Key messages
• Playing video games that involve physical activity ('exergaming') may help people with dementia and mild cognitive impairment to improve thinking skills such as learning and remembering items, but we are not totally sure about it.
• There is little evidence at present to suggest exergaming might help improve the ability of people with dementia and mild cognitive impairment to walk, keep their balance, or handle daily tasks like paying bills or going shopping.
What are dementia and mild cognitive impairment?
Dementia is a condition where the brain changes in a way that affects a person's memory, thinking, and ability to perform daily tasks. It can make it hard for someone to remember things, plan, focus, or communicate. These changes usually get worse over time and can eventually interfere with everyday life.
Mild cognitive impairment means having some trouble with memory and thinking, but not as much as someone with dementia. However, it could lead to dementia later on. Even though people with mild cognitive impairment might struggle with remembering things or thinking clearly, they can still handle everyday tasks like paying bills, going shopping, and keeping their home clean. Essentially, it is like having some memory and thinking difficulties that are not as severe as dementia, but could possibly get worse over time.
What is exergaming?
Currently, there are not many treatments that can slow down diseases like dementia. But we do know that staying active, both physically and mentally, throughout life can lower the risk of getting dementia. Some experts think that encouraging people to stay active in both these ways might help lessen dementia symptoms and the effects of mild cognitive impairment. With new technology, we can now use virtual reality and interactive games, called exergames, to provide physical and mental training. Exergames are seen as a good option because they are relatively easy for older adults to use at home, and they can boost motivation.
What did we want to find out?
We wanted to know whether playing exergames is more effective than no active treatment or conventional treatments, for improving physical abilities, thinking skills, and the ability to complete daily tasks, in individuals with dementia and mild cognitive impairment.
We also wanted to check if playing exergames has any side effects.
What did we do?
We searched through medical research to find studies that compared people who received an exergaming intervention with people who took part in other treatments. In some cases, people using exergaming were compared with people who did not get any special treatment (e.g. they just relaxed), or got treatments that studies have shown to have a positive effect, like aerobic exercise or brain training. We added the results of the studies together where possible, and we judged the quality of these studies, based on factors such as what methods were used and how many people with mild cognitive impairment or dementia were tested.
What did we find?
We found 11 studies. They were published between 2014 and 2023. Seven studies involved 308 people with mild cognitive impairment, and five studies involved 228 participants with dementia. One of the studies involved people with mild cognitive impairment and people with dementia.
We found that playing exergames might help improve thinking skills for people with dementia and mild cognitive impairment when compared to people that received usual care or interventions that were not very active, but not when compared to people receiving active treatments that we know have an effect.
We did not find that playing exergames improved physical abilities, such as walking or balancing, or the ability to do normal daily activities, such as shopping, for people with dementia and mild cognitive impairment.
In general, it appears that engaging in exergames may be safe for individuals with dementia and mild cognitive impairment when carried out in a controlled and supervised environment with help from healthcare professionals. We have no evidence about the safety of exergaming for people with dementia or MCI in a home environment without supervision.
What are the limitations of the evidence?
We looked at how well these studies were carried out, and we found that there were some problems with them. This means we need to be careful when interpreting the results mentioned above. One reason for this is that the studies did not include many participants.
How up to date is this evidence?
The evidence is up to date to 22 December 2023.
Overall, the evidence is very uncertain about the effects of exergaming on global physical and cognitive functioning, and ADL. There may be an improvement in global cognitive functioning at the end of treatment for both people with dementia and people with MCI, but the evidence is very uncertain. The potential benefit is observed only when exergaming is compared with a control intervention (e.g. usual care, listening to music, health education), and not when compared with an alternative treatment with a specific effect, such as physical activity (e.g. standing and sitting exercises or cycling).
The evidence is very uncertain about the effects of exergaming on adverse effects. All sessions took place in a controlled and supervised environment. Therefore, we do not know if exergaming can be safely used in a home environment, unsupervised.
Dementia and mild cognitive impairment are significant contributors to disability and dependency in older adults. Current treatments for managing these conditions are limited. Exergaming, a novel technology-driven intervention combining physical exercise with cognitive tasks, is a potential therapeutic approach.
