Autism and exergaming: effects on repetitive behaviors and cognition

Autism is a neurodevelopmental disorder that leads to impairment in social skills and delay in language development, and results in repetitive behaviors and restricted interests that impede academic and social involvement. Physical exercise has been shown to decrease repetitive behaviors in autistic children and improve cognitive function across the life-span. Exergaming combines physical and mental exercise simultaneously by linking physical activity movements to video game control and may yield better compliance with exercise. In this investigation, two pilot studies explored the potential behavioral and cognitive benefits of exergaming. In Pilot I, twelve children with autism spectrum disorders completed a control task and an acute bout of Dance Dance Revolution (DDR); in Pilot II, ten additional youths completed an acute bout of cyber cycling. Repetitive behaviors and executive function were measured before and after each activity. Repetitive behaviors significantly decreased, while performance on Digits Backwards improved following the exergaming conditions compared with the control condition. Additional research is needed to replicate these findings, and to explore the application of exergaming for the management of behavioral disturbance and to increase cognitive control in children on the autism spectrum

Social facilitation in virtual reality-enhanced exercise: competitiveness moderates exercise effort of older adults

This study examined the effect of virtual social facilitation and competitiveness on exercise effort in exergaming older adults. Fourteen exergaming older adults participated. Competitiveness was assessed prior to the start of exercise. Participants were trained to ride a “cybercycle;” a virtual reality-enhanced stationary bike with interactive competition. After establishing a cybercycling baseline, competitive avatars were introduced. Pedaling effort (watts) was assessed. Repeated measures ANOVA revealed a significant group (high vs low competitiveness) × time (pre- to post-avatar) interaction (F[1,12] = 13.1, P = 0.003). Virtual social facilitation increased exercise effort among more competitive exercisers. Exercise programs that match competitiveness may maximize exercise effort

Comparing the effects of an acute bout of physical exercise with an acute bout of interactive mental and physical exercise on electrophysiology and executive functioning in younger and older adults

Background Physical exercise has been shown to improve cognitive and neural functioning in older adults. Aims and methods The current study compared the effects of an acute bout of physical exercise with a bout of interactive mental and physical exercise (i.e., “exergaming”) on executive (Stroop) task performance and event-related potential (ERP) amplitudes in younger and older adults. Results Results revealed enhanced executive task performance in younger and older adults after exercise, with no differences in performance between exercise conditions. Stroop (RT) performance in older adults improved more than in younger adults from pre- to post-exercise. A significant increase in EEG amplitude from pre- to post-exercise was found at the Cz site from 320 to 700 ms post-stimulus for both younger and older adults, with older adults demonstrating a larger Stroop interference effect. While younger adults exhibited overall greater EEG amplitudes than older adults, they showed no differences between congruent and incongruent trials (i.e., minimal interference). Compared to peers with higher BMI (body mass index), older adults with lower BMI showed a greater reduction in Stroop interference effects from pre- to post-exercise. Discussion and conclusions The beneficial effects of an acute bout of physical exercise on cognitive and neural functioning in younger and older adults were confirmed, with no difference between standard exercise and exergaming. Findings suggest that BMI, sometimes used as a proxy for fitness level, may modulate benefits that older adults derive from an acute bout of exercise. Findings have implications for future research that seeks to investigate unique effects of exergaming when compared to standard physical exercise

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Biomarker and cognitive effects of single bouts of moderate-intensity neuro-exergaming, high-intensity interval training (HIIT), and fasted exercise for mild cognitive impairment: A case study of serial interventions

