of reducing sedentary behavior on weight change in obese children.
Trial registration
ClinicalTrials.gov: NCT00962247
doi:10.1186/1479-5868-8-13
PMCID: PMC3053211  PMID: 21342518
20.  Brain Training Game Boosts Executive Functions, Working Memory and Processing Speed in the Young Adults: A Randomized Controlled Trial 
PLoS ONE  2013;8(2):e55518.
Background
Do brain training games work? The beneficial effects of brain training games are expected to transfer to other cognitive functions. Yet in all honesty, beneficial transfer effects of the commercial brain training games in young adults have little scientific basis. Here we investigated the impact of the brain training game (Brain Age) on a wide range of cognitive functions in young adults.
Methods
We conducted a double-blind (de facto masking) randomized controlled trial using a popular brain training game (Brain Age) and a popular puzzle game (Tetris). Thirty-two volunteers were recruited through an advertisement in the local newspaper and randomly assigned to either of two game groups (Brain Age, Tetris). Participants in both the Brain Age and the Tetris groups played their game for about 15 minutes per day, at least 5 days per week, for 4 weeks. Measures of the cognitive functions were conducted before and after training. Measures of the cognitive functions fell into eight categories (fluid intelligence, executive function, working memory, short-term memory, attention, processing speed, visual ability, and reading ability).
Results and Discussion
Our results showed that commercial brain training game improves executive functions, working memory, and processing speed in young adults. Moreover, the popular puzzle game can engender improvement attention and visuo-spatial ability compared to playing the brain training game. The present study showed the scientific evidence which the brain training game had the beneficial effects on cognitive functions (executive functions, working memory and processing speed) in the healthy young adults.
Conclusions
Our results do not indicate that everyone should play brain training games. However, the commercial brain training game might be a simple and convenient means to improve some cognitive functions. We believe that our findings are highly relevant to applications in educational and clinical fields.
Trial Registration
UMIN Clinical Trial Registry 000005618.
doi:10.1371/journal.pone.0055518
PMCID: PMC3566110  PMID: 23405164
21.  Do Action Video Games Improve Perception and Cognition? 
Frequent action video game players often outperform non-gamers on measures of perception and cognition, and some studies find that video game practice enhances those abilities. The possibility that video game training transfers broadly to other aspects of cognition is exciting because training on one task rarely improves performance on others. At first glance, the cumulative evidence suggests a strong relationship between gaming experience and other cognitive abilities, but methodological shortcomings call that conclusion into question. We discuss these pitfalls, identify how existing studies succeed or fail in overcoming them, and provide guidelines for more definitive tests of the effects of gaming on cognition.
doi:10.3389/fpsyg.2011.00226
PMCID: PMC3171788  PMID: 21949513
video games; cognitive training; transfer of training; perceptual learning
22.  Shorter term aerobic exercise improves brain, cognition, and cardiovascular fitness in aging 
Physical exercise, particularly aerobic exercise, is documented as providing a low cost regimen to counter well-documented cognitive declines including memory, executive function, visuospatial skills, and processing speed in normally aging adults. Prior aging studies focused largely on the effects of medium to long term (>6 months) exercise training; however, the shorter term effects have not been studied. In the present study, we examined changes in brain blood flow, cognition, and fitness in 37 cognitively healthy sedentary adults (57–75 years of age) who were randomized into physical training or a wait-list control group. The physical training group received supervised aerobic exercise for 3 sessions per week 1 h each for 12 weeks. Participants' cognitive, cardiovascular fitness and resting cerebral blood flow (CBF) were assessed at baseline (T1), mid (T2), and post-training (T3). We found higher resting CBF in the anterior cingulate region in the physical training group as compared to the control group from T1 to T3. Cognitive gains were manifested in the exercise group's improved immediate and delayed memory performance from T1 to T3 which also showed a significant positive association with increases in both left and right hippocampal CBF identified earlier in the time course at T2. Additionally, the two cardiovascular parameters, VO2 max and rating of perceived exertion (RPE) showed gains, compared to the control group. These data suggest that even shorter term aerobic exercise can facilitate neuroplasticity to reduce both the biological and cognitive consequences of aging to benefit brain health in sedentary adults.
doi:10.3389/fnagi.2013.00075
PMCID: PMC3825180  PMID: 24282403
aging; CBF; exercise; memory; MRI
23.  Changes in Cognitive Function in a Randomized Trial of Physical Activity: Results of the Lifestyle Interventions and Independence for Elders Pilot Study 
Background
Cognitive impairment is an important contributor to disability. Limited clinical trial evidence exists regarding the impact of physical exercise on cognitive function (CF). We report results of a pilot study to provide estimates of the relative impact of physical activity (PA) on 1-year changes in cognitive outcomes and to characterize relationships between changes in mobility disability and changes in cognition in older adults at increased risk for disability.
