While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Cay Anderson-Hanley, Paul J. Arciero, Adam M. Brickman, Joseph P. Nimon, Naoko Okuma, Sarah C. Westen, Molly E. Merz, Brandt D. Pence, Jeffrey A. Woods, Arthur F. Kramer, and Earl A. Zimmerman are the authors of "Exergaming and Older Adult Cognition," published in the February 2012 issue of the American Journal of Preventive Medicine. This project was funded as part of Health Games Research, a national program of the Robert Wood Johnson Foundation dedicated to funding and supporting research to advance the effectiveness of interactive games for health.
The hope is that all of us, as we age into older adulthood, might benefit from the improvements that science can show us about how to protect ourselves from an insidious cognitive decline."
What was the inspiration for this study—the critical knowledge gap you were trying to fill or the challenge you were trying to address?
With our longevity increasing, and the aging of our Baby Boomer population, there are an estimated 50 million cases of dementia worldwide at this present time—such as that caused by Alzheimer’s. It’s an epidemic that’s been approaching for the last several decades—and it’s really now upon us. And, that figure is expected to roughly double in the next decade.
While scientists continue to search for cures, many have called for interventions that might at least delay onset or progression of the disease. Data out of Johns Hopkins has suggested that even a small delay of one or two years in the onset or diagnosis of dementia could decrease the number of cases by 10 to 20 million per year. One intervention that’s well known for its impact on cognitive function is physical exercise. Yet despite that, fewer than one in 10 older adults exercises at the recommended levels. So the inspiration for this study really came out of that concern about cognitive decline in later life and the need for more kinds of exercise that might motivate older adults to actually engage in it. And, thinking about the possibilities of the spread of exergame technologies, there were some exciting possibilities to think about.
In a nutshell, what were the key findings and why are they significant?
More than 60 older adults completed our trial. They exercised on average about three times a week for a three-month period. About half of the group used a regular stationary bike, and half used this virtual-reality enhanced exergame we called the “cyber cycle,” where they could see themselves traveling down a virtual pathway along a scenic route, past mountains or oceans, and other riders as well—potential competitors that were on the trail.
What we found was that those who were in the exergaming condition experienced greater cognitive benefit than those who were riding the traditional stationary bike. Both groups were comparable in terms of their level of effort and participation. And so, what we really were able to conclude is that there seems to be something special in doing those two things at once on the bike—watching a virtual reality scene unfold and interacting with it as you pedal and steer.
The main cognitive function we focused on is executive function, the domain that encompasses a variety of processes that are very important to staying independent in later life—things like being able to balance our own checkbook or plan out a recipe or safely take care of things in our home. It is one of the areas of decline that will cause people to slide from independent living into institutional living. So, seeing even a small incremental change in executive function was significant, and we think over time could have a meaningful impact in slowing or delaying cognitive decline in older adults.
Who did you most want this research to reach, and what influence did you hope to have?
Ultimately, the hope is that all of us, as we age into older adulthood, might benefit from the improvements that science can show us about how to protect ourselves from an insidious cognitive decline like the type that Alzheimer’s can bring about. That real people would garner some additional motivation, energy, and thoughtfulness in terms of taking the steps to add exercise into their armada for fighting off cognitive decline.
What are a couple examples of uptake and impact you are particularly proud of thus far?
After the study was published, there was this wave of response that we received where different news outlets and clinical communities picked up the news and sought us out to find out more information. There were a variety of popular press reports that covered the academic piece, like Time magazine or Oprah’s magazine, in a different kind of way, making it accessible to a broader population.
We also heard directly from people themselves who were being affected by cognitive decline. We heard from family members who were watching their loved one decline and wanted to try to do something, and were very serious about exercise. And we also had a lot of discussion with clinical practitioners, whether it be general care physicians or neurologists.
In particular, it was really striking to hear so many personal stories of people who, for example, wanted to get their mother an exergaming bike that would perhaps be of help. While we can’t say that this is going to cure or halt anybody’s disease process, we do think there’s some value in adding this to the tools someone might employ to try to slow or impede progress of dementia.
Are there other unexpected audiences who have taken interest, and/or new audiences you did not initially think about who you feel would benefit from this research?
From my point of view, the science still needs to keep going forward. But of course as that happens, I hope it could also help create opportunities to make this technology more affordable and available to the average homeowner, or facilities like a retirement community, where more people can access it.
At present, you can’t go out to your local department store and pick up one of these bikes. At this point you have to be a pretty dedicated consumer to find the kind of equipment that might match what our study implemented. So, ultimately I do also think it is an interesting question to ponder how policy or perhaps marketplace-oriented changes might help influence implementation of these kinds of interventions, so that more people can readily access this kind of technology.
Are there any lessons from this project that will inform your future research, or that you’d share with other researchers who want to maximize the impact and reach of their work?
It takes a tremendous amount of work and effort to accomplish this kind of clinical trial—and yet despite all of the various challenges we faced, it was well worth it. We needed a great deal of persistence to hold the course and ride out the variety of ups and downs that come with this kind of research, at the intersection of people and technology and real-life phenomena. That was a very important lesson.
I will also say that to the degree one can choose a topic they have a passion for and dedication for the cause, that will help drive the perseverance. Every time we faced challenges over the years conducting the study, when we’d go out into the field and sit and talk with our participants, it would reenergize us for the cause—just remembering the real people we were hoping to help, and hearing the stories about their experiences.
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