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Published on in Vol 10, No 4 (2022): Oct-Dec

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/38192, first published .
Are Conventional Combined Training Interventions and Exergames Two Facets of the Same Coin to Improve Brain and Cognition in Healthy Older Adults? Data-Based Viewpoint

Are Conventional Combined Training Interventions and Exergames Two Facets of the Same Coin to Improve Brain and Cognition in Healthy Older Adults? Data-Based Viewpoint

Are Conventional Combined Training Interventions and Exergames Two Facets of the Same Coin to Improve Brain and Cognition in Healthy Older Adults? Data-Based Viewpoint

Authors of this article:

Jean-Jacques Temprado1 Author Orcid Image ;   Marta Maria Torre1 Author Orcid Image
Article Authors Cited by (2) Tweetations (2) Metrics

    Viewpoint

    Aix Marseille Université, Institut des Sciences du Mouvement, Marseille, France

    *all authors contributed equally

    Corresponding Author:

    Jean-Jacques Temprado, PhD

    Aix Marseille Université

    Institut des Sciences du Mouvement

    163 Avenue de Luminy

    BP 910

    Marseille, 13288

    France

    Phone: 33 611837288

    Fax:33 491172256

    Email: jean-jacques.temprado@univ-amu.fr


    Combining physical, motor, and cognitive exercises is expected to be effective to attenuate age-related declines of brain and cognition in older adults. This can be achieved either by conventional interventions or by exergames. This paper aimed to determine whether conventional combined training and exergame interventions are two comparable ways for delivering combined training. In total, 24 studies on conventional training and 23 studies on exergames were selected and compared. A common framework was used to analyze both types of combined training interventions. Our analysis showed that conventional combined training interventions were more effective than separated physical and motor training to improve brain and cognition, while their superiority over cognitive training alone remains to be confirmed. Exergames scarcely led to cognitive benefits superior to those observed after physical, motor, or cognitive training alone. Thus, although both conventional training interventions and exergames allowed delivering combined training programs, they are not two facets of the same coin. Further studies that are more theoretically grounded are necessary to determine whether interventions delivered via exergames may lead to superior benefits compared to conventional separated and combined training interventions.

    JMIR Serious Games 2022;10(4):e38192

    doi:10.2196/38192

    Keywords

    aging; older; gerontology; exergame; physical activity; cognition; training; intervention; cognitive; brain; older adult; motor skills; exercise; physical; motor; combined training 


    Delaying or attenuating age-related cognitive decline is critical for preserving autonomy and quality of life of the increasing number of older adults. It has been widely demonstrated that separate cognitive, aerobic, muscular, and motor training are effective in this respect [1]. Moreover, it has been suggested that their integration into combined training interventions (CTIs) might be more effective than separated training [2-4]. In this context and in view of the role played by cognitive stimulations in CTIs [5,6], exergames (ie, interactive video games that require participants to be physically active to play) might be even more effective than conventional combined training programs, since they conjugate the effects of physical and motor exercises [1,7] and those of video game training on cognitive performance [8,9]. However, until now, no study has systematically compared, within the same experimental protocols, the respective benefits of ‘conventional’ CTIs and exergames with regard to cognitive outcomes in healthy older adults. “A review of reviews” (ie, 3 reviews on conventional cognitive and motor training and 3 on exergames) [10] recently addressed this issue and reported conflicting results. Specifically, the benefits of conventional CTIs were found superior to those of separated training in 2 reviews, but the superiority of exergames over physical or cognitive training alone was unclear in the selected reviews.

    This paper aims to go a step further by reporting the results of a detailed comparison of studies that used conventional CTIs and those that used exergames to improve brain and cognition in healthy older adults. To fulfill this objective, based on the framework developed in 2 recently published review papers dedicated to conventional CTIs [11] and exergames [12], we compiled the data of 47 studies to compare randomized controlled trials and controlled trials that have used either conventional combined training or exergames to improve cognitive functions (Table 1 and Table 2).

    Table 1. Selected reviews and studies on conventional combined training interventions. Studies were classified as a function of the type of combined intervention.
    Conventional combined training interventionsStudies
    ReviewsLaw et al [13], Wollesen and Voelcker-Rehage [14], Zhu et al [15], Lauenroth et al [3], Levin et al [16], Tait et al [17], Gheysen et al [2], Joubert and Chainay [18], Gavelin et al [19], Wollesen et al [20], Gallou et al [10], Gou et al [21]
    Studies

    		Sequential


    		PCTaFabre et al [22], Legault et al [23]
    Shatil et al [24], Linde and Alfermann [25], Shah et al [26], Mc Daniel et al [27], Desjardins-Crépeau et al [28]


    		MCTbOswald et al [29]


    		MDTcPieramico et al [30], Van het Reve and de Bruin [31], Rahe et al [32], Rahe et al [33], Kalbe et al [34]

    		Simultaneous


    		PCTTheill et al [35], Leon et al [36], Norouzi et al [37], Eggenberger et al [38], Eggenberger et al [39]


    		MCTHiyamizu et al [40], Marmeleira et al [41], Falbo et al [42]


    		MDTAnsai et al [43], Yokoyama et al [44], Nishiguchi et al [45], Jardim et al [46]

    aPCT: physical-cognitive training.

    bMCT: motor-cognitive training.

    cMDT: multidomain training.

