Acute effects of virtual reality treadmill training on gait and cognition in older adults: A randomized controlled trial

Abstract

Introduction Everyday walking often involves walking with divided attention (i.e., dual-tasking). Exercise interventions for older adults should mimic these simultaneous physical and cognitive demands. This proof-of-concept study had a two-fold purpose: 1) identify acute cognitive and gait benefits of a single session of virtual reality treadmill training (VRTT), relative to conventional treadmill training (CTT), and 2) identify differences between those who reduced dual-task costs (i.e., responders) on gait or cognition and those who did not, after the session. Methods Sixty older adults were randomized to complete a single 30-minute session of VRTT (n = 30, 71.2±6.5 years, 22 females) or CTT (n = 30, 72.0±7.7 years, 21 females). Pre- and post-exercise session, participants performed single-task walking, single-task cognitive, and dual-task walking trials while gait and cognition were recorded. Gait variables were gait speed and gait speed variability. Cognition variables were response reaction time, response accuracy, and cognitive throughput. Dual-task effects (DTE) on gait and cognition variables were also calculated. Results Post-exercise, there were no group differences (all p>0.05). During single- and dual-task trials, both groups walked faster (single-task: F(1, 58) = 9.560, p = 0.003; dual-task: F(1, 58) = 19.228, p<0.001), responded more quickly (single-task: F(1, 58) = 5.054, p = 0.028; dual-task: F(1, 58) = 8.543, p = 0.005), and reduced cognitive throughput (single-task: F(1, 58) = 6.425, p = 0.014; dual-task: F(1, 58) = 28.152, p<0.001). Both groups also exhibited reduced DTE on gait speed (F(1, 58) = 8.066, p = 0.006), response accuracy (F(1, 58) = 4.123, p = 0.047), and cognitive throughput (F(1, 58) = 6.807, p = 0.012). Gait responders and non-responders did not differ (all p>0.05), but cognitive responders completed fewer years of education (t(58) = 2.114, p = 0.039) and better information processing speed (t(58) = -2.265, p = 0.027) than cognitive non-responders. Conclusions The results indicate that both VRTT and CTT may acutely improve gait and cognition. Therefore, older adults will likely benefit from participating in either type of exercise. The study also provides evidence that baseline cognition can impact training effects on DTE on cognition.

Comparison of Exergames Versus Conventional Exercises on the Health Benefits of Older Adults: Systematic Review With Meta-Analysis of Randomized Controlled Trials

“…The 12 included studies had a total sample size of 919 participants, with individual studies ranging from 18 to 282 participants. One study only recruited women [ 56 ], 1 study had an equal proportion of female and male participants [ 55 ], 6 studies recruited more female participants [ 29 , 40 , 49 , 52 , 53 , 56 ], and 5 studies recruited more male participants [ 38 , 50 , 51 , 54 , 57 ]. In total, 6 studies focused on older adults with Parkinson disease [ 38 , 50 , 51 , 54 , 55 , 57 ], 1 on older adults with mild cognitive impairment [ 49 ], and 1 on frailty [ 29 ]; 4 investigated older adults without special conditions [ 40 , 52 , 53 , 56 ].…”

“…Five studies focused on community-dwelling older adults [38,[49][50][51][52], 3 studies recruited older adults from care facilities [29,40,53], 1 study was conducted in hospital and home [54], 1 study recruited older adults in a clinical physical rehabilitation unit [55], and 2 studies did not report the research setting [56,57]. Multimedia Appendix 2 [29,38,40,[49][50][51][52][53][54][55][56][57] presents the characteristics of the included studies.…”

“…A 2-arm design was used in 11 studies, including an intervention arm and a control arm [29,38,40,[50][51][52][53][54][55][56][57]; 1 study used a 3-arm design, including 2 intervention arms and a control arm [49]. The intervention duration ranged from 5 to 12 weeks, and the most widely used duration was 6 weeks.…”

“…The frequency was 2 or 3 times per week, and the length of each session was 30 to 90 minutes. The older people in 2 studies only participated in a single session of exercise training [52,53]. In total, 4 studies used Nintendo Wii for the intervention [53,54,56,57], 5 studies used Kinect for the intervention [29,38,[49][50][51], 1 study used Tymo for the intervention [55], 1 study used GRAIL for the intervention [52], and 1 study did not report the intervention device [40].…”

“…Among the control group exercises, 1 study consisted of squats, postural displacements, dance, and sports (volleyball and boxing) [53]; 1 included resistance exercise, aerobic exercise, Tai Chi, and balance exercises [29]; 1 included global exercises and balance exercises [57]; 1 used Tai Chi [49]; 1 included task-oriented exercise, walking, stretching, balance training, flexibility exercises, and coordination exercises [55]; 1 included passive range of motion for lower extremities, active free exercises, stretching exercises, strength training, resisted exercise, and balance training [54]; 2 included strength exercises and core training [40,56]; and 4 studies used treadmill training in the control group [38,[50][51][52].…”