To assess the effects of exergaming interventions on physical and cognitive outcomes, and activities of daily living, in people with dementia and mild cognitive impairment.
On 22 December 2023, we searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov, and the WHO (World Health Organization) meta-register the International Clinical Trials Registry Portal.
We included randomised controlled trials (RCTs) that recruited individuals diagnosed with dementia or mild cognitive impairment (MCI). Exergaming interventions involved participants being engaged in physical activity of at least moderate intensity, and used immersive and non-immersive virtual reality (VR) technology and real-time interaction. We planned to classify comparators as inactive control group (e.g. no treatment, waiting list), active control group (e.g. standard treatment, non-specific active control), or alternative treatment (e.g. physical activity, computerised cognitive training). Outcomes were to be measured using validated instruments.
Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias using the Cochrane risk of bias tool RoB 2, and assessed the certainty of the evidence using GRADE. We consulted a third author if required. Where possible, we pooled outcome data using a fixed-effect or random-effects model. We expressed treatment effects as standardised mean differences (SMDs) for continuous outcomes and as risk ratios (RRs) for dichotomous outcomes, along with 95% confidence intervals (CIs). When data could not be pooled, we presented a narrative synthesis.
We included 11 studies published between 2014 and 2023. Six of these studies were pre-registered. Seven studies involved 308 participants with mild cognitive impairment, and five studies included 228 individuals with dementia. One of the studies presented data for both MCI and dementia separately. Most comparisons exhibited a high risk or some concerns of bias. We have only low or very low certainty about all the results presented below.
Effects of exergaming interventions for people with dementia
Compared to a control group
Exergaming may improve global cognitive functioning at the end of treatment, but the evidence is very uncertain (SMD 1.47, 95% 1.04 to 1.90; 2 studies, 113 participants). The evidence is very uncertain about the effects of exergaming at the end of treatment on global physical functioning (SMD −0.20, 95% −0.57 to 0.17; 2 studies, 113 participants) or activities of daily living (ADL) (SMD −0.28, 95% −0.65 to 0.09; 2 studies, 113 participants).
The evidence is very uncertain about adverse effects due to the small sample size and no events. Findings are based on two studies (113 participants), but data could not be pooled; both studies reported no adverse reactions linked to the intervention or control group.
Compared to an alternative treatment group
At the end of treatment, the evidence is very uncertain about the effects of exergaming on global physical functioning (SMD 0.14, 95% −0.30 to 0.58; 2 studies, 85 participants) or global cognitive functioning (SMD 0.11, 95% −0.33 to 0.55; 2 studies, 85 participants). For ADL, only one study was available (n = 67), which provided low-certainty evidence of little to no difference between exergaming and exercise.
The evidence is very uncertain about adverse effects of exergaming compared with alternative treatment (RR 7.50, 95% CI 0.41 to 136.52; 2 studies, 2/85 participants).
Effects of exergaming interventions for people with mild cognitive impairment (MCI)
Compared to a control group
Exergaming may improve global cognitive functioning at the end of treatment for people with MCI, but the evidence is very uncertain, (SMD 0.79, 95% 0.05 to 1.53; 2 studies, 34 participants). The evidence is very uncertain about the effects of exergaming at the end of treatment on global physical functioning (SMD 0.27, 95% −0.41 to 0.94; 2 studies, 34 participants) and ADL (SMD 0.51, 95% −0.01 to 1.03; 2 studies, 60 participants).
The evidence is very uncertain about the effects of exergaming on adverse effects due to a small sample size and no events (0/14 participants). Findings are based on one study.
Compared to an alternative treatment group
The evidence is very uncertain about global physical functioning at the end of treatment. Only one study was included (n = 45). For global cognitive functioning, we included four studies (n = 235 participants), but due to considerable heterogeneity (I² = 96%), we could not pool results. The evidence is very uncertain about the effects of exergaming on global cognitive functioning. No study evaluated ADL outcomes.
The evidence is very uncertain about adverse effects of exergaming due to the small sample size and no events (n = 123 participants). Findings are based on one study.