Methods
Sedentary persons (102) at increased risk for disability (aged 70–89 years) were randomized to moderate-intensity PA or health education. Participants were administered the Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), modified Stroop test, and Modified Mini-Mental State Examination at baseline and 1 year.
Results
Group differences were not significant but improvements in cognitive scores were associated with improvements in physical function. Specifically, the DSST significantly correlated with change in the Short Physical Performance Battery score (r = .38, p = .0002), in chair stand score (r = .26, p = .012), in balance score (r = .21, p = .046), and in 400-m gait speed (r = .15, p = .147). Change recall on the RAVLT and in the Stroop test was also positively correlated with changes in chair stand and balance, respectively.
Conclusions
These results provide further support for the benefits of exercise on CF in older adults. An adequately powered clinical trial of PA involving older adults at increased risk for cognitive disability is needed to expand the indications for prescribing exercise for prevention of decline in brain function.
doi:10.1093/gerona/glp014
PMCID: PMC2679423  PMID: 19244157
Exercise; Cognition; Aging; Prevention; LIFE study
24.  Novel Approaches to Obesity Prevention: Effects of Game Enjoyment and Game Type on Energy Expenditure in Active Video Games 
Background
Some active video games have been found to promote physical activity adherence because of enjoyment. However, many active games are exercise themed, which may interfere with the distracting properties that make game-based exercise more enjoyable than traditional exercise. This study compared exercise-themed and game-themed active games to investigate differences in energy expenditure and enjoyment.
Method
Young adults (N = 100, 50 female, 55 overweight, aged 18–35 years) played two of four Wii Fit games (one aerobic game and one balance game per person) for 10 min each. Of the two aerobic games, one was exercise themed (jogging) and the other was game themed (hula hooping). Both balance games were game themed. Energy expenditure and enjoyment were measured.
Results
After adjustment for gender and weight, aerobic games produced 2.70 kcal/kg-1/h-1 (95% confidence interval 2.41, 3.00) greater energy expenditure than balance games (p < .001), but balance games were more enjoyable (p < .001). In aerobic games, jogging produced greater energy expenditure than hula hooping in normal-weight and male participants (p < .001); in overweight and female participants, no differences were found (p > .17). Hula hooping was enjoyed more than jogging (p = .008). Enjoyment predicted energy expenditure in aerobic games (B = 0.767, p = .010).
Conclusions
Aerobic games produced greater energy expenditure but lower enjoyment than balance games, and a game-themed aerobic game was found more enjoyable than an exercise-themed aerobic game. Integrating more strenuous activity into entertaining games instead of games that simply simulate exercise may be a fruitful avenue for active game development.
PMCID: PMC3440155  PMID: 22920810
energy expenditure; gender; obesity; video game
25.  Real-Time Strategy Game Training: Emergence of a Cognitive Flexibility Trait 
PLoS ONE  2013;8(8):e70350.
Training in action video games can increase the speed of perceptual processing. However, it is unknown whether video-game training can lead to broad-based changes in higher-level competencies such as cognitive flexibility, a core and neurally distributed component of cognition. To determine whether video gaming can enhance cognitive flexibility and, if so, why these changes occur, the current study compares two versions of a real-time strategy (RTS) game. Using a meta-analytic Bayes factor approach, we found that the gaming condition that emphasized maintenance and rapid switching between multiple information and action sources led to a large increase in cognitive flexibility as measured by a wide array of non-video gaming tasks. Theoretically, the results suggest that the distributed brain networks supporting cognitive flexibility can be tuned by engrossing video game experience that stresses maintenance and rapid manipulation of multiple information sources. Practically, these results suggest avenues for increasing cognitive function.
doi:10.1371/journal.pone.0070350
PMCID: PMC3737212  PMID: 23950921

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