    Table 2. Selected reviews and studies on exergames. Studies were classified as a function of the type of combined intervention.
    Exergames interventionsStudies
    ReviewsZhang and Kaufman [47], Bleakley et al [48], Ogawa et al [49], Howes et al [50], Stanmore et al [51], Vázquez et al [52], Mansor et al [53], Stojan and Voelcker-Rehage [54], Gallou-Guyot et al [10], Wollesen et al [20], Gavelin et al [19], Sakaki et al [55], Soares et al [56]
    Studies

    		Sequential


    		PCTa—b


    		MCTcPark and Yim [57]


    		MDTdKayama et al [58]

    		Simultaneous


    		PCTAnderson-Hanley et al [59], Barcelos et al [60]


    		MCTSchoene et al [61], Schoene et al [62], Gschwind et al [63], Schättin et al [64], Adcock et al [65], Carrasco et al [66], Eggenberger et al [39], Eggenberger et al [67], Huang [68], Li et al [69]


    		MDTMaillot et al [70], Chuang et al [71], Ordnung et al [72], Guimaraes et al [73], Htut et al [74], Bacha et al [75], Peng et al [76], Moreira et al [77], Gouveia et al [78]

    aPCT: physical-cognitive training.

    bNot available.

    cMCT: motor-cognitive training.

    dMDT: multidomain training.


    We developed a framework to analyze CTIs, independent of whether they were delivered via conventional interventions or via exergames. Specifically, we distinguished the following: (1) the stimuli, which refer to different types of combined training; (2) the settings, which are the organizing features of training programs (ie, frequency, duration, intensity, instructions, feedback, individualization, and progressivity of increase in difficulty); (3) the targets of training, which were limited in this review to brain and cognitive levels, but other levels could be added in future works; (4) the markers, that is, the tasks and tests used to train or assess the participants, respectively; (5) the outcomes of different types of training, that is, the different variables that allow for quantifying the observed effects at brain and cognitive levels; (6) the moderators, who modulated the effects of training; and (7) the potential mechanisms, which were explicitly mentioned in different studies to predict and explain the effects of combined training (Figure 1).

    Accordingly, 3 main training modes were distinguished: (1) physical-cognitive training (PCT), which correspond to the association of endurance (aerobic) and muscular resistance training and cognitive training, either sequentially or simultaneously; (2) motor-cognitive training (MCT), which refers to the association of complex motor skills training and cognitive training, implemented through the addition of cognitive tasks separated from the motor tasks (eg, mental calculation); and (3) multidomain training (MDT), which consists of associating aerobic exercises, complex motor skills, and cognitive tasks through laboratory-customized training situations. Notably, for conventional CTIs, we limited our analysis to randomized controlled trials and controlled trials in which it was possible to identify different training components (ie, physical, motor, and cognitive) that were associated with each other. Thus, according to this criterion, interventions implemented through natural motor activities (eg, tai chi, dance, or Nordic walking) were excluded. Although these activities included physical, motor, and cognitive components, their respective weights and levels of intensity or complexity were difficult to quantify. Based on this framework, in this study, we focused our comparative analysis on the following 4 main constructs: stimuli, settings, targets, and outcomes.

    ‎
    Figure 1. A multidimensional framework to analyze combined training interventions (detailed explanations are presented in a previous study [11]). Published under Creative Commons Attribution 4.0 International License.
    View this figure

    Our analysis was grounded on the material included in 2 recently published reviews dedicated to conventional CTIs [11] and exergames [12], respectively. Specifically, 24 studies on conventional training and 23 studies on exergames, published from 2010 to November 2021, were selected on the basis of several criteria [11,12]. These studies were then analyzed to compare them according to the 4 chosen constructs of our framework (Table 1 and Table 2).


    Stimuli

    Motor and cognitive exercises were performed simultaneously in 100% (n=23) of the exergames studies, whereas sequential presentation of physical and cognitive exercises was used in 58% (7/12) of conventional PCT studies, 22% (2/9) of MDT studies, and 50% (2/4) of MCT studies. Thus, one can hypothesize that several studies on conventional CTIs used mechanisms that were different from those involved in exergame interventions. Another important issue concerns the distribution of the 3 training modes (ie, PCT, MCT, and MDT), which differed in conventional CTI and exergames studies. Indeed, the proportion of PCT studies was much higher for conventional interventions compared to exergaming (12/24, 50% and 2/23, 8%, respectively), whereas the inverse was observed for MCT 16% (4/24) for conventional interventions and 47% (11/23) for exergaming, respectively) and MDT studies 37% (9/24) for conventional studies and 43% (10/23) for exergaming, respectively). This resulted from the predominant use of commercial exergames (eg, Xbox Kinect and Wii Balance Board), which were cheaper than the stationary cybercycle used for implementing PCT in exergames studies [59,60]. It could be concluded from the distribution of PCT in both conventional and exergaming intervention studies that, on average, the latter was less physically demanding than the former; supporting evidence could be found in a study by Graves et al [79], and a discussion is presented in Gonçalves et al’s 2021 study [80]. However, this issue is a matter of debate, since few studies demonstrated that commercial exergames can be the support of intense physical activity [81,82], whereas others showed that they only facilitated light- to moderate-intensity physical activity [83]. On the other hand, since commercial exergames usually required upper limb movements, whole body movements, stepping, weight shifting or balance control, motor exercises supporting MCT and MDT in conventional CTIs and exergames studies were roughly similar.

