Combining Exergame Training with Omega-3 Fatty Acid Supplementation: Protocol for a Randomized Controlled Study Assessing the Effect on Neuronal Structure/Function in the Elderly Brain

Abstract

A common problem in the older population is the risk of falling and related injury, immobility, and reduced survival. Age-related neuronal changes, e.g., decline in gray-and white-matter, affect neuronal, cognitive, and motor functioning. The improvement of these factors might decrease fall events in elderly. Studies showed that administration of video game-based physical exercise, a so-called exergame, or omega-3 fatty acid (FA) may improve motor and/or cognitive functioning through neuronal changes in the brain of older adults. The aim of this study is to assess the effects of a combination of exergame training with omega-3 FA supplementation on the elderly brain. We hypothesize that an intervention using a combination approach differently affects on the neuronal structure and function of the elderly's brain as compared to the sole administration of exergame training. The study is a parallel, double-blinded, randomized controlled trial lasting 26 weeks. Sixty autonomous living, non-smoking, and right-handed healthy older (>65 years) adults who live independently or in a senior residency are included, randomized, and allocated to one of two study groups. The experimental group receives a daily amount of 13.5 ml fish oil (including 2.9 g of omega-3 FA), whereas the control group receives a daily amount of 13.5 ml olive oil for 26 weeks. After 16 weeks, both groups start with an exergame training program three times per week. Measurements are performed on three time-points by treatment blinded investigators: pre-intervention measurements, blood sample after 16 week, and post-intervention measurements. The main outcomes are motor evoked potentials of the right M. tibialis anterior (transcranial magnetic stimulation) and response-related potentials (electroencephalography) during a cognitive test. For secondary outcomes, reaction time during cognitive tests and spatio-temporal parameters during gait performance are measured. Statistics will include effect sizes and a 2 × 2-ANOVA with normally distributed data or the non-parametric equivalent for data not fulfilling normal distribution. The randomized controlled study is the first to investigate the effectiveness of exergame training combined with omega-3 FA in counteracting age- and behavioral-dependent neuronal changes in the brain. This study has been registered in the Swiss National Clinical Trials (SNCTP000001623) and the ISRCTN (ISRCTN12084831) Portals.

Effects of exergame training combined with omega-3 fatty acids on the elderly brain: a randomized double-blind placebo-controlled trial

“…The study was a randomized double-blinded, placebo-controlled trial involving older adults above 65 years. Detailed information about the study procedure and protocol has been previously described [ 53 ]. Between December 2015 and June 2016, potential participants were recruited from the Senior’s University Zurich (Switzerland), senior residency dwellings in Zurich (Switzerland), and through public advertisement and flyers.…”

“…stroke or epilepsy) that prevent training participation, (4) history of heart attack, (5) medication that interacts with NS (i.e., oral hypoglycemic drugs or anticoagulants), (6) medication that acts on neuronal level (i.e., psychotropic medications), (7) cognitive impairment (Mini Mental Status Examination < 22 points) [ 56 ], (8) signs of depression (Geriatric Depression Scale > 5 points), (9) electronic or metallic head implants (self-reported), and (10) personal history of dizziness (self-reported). Prior power calculation can be found in the previously published study protocol [ 53 ].…”

“…The study intervention has been previously published in detail [ 53 ] in line with the Template for Intervention Description and Replication (TIDieR) guidelines [ 57 ].…”

“…An external center (Kantonsapotheke Zurich, Switzerland) was responsible for blinding to achieve double blinding. For group randomization, a computer-generated list including numbers from 001 to 060 was created by an external center (for detailed information [ 53 ]). The individual who maintained the master randomization list (EDB) was responsible for assigning randomization codes, securely storing all randomization files out of reach and sight of the other investigators, and notifying appropriate study staff that the participant had been randomized.…”

The Role of Physical Exercise and Omega-3 Fatty Acids in Depressive Illness in the Elderly

“…As for human researches, a pilot study reported that combined omega-3 fatty acids, aerobic exercise, and cognitive stimulation may prevent gray matter volume loss in frontal, parietal, and cingulate cortex in patients with mild cognitive impairment [ 274 ]. A randomized controlled trial by Schättin and de Bruin [ 275 ] is now investigating the effectiveness of exergame training (a kind of physical exercise based on video games) combined with omega-3 fatty acid supplementation in counteracting age-dependent neuronal changes in the brain. From a clinical point of view, the combined antidepressant effects of exercise and omega-3 fatty acids underpin the “Antidepressant-Lifestyle-Psychological-Social (ALPS) depression treatment model”, an evidence-based integrated mental health approach including pharmaceutical medicines as well as psychological therapies, complementary medicines, nutraceuticals, and physical activity [ 276 ].…”