The Effect of Application-Based Exergames on Cognitive Function in Hemodialysis Patients

Authors

  • Achmad Fauzi STIKes Abdi Nusantara, Jakarta
  • Linlin Lindayani STIKep PPNI Jawa Barat
  • Astri Mutiar STIKep PPNI Jawa Barat
  • Irma Darmawati Universitas Pendidikan Indonesia

DOI:

https://doi.org/10.33755/jkk.v10i5.756

Keywords:

Mobile Application, Exergames, Cognitive Function, Hemodialysis

Abstract

Aims: Hemodialysis (HD) patients may disrupt physical and cognitive capabilities, affecting older mobility, independence, psychological well-being, and health care expenditures. Home-based exergame training overcomes accessibility issues.

Methods: This research examined how mobile app exergames affected cognitive performance in hemodialysis patients. This research used a repeated measurement-quasi-experiment two-group pretest-posttest design in a West Java. The intervention group trained three times a week for 30-40 minutes for two months, totaling 24 sessions (8 weeks). In the control group, participants were told to live normally.

Results: Inlcusion criteria was performing HD at least twice a week,  age > 65, living independently, self-reported health, ability to stand for 10 minutes without help, and access to a TV with HDMI connection. The Trail Making Test (TMT) measured psychomotor speed and executive function. ANCOVA was used to compare scores before and after the intervention in both groups.  The repeated ANOVA test revealed that the trial making test A (TMT A) decreased significantly in the intervention group after one month intervention (T2) (from 79.77 ± 7.23 at baseline to 40.87 ± 5.33 at follow up), with the effect size was 0.41, indicating moderate effect size.  The trial making test B (TMT B) decreased significantly in the intervention group after one month intervention (T2) (from 77.6 ± 24.2 at baseline to 70.32 ± 23.3 at follow up), with the effect size was 0.45, indicating moderate effect size. However, there was not significant change of Trial making Test A and B from baseline to follow up time in the control group.

Conclusions: Findings of this study could be one of the new solutions to help patients undergoing hemodialysis improve their cognitive function. Exergame training may be done at home, which helps to overcome accessibility constraints.

References

(Crocker T, Young J, Forster A, Brown L, Ozer S, Greenwood DC. The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis. Age Ageing. 2013 Nov;42(6):682–8. doi: 10.1016/j.cger.2013.07.002

Departemen kesehatan RI. Profil Kesehatan Indonesia (Internet).Indonesia:Depkes RI;2018 (cited 2024 Mar 10). Available from: http://wwwdepkes.go.id

Harada CN, Natelson Love MC, Triebel KL. Normal cognitive aging. Clin Geriatr Med. 2013 Nov;29(4):737–52. doi:10.1515/REVNEURO.2010.21.3.187

Fjell AM, Walhovd KB. Structural brain changes in aging: Courses, causes and cognitive consequences. Rev Neurosci. 2010 Jan;21(3). doi: 10.1093/ageing/aft133

Reuter-Lorenz PA, Cooke KA. Neuropsychology of aging, past, present and future: Contributions of Morris Moscovitch. Neuropsychologia. 2016 Sep;90:117–24. doi: 10.1016/j.neuropsychologia.2016.06.018

Hertzog C, Kramer AF, Wilson RS, Lindenberger U. Enrichment effects on adult cognitive development. Psychological Science in the Public Interest. 2008 Oct 1;9(1):1–65. doi: 10.1111/j.1539-6053.2009.01034.x

Chen P, Cai H, Bai W, Su Z, Tang YL, Ungvari GS, et al. Global prevalence of mild cognitive impairment among older adults living in nursing homes: a meta-analysis and systematic review of epidemiological surveys. Transl Psychiatry. 2023 Mar 11;13(1):88. doi: 10.1038/s41398-023-02361-1

Cordes T, Bischoff LL, Schoene D, Schott N, Voelcker-Rehage C, Meixner C, et al. A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: A study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project. BMC Geriatr. 2019 Dec 23;19(1):369. doi: 10.1186/s12877-019-1386-6

Maryati H, Bhakti DS, Dwiningtyas M. Gambaran fungsi kognitif pada lansia di UPT Panti Werdha Mojokerto. Jurn Metabolisme. 2013 Apr;2(2).

Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report. J Am Geriatr Soc. 2004 Apr 30;52(4):625–34. doi: 10.1111/j.1532-5415.2004.52174.x.