    Settings

    Conventional CTIs most frequently aimed to compare several groups simultaneously. Indeed, 21/24 (87%) involved a passive control group, alone or together with cognitive training (15/24, 62%) and physical or motor training (13/24, 54%) groups. In total, 8/24 (33%) of the conventional training studies involved 3 training groups (ie, CTI, physical or motor, and cognitive), whereas it was the case in only 1/23 (4.3%) of the exergames studies. Most frequently, exergames studies included 2 groups, that is, either a passive control group (9/23, 39.1%), a physical or motor training group (13/23, 56.5%), or less frequently, a cognitive training group (2/23, 8.6%), in addition to the exergaming group. In both conventional CTI and exergames studies, permanence and transfer of training effects were scarcely investigated, so no reliable conclusion can be drawn in this respect.

    Targets

    No main difference was observed between the cognitive abilities tested in conventional CTIs and exergames studies. The most frequently tested were memory, executive functions, attention, and information processing speed, but there were no ‘a priori’ assumptions about the type of functions that could be affected more or less by each CTI. The respective effects of conventional combined training and exergames on brain health and neurobiological mechanisms cannot be reliably compared due to the small number of related studies and their heterogeneity (ie, 4 and 2 studies, respectively).

    Outcomes

    Combined Training Versus Passive Control Groups

    Independent of the training modes (ie, PCT, MCT, or MDT), positive effects were observed, relative to passive control groups, in all conventional CTIs and exergames studies, for at least one of the targeted cognitive functions, that is, memory, attention, executive functions, and information processing speed. These results were observed for both sequential and simultaneous associations between cognitive and physical or motor exercises. Unfortunately, it was impossible to determine whether cognitive functions were differently impacted by conventional combined training and exergames, respectively. These results are consistent with those reported by Gallou-Guyot et al [10]. Unsurprisingly, they suggest that regardless of how combined training is delivered (ie, conventional interventions or exergames, and PCT, MCT, or MDT), combined training programs always lead to superior benefits compared to inactivity.

    Combined Training Versus Physical Training

    In conventional CTIs, superior benefits of combined training over separated physical training were observed in 100% (n=13) of MCT and MDT studies and in most of the PCT studies (8/12, 66.6%). On the other hand, superior benefits of exergaming compared to conventional physical or motor training alone were observed in only one study on exergames [59], whereas no difference was found between the exergames and separated training groups in the 4 other studies (2 on MCT and 2 on MDT).

    Combined Training Versus Cognitive Training

    In conventional training studies, compared to cognitive training alone, superior benefits of CTIs were observed in almost one-third of PCT studies (n=4), but never in MCT and MDT studies. In the 2 studies that compared exergaming and cognitive training, one reported a superiority of the former over the latter on executive functions [67], whereas the other did not [74]. Thus, the number of related studies was too small to draw reliable conclusions about the superiority of exergames over cognitive training alone.


    The studies including 4 training groups (ie, combined training, separated physical and cognitive training, and a control group), which could allow for a complete comparison, were scarce (ie, 8 conventional training studies out of 47, in total). A second observation was that despite the type of intervention (ie, conventional or exergames), the mechanisms underlying eventual differences with physical and cognitive training groups were rarely addressed in the reviewed studies. A third observation was that information relative to intensity and the nature of physical exercises, the nature and levels of complexity of motor exercises, and progressivity of difficulty was neglected in most studies, so it was impossible to estimate why physical or motor training was effective (or not) to improve physical, motor, or cognitive performance. This was the case, in particular, in exergames studies. In addition, in several studies, cognitive training procedures and (exer)game contents were not described or were only superficially described. Finally, due to the small number of studies available to support some comparisons (eg, exergames and cognitive training; conventional CTI vs exergames), the results remain to be confirmed or even established in future studies.


    In this paper, we aimed to determine whether conventional CTIs and exergames were two comparable ways for delivering combined training. Our analysis showed that conventional CTIs were more effective than separated physical and motor training to improve brain and cognition, but their superiority over cognitive training alone remains to be confirmed in further studies. On the other hand, exergames scarcely led to cognitive benefits superior to those observed after physical, motor, or cognitive training alone. A plausible reason is that the existing exergames did not allow reaching high enough levels of physical effort [10] or motor skills complexity, and they used the resources of virtual reality and video games insufficiently to improve the cognitive load of different exercises [84]. This is not to say that exergame interventions cannot succeed in being more effective than conventional CTIs. However, further studies, grounded on theoretical knowledge provided by the literature on physical, motor, and cognitive training are necessary to determine whether interventions delivered via exergames may lead to superior benefits compared to separated and combined CTIs. In particular, since commercial exergames are not designed specifically for older adults, exergames studies should use new solutions that are more grounded on theoretical foundations [84].

