Virtual Exercise Gaming & Cognition

Interventions are needed to address dementia and cognitive decline. A developing body of literature suggests that physical exercise might prevent, delay, or reduce the symptoms of dementia, possibly by improving neural networks in the brain that might result from exercise. Research might soon be able to add these benefits to the list of already established exercise outcomes like cardiovascular benefits and reduced falls risk.

At the same time, exercise and general physical activity rates are low among older adults in the United States. There is a need for interventions that increase people’s motivation to exercise. “Exergames,” or exercise that is enhanced by virtual reality game interfaces, have been an increasingly popular way to engage older adults. For example, the Wii™ Fit is being used at many senior centers and CCRCs. These game systems help center the participant’s attention upon engaging aspects of the game such as competition or pleasing visuals.

A recent, randomized clinical trial (RCT) compared an exercise bike exergame—which included a “virtual tour” with visuals and a competitive aspect—with traditional, solitary stationary bike use. The researchers hypothesized that the cycling exergame would lead to improved cognitive function through improved interest in its visuals and gaming functions. The researchers recruited individuals in eight independent living facilities in the United States. Facilities were each similar in size and had sufficient indoor space to set up an exercise bike. In total, 79 participants were enrolled from the eight sites. The sites were randomly assigned either the exergame cycle or a control bike.

Participants were provided one month of familiarization with the equipment, and then asked to ride the bike at least 25 times over the next two months. Each bike recorded the energy output of the user. At baseline and at the end of the period, participants were given a measure of cognitive ability; assessed on physiological health measures such as body composition and muscle strength; and had plasma samples drawn for the presence of brain-derived neurotrophic factor (BDNF).[1]

Participants in the exergame groups had better cognitive function after three months than those who used the traditional bike. The effect of exercise was larger in this study than in most previous research. Interestingly, the effort used in exercise and improvements in physical fitness was not associated with the cognitive difference, so it is unclear why those on the exergame bike received more benefit. The authors of the article speculate that this may be due to the added mental stimulation provided by the exergame. There was a significantly greater increase in BDNF in the exergame participants, which has been found by previous research to increase after cognitive training.

The authors acknowledge some limitations to their study, such as the fact that the two groups were unequal on age and education level (participants in the control group were slightly older, on average, though with a higher average level of education), and that participants in both had a relatively high level of education compared to the general population. Further, because the group (study or control) assignment was done by site, it is possible that some of the differences between the groups resulted from different site conditions. Still, this study is noteworthy as the first RCT to compare traditional exercise with a virtual reality-based exercise among older adults.


Anderson-Hanley C, Arciero PJ, Brickman AM, et al (2012). Exergaming and Older Adult Cognition: A Cluster Randomized Clinical Trial. American Journal of Preventive Medicine 42(2):109-119.


[1] BDNF is a protein that helps maintain neurons and which is used in the development of new neurons.


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