Pascual-Leone A, Amedi A, Fregni F, Merabet LB. The plastic human brain cortex. Annu Rev Neurosci. 2005 Jul 21;28(1):377–401. doi:10.1146/annurev.neuro.27.070203.144216

Cai L, Chan JSY, Yan JH, Peng K. Brain plasticity and motor practice in cognitive aging. Front Aging Neurosci. 2014 Mar 10;6. doi:10.3389/fnagi.2014.00031

Warburton DER. Health benefits of physical activity: the evidence. Can Med Assoc J. 2006 Mar 14;174(6):801–9. doi:10.1503/cmaj.051351

Chang YK, Pan CY, Chen FT, Tsai CL, Huang CC. Effect of resistance-exercise training on cognitive function in healthy older adults: A review. J Aging Phys Act. 2012 Oct;20(4):497–517. doi: 10.1123/japa.20.4.497

Netz Y, Wu MJ, Becker BJ, Tenenbaum G. Physical activity and psychological well-being in advanced age: meta-analysis of intervention studies. Psychol Aging. 2005;20(2):272–84. doi:A 10.1037/0882-7974.20.2.272

Kramer AF, Colcombe S. Fitness effects on the cognitive function of older adults: a meta-analytic study—revisited. Perspectives on Psychological Science. 2018 Mar 29;13(2):213–7. doi: 10.1177/1745691617707316

Best JR, Chiu BK, Liang Hsu C, Nagamatsu LS, Liu-Ambrose T. Long-term effects of resistance exercise training on cognition and brain volume in older women: Results from a randomized controlled trial. Journal of the International Neuropsychological Society. 2015 Nov 19;21(10):745–56. doi: 10.1017/S1355617715000673

Lista I, Sorrentino G. Biological mechanisms of physical activity in preventing cognitive decline. Cell Mol Neurobiol. 2010 May 30;30(4):493–503. doi: 10.1007/s10571-009-9488-x

Knaepen K, Goekint M, Heyman EM, Meeusen R. Neuroplasticity – exercise-induced response of peripheral brain-derived neurotrophic factor. Sports Medicine. 2010 Sep;40(9):765–801. doi: 10.2165/11534530-000000000-00000

Pereira AC, Huddleston DE, Brickman AM, Sosunov AA, Hen R, McKhann GM, et al. An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proceedings of the National Academy of Sciences. 2007 Mar 27;104(13):5638–43. doi: 10.1073/pnas.0611721104

Bediou B, Adams DM, Mayer RE, Tipton E, Green CS, Bavelier D. Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills. Psychol Bull. 2018 Jan;144(1):77–110. doi: 10.1037/bul0000130

Nguyen L, Murphy K, Andrews G. Cognitive and neural plasticity in old age: A systematic review of evidence from executive functions cognitive training. Ageing Res Rev. 2019 Aug;53:100912. doi: 10.1016/j.arr.2019.100912

Reijnders J, van Heugten C, van Boxtel M. Cognitive interventions in healthy older adults and people with mild cognitive impairment: A systematic review. Ageing Res Rev. 2013 Jan;12(1):263–75. doi: 10.1016/j.arr.2012.07.003

Korol DL, Gold PE, Scavuzzo CJ. Use it and boost it with physical and mental activity. Hippocampus. 2013 Nov 25;23(11):1125–35. doi: 10.1002/hipo.22197

Benzing V, Schmidt M. Exergaming for children and adolescents: Strengths, weaknesses, opportunities and threats. J Clin Med. 2018 Nov 8;7(11):422. doi: 10.3390/jcm7110422

Pirovano M, Surer E, Mainetti R, Lanzi PL, Alberto Borghese N. Exergaming and rehabilitation: A methodology for the design of effective and safe therapeutic exergames. Entertain Comput. 2016 May;14:55–65. doi: 10.1016/j.entcom.2015.10.002

Schutzer K. Barriers and motivations to exercise in older adults. Prev Med (Baltim). 2004 Nov;39(5):1056–61. doi: 10.1016/j.ypmed.2004.04.003

Stanmore E, Stubbs B, Vancampfort D, de Bruin ED, Firth J. The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials. Neurosci Biobehav Rev. 2017 Jul;78:34–43. doi: 10.1016/j.neubiorev.2017.04.011

Stojan R, Voelcker-Rehage C. A systematic review on the cognitive benefits and neurophysiological correlates of exergaming in healthy older adults. J Clin Med. 2019 May 23;8(5):734. doi: 10.3390/jcm8050734