    Finally, this analysis showed that conventional CTIs and exergames studies did not address the same research questions, thereby precluding reliable comparisons of their benefits. Specifically, conventional CTI studies prominently aimed to compare benefits of separate training programs, whereas exergames studies focused on the benefits of exergaming per se, most often relative to inactive control groups. Thus, contrarily to our expectations, they seem to be separated domains of the literature on aging, which, until now, have developed independently of each other. In particular, the literature on exergames has not yet reached the level of maturity of those on conventional CTIs, which itself remains heterogeneous and suffers from methodological weakness and lack of a strong conceptual background [11,84,85]. Therefore, although they both allow for delivering combined training programs, conventional and exergames interventions are not two facets of the same coin; rather, they are two coins we do not know which is more valuable. Accordingly, future studies should aim to develop new exergames that would capitalize more on the knowledge from studies on conventional CTIs, particularly concerning the underlying mechanisms. These studies should also systematically compare the effectiveness of existing or new exergames and that of conventional CTIs.

    Conflicts of Interest

    None declared.

    1. Netz Y. Is there a preferred mode of exercise for cognition enhancement in older age? a narrative review. Front Med (Lausanne) 2019 Mar 29;6-57:1-9. [CrossRef] [Medline]
    2. Gheysen F, Poppe L, DeSmet A, Swinnen S, Cardon G, De Bourdeaudhuij I, et al. Physical activity to improve cognition in older adults: can physical activity programs enriched with cognitive challenges enhance the effects? A systematic review and meta-analysis. Int J Behav Nutr Phys Act 2018 Jul 04;15(1):63 [FREE Full text] [CrossRef] [Medline]
    3. Lauenroth A, Ioannidis AE, Teichmann B. Influence of combined physical and cognitive training on cognition: a systematic review. BMC Geriatr 2016 Jul 18;16(1):141 [FREE Full text] [CrossRef] [Medline]
    4. Pesce C, Voelcker‐Rehage C. The unique contribution of physical activity to successful cognitive aging. In: Handbook of Sport Psychology, 1st Edition. Hoboken, NJ: Wiley; 2020:56.
    5. Chapman SB, Aslan S, Spence JS, Hart JJ, Bartz EK, Didehbani N, et al. Neural mechanisms of brain plasticity with complex cognitive training in healthy seniors. Cereb Cortex 2015 Feb 28;25(2):396-405 [FREE Full text] [CrossRef] [Medline]
    6. Chapman SB, Aslan S, Spence JS, Keebler MW, DeFina LF, Didehbani N, et al. Distinct brain and behavioral benefits from cognitive vs. Physical training: a randomized trial in aging adults. Front Hum Neurosci 2016 Jul 11;10:338 [FREE Full text] [CrossRef] [Medline]
    7. Bherer L, Erickson KI, Liu-Ambrose T. A review of the effects of physical activity and exercise on cognitive and brain functions in older adults. J Aging Res 2013;2013:657508-657508 [FREE Full text] [CrossRef] [Medline]
    8. Bediou B, Adams DM, Mayer RE, Tipton E, Green CS, Bavelier D. Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills. Psychol Bull 2018 Jan;144(1):77-110. [CrossRef] [Medline]
    9. Dale G, Joessel A, Bavelier D, Green CS. A new look at the cognitive neuroscience of video game play. Ann N Y Acad Sci 2020 Mar;1464(1):192-203. [CrossRef] [Medline]
    10. Gallou-Guyot M, Mandigout S, Bherer L, Perrochon A. Effects of exergames and cognitive-motor dual-task training on cognitive, physical and dual-task functions in cognitively healthy older adults: an overview. Ageing Res Rev 2020 Nov;63:101135. [CrossRef] [Medline]
    11. Torre MM, Temprado J. A review of combined training studies in older adults according to a new categorization of conventional interventions. Front Aging Neurosci 2021 Feb 1;13:808539 [FREE Full text] [CrossRef] [Medline]
    12. Torre MM, Temprado J. Effects of exergames on brain and cognition in older adults: a review based on a new categorization of combined training intervention. Front Aging Neurosci 2022 Mar 30;14:859715 [FREE Full text] [CrossRef] [Medline]
    13. Law LL, Barnett F, Yau MK, Gray MA. Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review. Ageing Res Rev 2014 May;15:61-75. [CrossRef] [Medline]
    14. Wollesen B, Voelcker-Rehage C. Training effects on motor–cognitive dual-task performance in older adults. Eur Rev Aging Phys Act 2013 Feb 24;11(1):5-24. [CrossRef]
    15. Zhu X, Yin S, Lang M, He R, Li J. The more the better? A meta-analysis on effects of combined cognitive and physical intervention on cognition in healthy older adults. Ageing Res Rev 2016 Nov;31:67-79. [CrossRef] [Medline]
