Tele-Medicine Based and Self-Administered Interactive Exercise Program (Tele-Exergame) to Improve Cognition in Older Adults with Mild Cognitive Impairment or Dementia: A Feasibility, Acceptability, and Proof-of-Concept Study

Catherine Park, Ram Kinker Mishra, Michele K York, Ana Enriquez, Abigail Lindsay, Gregory Barchard, Ashkan Vaziri, Bijan Najafi, Catherine Park, Ram Kinker Mishra, Michele K York, Ana Enriquez, Abigail Lindsay, Gregory Barchard, Ashkan Vaziri, Bijan Najafi

Abstract

Improved life expectancy is increasing the number of older adults who suffer from motor-cognitive decline. Unfortunately, conventional balance exercise programs are not tailored to patients with cognitive impairments, and exercise adherence is often poor due to unsupervised settings. This study describes the acceptability and feasibility of a sensor-based in-home interactive exercise system, called tele-Exergame, used by older adults with mild cognitive impairment (MCI) or dementia. Our tele-Exergame is specifically designed to improve balance and cognition during distractive conditioning while a telemedicine interface remotely supervises the exercise, and its exercises are gamified balance tasks with explicit augmented visual feedback. Fourteen adults with MCI or dementia (Age = 68.1 ± 5.4 years, 12 females) participated and completed exergame twice weekly for six weeks at their homes. Before and after 6 weeks, participants' acceptance was assessed by Technology Acceptance Model (TAM) questionnaire, and participants' cognition and anxiety level were evaluated by the Montreal Cognitive Assessment (MoCA) and Beck Anxiety Inventory (BAI), respectively. Results support acceptability, perceived benefits, and positive attitudes toward the use of the system. The findings of this study support the feasibility, acceptability, and potential benefit of tele-Exergame to preserve cognitive function among older adults with MCI and dementia.

Keywords: Alzheimer’s disease; cognitive impairment; dementia; exercise; exergame; gamification; telehealth.

Conflict of interest statement

B.N., Co-Author, is serving as a consultant for BioSensics LLC, manufacturers of some of the tools used in this study. However, he was also not involved in recruitment and data analysis from this study. R.k.M. is now with BioSensics LLC; however, his contribution to this study was limited to when he was a postdoc associate with Baylor College of Medicine. A.E, A.L., G.B. and A.V. are with BioSensics LLC. However, their contribution was limited to technology design, technical support, and interpretation of sensor data. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Tele-Exergame system. (A) Tablet and wearable sensor. (B) Leg raising exercise with the tele-Exergame system. (C) Foot flexion exercise with the tele-Exergame system.

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