Kappen DL, Mirza-Babaei P, Nacke LE. Older adults’ physical activity and exergames: A systematic review. Int J Hum Comput Interact. 2019 Jan 20;35(2):140–67. doi: 10.1080/10447318.2018.1441253

Ji L, Zhang H, Potter GG, Zang YF, Steffens DC, Guo H, et al. Multiple neuroimaging measures for examining exercise-induced neuroplasticity in older adults: A quasi-experimental study. Front Aging Neurosci. 2017 Apr 20;9. doi: 10.3389/fnagi.2017.00102

Anderson-Hanley C, Barcelos NM, Zimmerman EA, Gillen RW, Dunnam M, Cohen BD, et al. 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. Front Aging Neurosci. 2018 May 4;10. doi: 10.3389/fnagi.2018.00076

Anderson-Hanley C, Arciero PJ, Brickman AM, Nimon JP, Okuma N, Westen SC, et al. Exergaming and older adult cognition. Am J Prev Med. 2012 Feb;42(2):109–19. doi: 10.1016/j.amepre.2011.10.016

Gschwind YJ, Eichberg S, Ejupi A, de Rosario H, Kroll M, Marston HR, et al. ICT-based system to predict and prevent falls (iStoppFalls): Results from an international multicenter randomized controlled trial. European Review of Aging and Physical Activity. 2015 Dec 27;12(1):10. doi: 10.1186/s11556-015-0155-6

Ogawa EF, You T, Leveille SG. Potential benefits of exergaming for cognition and dual-task function in older adults: A systematic review. J Aging Phys Act. 2016 Apr;24(2):332–6. doi: 10.1123/japa.2014-0267

Rehfeld K, Lüders A, Hökelmann A, Lessmann V, Kaufmann J, Brigadski T, et al. Dance training is superior to repetitive physical exercise in inducing brain plasticity in the elderly. PLoS One. 2018 Jul 11;13(7):e0196636. doi: 10.1371/journal.pone.0196636

Cassilhas RC, Viana Var, Grassmann V, Santos RT, Santos RF, Tufik S, et al. The Impact of resistance exercise on the cognitive function of the elderly. Med Sci Sports Exerc. 2007 Aug;39(8):1401–7. doi: 10.1249/mss.0b013e318060111f

Howes SC, Charles DK, Marley J, Pedlow K, McDonough SM. Gaming for health: Systematic review and meta-analysis of the physical and cognitive effects of active computer gaming in older adults. Phys Ther. 2017 Dec 1;97(12):1122–37. doi: 10.1093/ptj/pzx088

Schättin A, Arner R, Gennaro F, de Bruin ED. Adaptations of prefrontal brain activity, executive functions, and gait in healthy elderly following exergame and balance training: A randomized-controlled study. Front Aging Neurosci. 2016 Nov 23;8. doi: 10.3389/fnagi.2016.00278

Beurskens R, Bock O. Age-related deficits of dual-task walking: A review. Neural Plast. 2012;2012:1–9. doi: 10.1155/2012/131608

Adcock M, Thalmann M, Schättin A, Gennaro F, de Bruin ED. A pilot study of an in-home multicomponent exergame training for older adults: Feasibility, usability and pre-post evaluation. Front Aging Neurosci. 2019 Nov 22;11. doi: 10.3389/fnagi.2019.00304

Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc. 2011 Jan;59(1):148–57. doi: 10.1111/j.1532-5415.2010.03234.x

Brach M, Hauer K, Rotter L, Werres C, Korn O, Konrad R, et al. Modern principles of training in exergames for sedentary seniors: requirements and approaches for sport and exercise sciences. Int J Comput Sci Sport. 2011 Nov:86–99. 10.13140/RG.2.1.3762.2647

Hesseberg K, Bentzen H, Bergland A. Reliability of the senior fitness test in community‐dwelling older people with cognitive impairment. Physiotherapy Research International. 2015 Mar 13;20(1):37–44. doi: 10.1002/pri.1594

Bowie CR, Harvey PD. Administration and interpretation of the Trail Making Test. Nat Protoc. 2006 Dec 21;1(5):2277–81. doi: 10.1038/nprot.2006.390)

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Published

2024-10-31

How to Cite

Fauzi, A., Lindayani, L. ., Mutiar, A. ., & Darmawati, I. . (2024). The Effect of Application-Based Exergames on Cognitive Function in Hemodialysis Patients. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 10(5), 651–660. https://doi.org/10.33755/jkk.v10i5.756