    16. Levin O, Netz Y, Ziv G. The beneficial effects of different types of exercise interventions on motor and cognitive functions in older age: a systematic review. Eur Rev Aging Phys Act 2017 Dec 21;14(1):20 [FREE Full text] [CrossRef] [Medline]
    17. Tait JL, Duckham RL, Milte CM, Main LC, Daly RM. Influence of sequential vs. simultaneous dual-task exercise training on cognitive function in older adults. Front Aging Neurosci 2017 Nov 07;9:368 [FREE Full text] [CrossRef] [Medline]
    18. Joubert C, Chainay H. Aging brain: the effect of combined cognitive and physical training on cognition as compared to cognitive and physical training alone - a systematic review. Clin Interv Aging 2018 Jul;13:1267-1301. [CrossRef] [Medline]
    19. Gavelin H, Dong C, Minkov R, Bahar-Fuchs A, Ellis KA, Lautenschlager NT, et al. Combined physical and cognitive training for older adults with and without cognitive impairment: a systematic review and network meta-analysis of randomized controlled trials. Ageing Res Rev 2021 Mar;66:101232. [CrossRef] [Medline]
    20. Wollesen B, Wildbredt A, van Schooten KS, Lim ML, Delbaere K. The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis. Eur Rev Aging Phys Act 2020 Jul 02;17(1):9 [FREE Full text] [CrossRef] [Medline]
    21. Guo W, Zang M, Klich S, Kawczyński A, Smoter M, Wang B. Effect of combined physical and cognitive interventions on executive functions in older adults: a meta-analysis of outcomes. Int J Environ Res Public Health 2020 Aug 25;17(17):6166 [FREE Full text] [CrossRef] [Medline]
    22. Fabre C, Chamari K, Mucci P, Massé-Biron J, Préfaut C. Improvement of cognitive function by mental and/or individualized aerobic training in healthy elderly subjects. Int J Sports Med 2002 Aug;23(6):415-421. [CrossRef] [Medline]
    23. Legault C, Jennings JM, Katula JA, Dagenbach D, Gaussoin SA, Sink KM, SHARP-P Study Group. Designing clinical trials for assessing the effects of cognitive training and physical activity interventions on cognitive outcomes: the Seniors Health and Activity Research Program Pilot (SHARP-P) study, a randomized controlled trial. BMC Geriatr 2011 May 26;11(1):27 [FREE Full text] [CrossRef] [Medline]
    24. Shatil E. Does combined cognitive training and physical activity training enhance cognitive abilities more than either alone? A four-condition randomized controlled trial among healthy older adults. Front Aging Neurosci 2013;5:8 [FREE Full text] [CrossRef] [Medline]
    25. Linde K, Alfermann D. Single versus combined cognitive and physical activity effects on fluid cognitive abilities of healthy older adults: a 4-month randomized controlled trial with follow-up. J Aging Phys Act 2014 Jul;22(3):302-313. [CrossRef] [Medline]
    26. Shah T, Verdile G, Sohrabi H, Campbell A, Putland E, Cheetham C, et al. A combination of physical activity and computerized brain training improves verbal memory and increases cerebral glucose metabolism in the elderly. Transl Psychiatry 2014 Dec 02;4(12):e487-e487 [FREE Full text] [CrossRef] [Medline]
    27. McDaniel MA, Binder EF, Bugg JM, Waldum ER, Dufault C, Meyer A, et al. Effects of cognitive training with and without aerobic exercise on cognitively demanding everyday activities. Psychol Aging 2014 Sep;29(3):717-730 [FREE Full text] [CrossRef] [Medline]
    28. Desjardins-Crépeau L, Berryman N, Fraser S, Vu TTM, Kergoat M, Li K, et al. Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults. Clin Interv Aging 2016 Sep;11:1287-1299 [FREE Full text] [CrossRef] [Medline]
    29. Oswald WD, Gunzelmann T, Rupprecht R, Hagen B. Differential effects of single versus combined cognitive and physical training with older adults: the SimA study in a 5-year perspective. Eur J Ageing 2006 Dec 10;3(4):179-192 [FREE Full text] [CrossRef] [Medline]
    30. Pieramico V, Esposito R, Sensi F, Cilli F, Mantini D, Mattei PA, et al. Combination training in aging individuals modifies functional connectivity and cognition, and is potentially affected by dopamine-related genes. PLoS One 2012 Aug 28;7(8):e43901 [FREE Full text] [CrossRef] [Medline]
    31. van het Reve E, de Bruin ED. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial. BMC Geriatr 2014 Dec 15;14(1):134 [FREE Full text] [CrossRef] [Medline]
    32. Rahe J, Becker J, Fink GR, Kessler J, Kukolja J, Rahn A, et al. Cognitive training with and without additional physical activity in healthy older adults: cognitive effects, neurobiological mechanisms, and prediction of training success. Front Aging Neurosci 2015 Oct 13;7:187 [FREE Full text] [CrossRef] [Medline]
