Attention, Cognitive Training, Executive Functions (EF), Healthy Adults, Xbox-based Exergames
Conditions
Keywords
Attention, Cognitive training, Executive functions, Healthy adults, Xbox-based exergames
Brief summary
Background: Exergames are increasingly used to support cognition in older adults; however, evidence comparing exergames with non-computerized cognitive training in healthy adults remains limited. Objective: This randomized controlled trial aimed to compare the effects of Xbox-based exergames and structured home-based cognitive training on attention and executive functions in healthy adults. Methods: Twenty healthy adults aged ≥50 years were randomly allocated to either an Xbox-based exergames group (n=10) or a structured home-based cognitive training group (n=10). Both groups received 12 sessions twice weekly. Before and after the intervention, participants were assessed using the Standardized Mini-Mental State Examination, d2 Test of Attention, Stroop Test, WMS-R Digit Span Test, Trail Making Test, and Benton Judgment of Line Orientation Test.
Interventions
BEHAVIORALXbox-based exergames intervention
The intervention was delivered using the Microsoft Xbox 360 Kinect™ as a non-VR exergaming platform. The Kinect system detects and tracks participants' body movements in real time without requiring a handheld controller. Exergames were selected by the researchers (DT, HA, and MK) based on their cognitive demands and relevance to the targeted cognitive functions. The selected games were incorporated into a predetermined intervention session plan. Before the intervention, each game was demonstrated once to familiarize participants with the gameplay and required movements. All games started at a basic level, and progression to advanced levels was determined by the therapists according to each participant's performance. Game levels and repetition numbers were individually adjusted to ensure appropriate progression throughout the intervention. The Xbox-based exergames group received 12 sessions twice weekly.
BEHAVIORALStructured home-based cognitive training
The structured home-based cognitive training program consisted of tasks specifically designed to improve different cognitive skills. The program included cognitive activities such as mathematical sequences, identifying differences between two pictures, finding missing objects, pattern completion, Sudoku, and maze completion. Taken together, these tasks provided a comprehensive and individualized program aimed at strengthening fundamental cognitive skills such as attention, EFs, spatial orientation, and visuomotor coordination. The cognitive tasks included in the structured home-based cognitive training program and their targeted parameters were specified, and the activities were explained to the participants once before implementation. The cognitive tasks and homework assignments were planned and adjusted based on the participants' initial assessment findings and in accordance with their individual performance capacities. This groups also received 12 sessions twice weekly.
Sponsors
Medipol University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Being 50 years of age or older * Obtaining a score of 24-30 on the Standardized Mini-Mental State Examination (SMMSE)
Exclusion criteria
* A Geriatric Depression Scale (GDS) score ≥9 * A Berg Balance Scale (BBS) score ≤40 * A history of head trauma * A diagnosis of a psychiatric or neurodegenerative disorder * A history of alcohol dependence * The presence of any physical illness
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Standardized Mini-Mental State Examination (SMMSE) | Baseline and 1 week after completion of the 12-session intervention | The SMMSE is a brief 30-item cognitive screening tool that assesses attention, memory, orientation, language, and visuospatial abilities. The Turkish validity and reliability of the Standardized Mini-Mental State Examination (SMMSE) were established by Güngen et al. (2002). In the Turkish version, a cutoff score of 23/24 has been established for dementia. |
| d2 Test of Attention | Baseline and 1 week after completion of the 12-session intervention | The d2 Test assesses sustained and selective attention, visual scanning, and mental concentration. The d2 Test of Attention consists of 14 rows, each containing 47 characters/items. Each row includes lowercase "p" and "d" letters accompanied by one to four marks positioned above or below the letters. Participants are required to identify and mark the letter "d" accompanied by two marks within a time limit of 20 seconds for each row. Scoring is based on the total number of items processed (TN), errors of omission (E1), errors of commission (E2), and concentration performance (CP). Higher TN and CP scores indicate better attentional performance, whereas higher E1 and E2 scores indicate a greater number of errors. |
| Stroop Test | Baseline and 1 week after completion of the 12-session intervention | The Stroop Test is a neuropsychological measure of selective attention, inhibitory control, processing speed, and cognitive flexibility. The Stroop Test Çapa Version consists of three parts: Stroop A, in which participants name the colors of colored rectangles; Stroop B, in which they read color words printed in incongruent ink colors; and Stroop C, in which they name the ink color while inhibiting the tendency to read the word. Completion time is recorded for each part. In the present study, the Stroop Test Interference Time Difference was calculated by subtracting the completion time of Stroop B from that of Stroop C. The Turkish validity and reliability of the Stroop Test Çapa Version were established by Emek-Savaş et al. |
| WMS-R Digit Span Test (DST) | Baseline and 1 week after completion of the 12-session intervention | The Digit Span Subtest of the Wechsler Memory Scale-Revised (WMS-R) assesses attention, short-term memory, and working memory. It consists of Forward and Backward Digit Span conditions, in which participants repeat progressively longer digit sequences in the presented or reverse order, respectively. Each sequence length includes two trials, and the respective condition is discontinued when both trials are answered incorrectly. The Turkish standardization of the WMS-R has been established, and normative data are available for the Digit Span Test in Turkish adults aged 50-83 years. |
| The Trail Making Test (TMT) | Baseline and 1 week after completion of the 12-session intervention | The Trail Making Test (TMT) consists of two parts, TMT-A and TMT-B. TMT-A primarily assesses visual scanning, attention, and processing speed, whereas TMT-B additionally requires cognitive flexibility, set-shifting, working memory, and inhibitory control. The basic scores for TMT-A and TMT-B are completion times in seconds, with longer completion times indicating poorer performance. The Turkish validity and reliability of the Trail Making Test were established. |
| Benton Judgment of Line Orientation Test | Baseline and 1 week after completion of the 12-session intervention | The Benton Judgment of Line Orientation Test was developed by Benton et al. (1978), and its Turkish standardization was conducted within the BİLNOT battery. The Benton Judgment of Line Orientation Test (BJLOT) is a neuropsychological measure of visuospatial perception and spatial orientation. The test assesses the ability to perceive and identify angular relationships between lines and comprises five practice items followed by 30 test items. Each correct response is scored as one point, yielding a maximum score of 30, with higher scores indicating better visuospatial performance. |
Countries
Turkey (Türkiye)
Contacts
STUDY_DIRECTORHalime Avunç, PhD Candidate
Medipol University
PRINCIPAL_INVESTIGATORAyşe Seren Taner, Occupational Therapist
Medipol University
PRINCIPAL_INVESTIGATOREylül Eşin, Occupational Therapist
Medipol University
PRINCIPAL_INVESTIGATORZeynep Demir, Occupational Therapist
Medipol University
STUDY_CHAIRMerve Keskin, PhD Candidate
Medipol University
STUDY_CHAIRDevrim Tarakcı, Prof. Dr.
Medipol University
Outcome results
None listed