Research has demonstrated benefits of exercise on cognition, but it remains unclear whether adjusting other variables can maximize the benefit. This case study examined the effects of fasting and moderate to high-intensity physical exercise on cognitive function and biomarkers in an older adult with mild cognitive impairment (MCI). We hypothesized that (1) cognition would improve throughout the intervention, (2) salivary cortisol would increase after fasted moderate exercise and high-intensity interval training (HIIT) and decrease after non-fasted moderate exercise, and (3) salivary alpha-amylase would increase after all exercise conditions. One adult participant completed all four study conditions: (1) fasting only, (2) non-fasting with moderate iPACES (neuro-exergaming) exercise, (3) fasting with moderate iPACES exercise, and (4) non-fasting with HIIT using iPACES. All study procedures were administered remotely due to the COVID-19 pandemic. The participant self-collected saliva samples using materials shipped to her residence from our lab. Cognition was assessed via the Montreal Cognitive Assessment (MoCA) and executive function via the paper Stroop test administered via videoconference pre/post intervention. Additionally, a digital Stroop test was administered pre/post each of the four serially assigned conditions. A time series display illustrated a slight improvement in the participant on the paper Stroop task from pre- to post-intervention with only slight improvement on the MoCA, possibly due to practice effects. However, we saw a marked improvement on the digital Stroop test following the fasted moderate exercise bout (the third condition in the series) despite its repeated administration. Biomarker analyses showed some increase in alpha-amylase for the non-fasted aerobic exercise condition and the HIIT condition. Pre/post for the fasting and fasted aerobic exercise conditions were similar. For cortisol, there was some decrease for the fasting condition and a marked decrease for the HIIT condition. Pre/post for both non-fasted and fasted aerobic exercise conditions were similar. The results partially supported our hypotheses and replicated previous findings from the literature, but further research with a sampling of additional participants is needed for statistical analyses to confirm our findings. This study tested the feasibility of our newly home-based neuro-exergaming intervention and a novel method of collecting and shipping biomarker samples for analysis. While we demonstrated the necessity of certain tools for our protocol, it had several limitations. These include difficulties with participant recruitment, the expensive and time-consuming shipping process, and faulty Bluetooth connections between fitness watch, Lenovo tablet, and cadence meter. Results also warrant further research to clarify possible moderating roles of other neuroprotective biomarkers (like BDNF or ketone bodies) as well as heart rate and diet regimen

Roundtable discussion: game interventions for autism spectrum disorder

It is nearly impossible to spend a day without hearing news or personal stories regarding autism. To Google ‘‘autism + health games’’ yields thousands of postings. The disorder is so broad in its symptoms and manifestations that it is referred to as autism spectrum disorder or ASD. It is of such a high priority that research on reward circuitry, autism,and games teaching social perceptual skills was one of The Robert Wood Johnson Foundation Pioneer Fund’s first projects.Earlier this year I read an interesting article by Dr. Micah Mazurek of the University of Missouri stating children with ASD tend to be fascinated by screen-based technology (SBT)and spend the majority of their free time using nonsocial media,including television and videogames. I asked Dr. Mazurek if she could assemble a panel of experts to discuss ASD and how those with the disorder can benefit from their fascination of videogames. To that end, the following roundtable discussion shares the expertise of Dr. Mazurek and her fellow ASD research leaders, Dr. Cay Anderson-Hanley, Dr. Zachary Warren, and Dr. Sarah Parsons

Exergaming and older adult cognition: A cluster randomized clinical trial

Background: Dementia cases may reach 100 million by 2050. Interventions are sought to curb or prevent cognitive decline. Exercise yields cognitive benefits, but few older adults exercise. Virtual realityenhanced exercise or exergames may elicit greater participation. Purpose: To test the following hypotheses: (1) stationary cycling with virtual reality tours ( cybercycle ) will enhance executive function and clinical status more than traditional exercise; (2) exercise effort will explain improvement; and (3) brain-derived neurotrophic growth factor (BDNF) will increase. Design: Multi-site cluster randomized clinical trial (RCT) of the impact of 3 months of cybercycling versus traditional exercise, on cognitive function in older adults. Data were collected in 20082010; analyses were conducted in 20102011. Setting/participants: 102 older adults from eight retirement communities enrolled; 79 were randomized and 63 completed. Interventions: A recumbent stationary ergometer was utilized; virtual reality tours and competitors were enabled on the cybercycle. Main outcome measures: Executive function (Color Trails Difference, Stroop C, Digits Backward); clinical status (mild cognitive impairment; MCI); exercise effort/fitness; and plasma BDNF. Results: Intent-to-treat analyses, controlling for age, education, and cluster randomization, revealed a significant group X time interaction for composite executive function (p=0.002). Cybercycling yielded a medium effect over traditional exercise (d=0.50). Cybercyclists had a 23% relative risk reduction in clinical progression to MCI. Exercise effort and fitness were comparable, suggesting another underlying mechanism. A significant group X time interaction for BDNF (p=0.05) indicated enhanced neuroplasticity among cybercyclists. Conclusions: Cybercycling older adults achieved better cognitive function than traditional exercisers, for the same effort, suggesting that simultaneous cognitive and physical exercise has greater potential for preventing cognitive decline. Trial registration: This study is registered at Clinicaltrials.gov NCT01167400. © 2012 American Journal of Preventive Medicine