    33. Rahe J, Petrelli A, Kaesberg S, Fink G, Kessler J, Kalbe E. Effects of cognitive training with additional physical activity compared to pure cognitive training in healthy older adults. CIA 2015 Jan:297. [CrossRef]
    34. Kalbe E, Roheger M, Paluszak K, Meyer J, Becker J, Fink GR, et al. Effects of a cognitive training with and without additional physical activity in healthy older adults: a follow-up 1 year after a randomized controlled trial. Front Aging Neurosci 2018 Dec 18;10:407 [FREE Full text] [CrossRef] [Medline]
    35. Theill N, Schumacher V, Adelsberger R, Martin M, Jäncke L. Effects of simultaneously performed cognitive and physical training in older adults. BMC Neurosci 2013 Sep 23;14(1):103 [FREE Full text] [CrossRef] [Medline]
    36. León J, Ureña A, Bolaños MJ, Bilbao A, Oña A. A combination of physical and cognitive exercise improves reaction time in persons 61-84 years old. J Aging Phys Act 2015 Jan;23(1):72-77. [CrossRef] [Medline]
    37. Norouzi E, Vaezmosavi M, Gerber M, Pühse U, Brand S. Dual-task training on cognition and resistance training improved both balance and working memory in older people. Phys Sportsmed 2019 Nov 03;47(4):471-478. [CrossRef] [Medline]
    38. Eggenberger P, Theill N, Holenstein S, Schumacher V, de Bruin E. Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up. CIA 2015 Oct:1711. [CrossRef]
    39. de Bruin E, Eggenberger P, Schumacher V, Angst M, Theill N. CIA 2015 Aug:1335. [CrossRef]
    40. Hiyamizu M, Morioka S, Shomoto K, Shimada T. Effects of dual task balance training on dual task performance in elderly people: a randomized controlled trial. Clin Rehabil 2012 Jan 18;26(1):58-67. [CrossRef] [Medline]
    41. Marmeleira JF, Godinho MB, Fernandes OM. The effects of an exercise program on several abilities associated with driving performance in older adults. Accid Anal Prev 2009 Jan;41(1):90-97. [CrossRef] [Medline]
    42. Falbo S, Condello G, Capranica L, Forte R, Pesce C. Effects of physical-cognitive dual task training on executive function and gait performance in older adults: a randomized controlled trial. Biomed Res Int 2016;2016:5812092 [FREE Full text] [CrossRef] [Medline]
    43. Ansai J, de Andrade LP, de Souza Buto MS, de Vassimon Barroso V, Farche ACS, Rossi PG, et al. Effects of the addition of a dual task to a supervised physical exercise program on older adults' cognitive performance. J Aging Phys Act 2017 Apr;25(2):234-239. [CrossRef] [Medline]
    44. Yokoyama H, Okazaki K, Imai D, Yamashina Y, Takeda R, Naghavi N, et al. The effect of cognitive-motor dual-task training on cognitive function and plasma amyloid β peptide 42/40 ratio in healthy elderly persons: a randomized controlled trial. BMC Geriatr 2015 May 28;15(1):60 [FREE Full text] [CrossRef] [Medline]
    45. Nishiguchi S, Yamada M, Tanigawa T, Sekiyama K, Kawagoe T, Suzuki M, et al. A 12-week physical and cognitive exercise program can improve cognitive function and neural efficiency in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc 2015 Jul 26;63(7):1355-1363. [CrossRef] [Medline]
    46. Jardim NYV, Bento-Torres NVO, Costa VO, Carvalho JPR, Pontes HTS, Tomás AM, et al. Dual-task exercise to improve cognition and functional capacity of healthy older adults. Front Aging Neurosci 2021 Feb 16;13:589299 [FREE Full text] [CrossRef] [Medline]
    47. Zhang F, Kaufman D. Physical and cognitive impacts of digital games on older adults: a meta-analytic review. J Appl Gerontol 2016 Nov 09;35(11):1189-1210. [CrossRef] [Medline]
    48. Bleakley CM, Charles D, Porter-Armstrong A, McNeill MDJ, McDonough SM, McCormack B. Gaming for health: a systematic review of the physical and cognitive effects of interactive computer games in older adults. J Appl Gerontol 2015 Apr 17;34(3):NP166-NP189. [CrossRef] [Medline]
    49. Ogawa E, You T, Leveille S. Potential benefits of exergaming for cognition and dual-task function in older adults: a systematic review. J Aging Phys Act 2016;24:6. [CrossRef]
    50. Howes S, Charles D, Marley J, Pedlow K, McDonough SM. health: systematic review and meta-analysis of the physical and cognitive effects of active computer gaming in older adults. Phys Ther 2017 Dec 01;97(12):1122-1137. [CrossRef] [Medline]
    51. Stanmore E, Stubbs B, Vancampfort D, de Bruin ED, Firth J. The effect of active video games on cognitive functioning in clinical and non-clinical populations: a meta-analysis of randomized controlled trials. Neurosci Biobehav Rev 2017 Jul;78:34-43 [FREE Full text] [CrossRef] [Medline]
    52. Vázquez FL, Otero P, García-Casal JA, Blanco V, Torres, Arrojo M. Efficacy of video game-based interventions for active aging. A systematic literature review and meta-analysis. PLoS One 2018 Dec 11;13(12):e0208192 [FREE Full text] [CrossRef] [Medline]
