The interactive Physical and Cognitive Exercise System (iPACES™): effects of a 3-month in-home pilot clinical trial for mild cognitive impairment and caregivers

Cay Anderson-Hanley, Jessica Stark, Kathryn M Wall, Marisa VanBrakle, Makenzie Michel, Molly Maloney, Nicole Barcelos, Kristina Striegnitz, Brian D Cohen, Arthur F Kramer, Cay Anderson-Hanley, Jessica Stark, Kathryn M Wall, Marisa VanBrakle, Makenzie Michel, Molly Maloney, Nicole Barcelos, Kristina Striegnitz, Brian D Cohen, Arthur F Kramer

Abstract

Background: Alzheimer's and related dementias are on the rise, and older adults and their families are seeking accessible and effective ways to stave off or ameliorate mild cognitive impairment (MCI).

Aim: This pilot clinical trial (ClinicalTrials.gov Identifier: 03069391) examined neuropsychological and neurobiological outcomes of interactive physical and mental exercise.

Participants and methods: Older adults (MCI and caregivers) were enrolled in a 3-month, in-home trial of a portable neuro-exergame (the interactive Physical and Cognitive Exercise System [iPACES™]), in which they pedaled and steered along a virtual bike path to complete a list of errands (Memory Lane™). Neuropsychological function and salivary biomarkers were measured at pre-, mid-, and posttrial. Ten older adults complied with the recommended use of iPACES (complete dose; ≥2×/wk, 67% of the 15 who also had pre- and postevaluation data). Statistical analyses compared change over time and also change among those with a complete dose vs inadequate dose. Correlations between change in neuropsychological and biomarker measures were also examined.

Results: Executive function and verbal memory increased after 3 months (p = 0.01; no significant change was found with an inadequate dose). Change in salivary biomarkers was moderately associated with increasing cognition (cortisol, r = 0.68; IGF-1, r = 0.37).

Conclusion: Further research is needed, but these pilot data provide preliminary indications to suggest neuro-exergaming can impact cognitive function, perhaps via neurobiological mechanisms, and as such may provide an effective and practical way to promote healthy aging.

Keywords: MCI; aging; cognition; executive function; exergame; neuro-exergame; neurogame.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in the conduct or report of this research.

Figures

Figure 1
Figure 1
The interactive Physical and Cognitive Exercise System (iPACES) shown as used in-home via a portable tablet-laptop paired with a cadence monitor on an under-table elliptical and operated by a joystick equipped with a HR monitor (finger sensor). Notes: The image in Figure 1 shows the use of iPACES (tablet, pedaler, controller, and HR monitor) in a home environment. The person in Figure 1 has provided written informed consent for his image to be published. Abbreviation: HR, heart rate.
Figure 2
Figure 2
CONSORT flow diagram showing enrollment and progress through trial. Abbreviations: CONSORT, Consolidated Standards of Reporting Trials; eval, evaluate; wk, week; indiv, individual; inadeq, inadequate.
Figure 3
Figure 3
Executive function improves after 3 months pedaling and playing the interactive Physical and Cognitive Exercise System (iPACES) for community-dwelling older adults (MCI and caregiver/companions). Abbreviations: MoCA, Montreal Cognitive Assessment; wk, week; es, effect size.
Figure 4
Figure 4
Verbal memory improves after 3 months pedaling and playing the interactive Physical and Cognitive Exercise System (iPACES) for community-dwelling older adults (MCI and caregiver/companions). Abbreviations: ADAS, Alzheimer’s Disease Assessment Scale; MoCA, Montreal Cognitive Assessment; wk, week; es, effect size.

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