The Enhanced Interactive Physical and Cognitive Exercise System (iPACESTM v2.0): Pilot Clinical Trial of an In-Home iPad-Based Neuro-Exergame for Mild Cognitive Impairment (MCI)

Given increasing longevity worldwide, older adults and caregivers are seeking ways to curb cognitive decline especially for those with mild cognitive impairment (MCI, now mild neurocognitive disorder, mNCD, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V). This quasi-experimental, within-subjects pilot clinical trial was designed to replicate and extend the study of cognitive benefits for MCI by improving upon our prior interactive Physical and Cognitive Exercise Study (iPACESTM v1.0) by increasing the usability of the neuro-exergame and exploring possible underlying neurobiological mechanisms. Older adults were enrolled in a three-month, in-home trial of a portable neuro-exergame (iPACES&trade; v2.0) where participants pedaled and steered along a virtual bike path (Memory Lane&trade;). Neuropsychological function was assessed at baseline after component familiarization intervals (e.g., two weeks of exercise-only, game-only, etc.) and after three months of interactive neuro-exergame intervention. Fourteen participants were enrolled in the study and seven completed the final evaluation. Intent-to-treat analyses were conducted with imputed missing data (total n = 14). Significant improvement in executive function (Stroop) was found (d = 0.68, p = 0.02) only. Changes in salivary biomarkers (cortisol and insulin-like growth factor 1; IGF-1) were significantly associated with improved cognition. Further research is needed, but pilot data suggest that a portable in-home neuro-exergame may be an additional, practical tool to fight back against cognitive decline and dementia

The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial

Prior research has found that cognitive benefits of physical exercise and brain health in older adults may be enhanced when mental exercise is interactive simultaneously, as in exergaming. It is unclear whether the cognitive benefit can be maximized by increasing the degree of mental challenge during exercise. This randomized clinical trial (RCT), the Aerobic and Cognitive Exercise Study (ACES) sought to replicate and extend prior findings of added cognitive benefit from exergaming to those with or at risk for mild cognitive impairment (MCI). ACES compares the effects of 6 months of an exer-tour (virtual reality bike rides) with the effects of a more effortful exer-score (pedaling through a videogame to score points). Fourteen community-dwelling older adults meeting screening criteria for MCI (sMCI) were adherent to their assigned exercise for 6 months. The primary outcome was executive function, while secondary outcomes included memory and everyday cognitive function. Exer-tour and exer-score yielded significant moderate effects on executive function (Stroop A/C; d's = 0.51 and 0.47); there was no significant interaction effect. However, after 3 months the exer-tour revealed a significant and moderate effect, while exer-score showed little impact, as did a game-only condition. Both exer-tour and exer-score conditions also resulted in significant improvements in verbal memory. Effects appear to generalize to self-reported everyday cognitive function. Pilot data, including salivary biomarkers and structural MRI, were gathered at baseline and 6 months; exercise dose was associated with increased BDNF as well as increased gray matter volume in the PFC and ACC. Improvement in memory was associated with an increase in the DLPFC. Improved executive function was associated with increased expression of exosomal miRNA-9. Interactive physical and cognitive exercise (both high and low mental challenge) yielded similarly significant cognitive benefit for adherent sMCI exercisers over 6 months. A larger RCT is needed to confirm these findings. Further innovation and clinical trial data are needed to develop accessible, yet engaging and effective interventions to combat cognitive decline for the growing MCI population.ClinicalTrials.gov ID: NCT0223756