    53. Mansor NS, Chow CM, Halaki M. Cognitive effects of video games in older adults and their moderators: a systematic review with meta-analysis and meta-regression. Aging Ment Health 2020 Jun 20;24(6):841-856. [CrossRef] [Medline]
    54. Stojan R, Voelcker-Rehage C. A systematic review on the cognitive benefits and neurophysiological correlates of exergaming in healthy older adults. J Clin Med 2019 May 23;8(5):734 [FREE Full text] [CrossRef] [Medline]
    55. Sakaki K, Nouchi R, Matsuzaki Y, Saito T, Dinet J, Kawashima R. Benefits of VR physical exercise on cognition in older adults with and without mild cognitive decline: a systematic review of randomized controlled trials. Healthcare (Basel) 2021 Jul 13;9(7):883 [FREE Full text] [CrossRef] [Medline]
    56. Soares VN, Yoshida HM, Magna TS, Sampaio RAC, Fernandes PT. Comparison of exergames versus conventional exercises on the cognitive skills of older adults: a systematic review with meta-analysis. Arch Gerontol Geriatr 2021 Nov;97:104485. [CrossRef] [Medline]
    57. Park J, Yim J. A new approach to improve cognition, muscle strength, and postural balance in community-dwelling elderly with a 3-d virtual reality kayak program. Tohoku J Exp Med 2016 Jan;238(1):1-8 [FREE Full text] [CrossRef] [Medline]
    58. Kayama H, Okamoto K, Nishiguchi S, Yamada M, Kuroda T, Aoyama T. Effect of a Kinect-based exercise game on improving executive cognitive performance in community-dwelling elderly: case control study. J Med Internet Res 2014 Feb 24;16(2):e61 [FREE Full text] [CrossRef] [Medline]
    59. Anderson-Hanley C, Arciero PJ, Brickman AM, Nimon JP, Okuma N, Westen SC, et al. Exergaming and older adult cognition: a cluster randomized clinical trial. Am J Prev Med 2012 Feb;42(2):109-119. [CrossRef] [Medline]
    60. Barcelos N, Shah N, Cohen K, Hogan MJ, Mulkerrin E, Arciero PJ, et al. Aerobic and cognitive exercise (ACE) pilot study for older adults: executive function improves with cognitive challenge while exergaming. J Int Neuropsychol Soc 2015 Nov 19;21(10):768-779. [CrossRef]
    61. Schoene D, Lord SR, Delbaere K, Severino C, Davies TA, Smith ST. A randomized controlled pilot study of home-based step training in older people using videogame technology. PLoS One 2013 Mar 5;8(3):e57734 [FREE Full text] [CrossRef] [Medline]
    62. Schoene D, Valenzuela T, Toson B, Delbaere K, Severino C, Garcia J, et al. Interactive cognitive-motor step training improves cognitive risk factors of falling in older adults - a randomized controlled trial. PLoS One 2015 Dec 16;10(12):e0145161 [FREE Full text] [CrossRef] [Medline]
    63. Gschwind YJ, Schoene D, Lord SR, Ejupi A, Valenzuela T, Aal K, et al. The effect of sensor-based exercise at home on functional performance associated with fall risk in older people - a comparison of two exergame interventions. Eur Rev Aging Phys Act 2015 Nov 30;12(1):11 [FREE Full text] [CrossRef] [Medline]
    64. Schättin A, Arner R, Gennaro F, de Bruin ED. Adaptations of prefrontal brain activity, executive functions, and gait in healthy elderly following exergame and balance training: a randomized-controlled study. Front Aging Neurosci 2016;8:278 [FREE Full text] [CrossRef] [Medline]
    65. Adcock M, Fankhauser M, Post J, Lutz K, Zizlsperger L, Luft AR, et al. Effects of an in-home multicomponent exergame training on physical functions, cognition, and brain volume of older adults: a randomized controlled trial. Front Med (Lausanne) 2019 Jan 28;6:321 [FREE Full text] [CrossRef] [Medline]
    66. Carrasco M, Ortiz-Maqués N, Martínez-Rodríguez S. Playing with Nintendo Wii sports: impact on physical activity, perceived health and cognitive functioning of a group of community-dwelling older adults. Activ Adapt Aging 2019 Apr 08;44(2):119-131. [CrossRef]
    67. Eggenberger P, Wolf M, Schumann M, de Bruin ED. Exergame and balance training modulate prefrontal brain activity during walking and enhance executive function in older adults. Front Aging Neurosci 2016 Apr 12;8:66 [FREE Full text] [CrossRef] [Medline]
    68. Huang K. Exergaming executive functions: an immersive virtual reality-based cognitive training for adults aged 50 and older. Cyberpsychol Behav Soc Netw 2020 Mar 01;23(3):143-149. [CrossRef] [Medline]
    69. Li X, Niksirat KS, Chen S, Weng D, Sarcar S, Ren X. The impact of a multitasking-based virtual reality motion video game on the cognitive and physical abilities of older adults. Sustainability 2020 Nov 02;12(21):9106. [CrossRef]
    70. Maillot P, Perrot A, Hartley A. Effects of interactive physical-activity video-game training on physical and cognitive function in older adults. Psychol Aging 2012 Sep;27(3):589-600. [CrossRef] [Medline]
    71. Chuang L, Hung H, Huang C, Chang Y, Hung T. A 3-month intervention of Dance Dance Revolution improves interference control in elderly females: a preliminary investigation. Exp Brain Res 2015 Apr 17;233(4):1181-1188. [CrossRef] [Medline]
    72. Ordnung M, Hoff M, Kaminski E, Villringer A, Ragert P. No overt effects of a 6-week exergame training on sensorimotor and cognitive function in older adults. a preliminary investigation. Front Hum Neurosci 2017;11:160 [FREE Full text] [CrossRef] [Medline]
    73. Guimarães V, Pereira A, Oliveira E. Design and evaluation of an exergame for motor-cognitive training and fall prevention in older adults. In: Proceedings of the 4th EAI International Conference on Smart Objects and Technologies for Social Good. 2018 Presented at: Goodtechs ’18; Nov 28-30; Bologna, Italy p. 202-207. [CrossRef]
    74. Htut TZC, Hiengkaew V, Jalayondeja C, Vongsirinavarat M. Effects of physical, virtual reality-based, and brain exercise on physical, cognition, and preference in older persons: a randomized controlled trial. Eur Rev Aging Phys Act 2018 Oct 2;15(1):10 [FREE Full text] [CrossRef] [Medline]
    75. Bacha JMR, Gomes GCV, de Freitas TB, Viveiro LAP, da Silva KG, Bueno GC, et al. Effects of Kinect Adventures games versus conventional physical therapy on postural control in elderly people: a randomized controlled trial. Games Health J 2018 Feb;7(1):24-36. [CrossRef] [Medline]
    76. Peng H, Tien C, Lin P, Peng H, Song C. Novel Mat exergaming to improve the physical performance, cognitive function, and dual-task walking and decrease the fall risk of community-dwelling older adults. Front Psychol 2020 Jul 24;11:1620 [FREE Full text] [CrossRef] [Medline]
    77. Moreira NB, Rodacki AL, Costa SN, Pitta A, Bento PC. Perceptive-cognitive and physical function in prefrail older adults: exergaming versus traditional multicomponent training. Rejuvenation Res 2021 Feb 01;24(1):28-36. [CrossRef] [Medline]
    78. Gouveia, Smailagic A, Ihle A, Marques A, Gouveia BR, Cameirão M, et al. The efficacy of a multicomponent functional fitness program based on exergaming on cognitive functioning of healthy older adults: a randomized controlled trial. J Aging Phys Act 2021 Aug 01;29(4):586-594. [CrossRef] [Medline]
    79. Graves L, Ridgers N, Williams K, Stratton G, Atkinson G, Cable NT. The physiological cost and enjoyment of Wii Fit in adolescents, young adults, and older adults. J Phys Act Health 2010 May;7(3):393-401. [CrossRef] [Medline]
    80. Gonçalves AR, Muñoz JE, Gouveia ER, Cameirão MDS, Bermúdez i Badia S. Effects of prolonged multidimensional fitness training with exergames on the physical exertion levels of older adults. Vis Comput 2019 Jul 29;37(1):19-30. [CrossRef]
    81. Martin-Niedecken AL, Mahrer A, Rogers K, de Bruin ED, Schättin A. “HIIT” the ExerCube: comparing the effectiveness of functional high-intensity interval training in conventional vs. exergame-based training. Front Comput Sci 2020 Oct 23;2:33. [CrossRef]
    82. Polechoński J, Dębska M, Dębski PG. Exergaming can be a health-related aerobic physical activity. Biomed Res Int 2019 Jun 04;2019:1890527-1890527 [FREE Full text] [CrossRef] [Medline]
    83. Peng W, Lin J, Crouse J. Is playing exergames really exercising? A meta-analysis of energy expenditure in active video games. Cyberpsychol Behav Soc Netw 2011 Nov;14(11):681-688. [CrossRef] [Medline]
    84. Temprado J. Can exergames be improved to better enhance behavioral adaptability in older adults? an ecological dynamics perspective. Front Aging Neurosci 2021 May 28;13:670166 [FREE Full text] [CrossRef] [Medline]
    85. Bruderer-Hofstetter M, Rausch-Osthoff A, Meichtry A, Münzer T, Niedermann K. Effective multicomponent interventions in comparison to active control and no interventions on physical capacity, cognitive function and instrumental activities of daily living in elderly people with and without mild impaired cognition - a systematic review and network meta-analysis. Ageing Res Rev 2018 Aug;45:1-14. [CrossRef] [Medline]

    ‎
    CTI: combined training intervention
    MCT: motor-cognitive training
    MDT: multidomain training
    PCT: physical-cognitive training

    Edited by N Zary; submitted 22.03.22; peer-reviewed by M Gallou-Guyot; comments to author 21.07.22; revised version received 22.07.22; accepted 04.08.22; published 03.10.22

    Copyright

    ©Jean-Jacques Temprado, Marta Maria Torre. Originally published in JMIR Serious Games (https://games.jmir.org), 03.10.2022.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on https://games.jmir.org, as well as this copyright and license information must be included.