Background: Therapeutic virtual reality (VR) has emerged as an effective treatment modality for cognitive and physical training in people with mild cognitive impairment (MCI). However, to replace existing nonpharmaceutical treatment training protocols, VR platforms need significant improvement if they are to appeal to older people with symptoms of cognitive decline and meet their specific needs. Objective: This study aims to design and test the acceptability, usability, and tolerability of an immersive VR platform that allows older people with MCI symptoms to simultaneously practice physical and cognitive skills on a dual task. Methods: On the basis of interviews with 20 older people with MCI symptoms (15 females; mean age 76.25, SD 5.03 years) and inputs from their health care providers (formative study VR1), an interdisciplinary group of experts developed a VR system called VRADA (VR Exercise App for Dementia and Alzheimer’s Patients). Using an identical training protocol, the VRADA system was first tested with a group of 30 university students (16 females; mean age 20.86, SD 1.17 years) and then with 27 older people (19 females; mean age 73.22, SD 9.26 years) who had been diagnosed with MCI (feasibility studies VR2a and VR2b). Those in the latter group attended two Hellenic Association Day Care Centers for Alzheimer’s Disease and Related Disorders. Participants in both groups were asked to perform a dual task training protocol that combined physical and cognitive exercises in two different training conditions. In condition A, participants performed a cycling task in a lab environment while being asked by the researcher to perform oral math calculations (single-digit additions and subtractions). In condition B, participants performed a cycling task in the virtual environment while performing calculations that appeared within the VR app. Participants in both groups were assessed in the same way; this included questionnaires and semistructured interviews immediately after the experiment to capture perceptions of acceptability, usability, and tolerability, and to determine which of the two training conditions each participant preferred. Results: Participants in both groups showed a significant preference for the VR condition (students: mean 0.66, SD 0.41, t29=8.74, P<.001; patients with MCI: mean 0.72, SD 0.51, t26=7.36, P<.001), as well as high acceptance scores for intended future use, attitude toward VR training, and enjoyment. System usability scale scores (82.66 for the students and 77.96 for the older group) were well above the acceptability threshold (75/100). The perceived adverse effects were minimal, indicating a satisfactory tolerability. Conclusions: The findings suggest that VRADA is an acceptable, usable, and tolerable system for physical and cognitive training of older people with MCI and university students. Randomized controlled trial studies are needed to assess the efficacy of VRADA as a tool to promote physical and cognitive health in patients with MCI.

This study examined the effects of a physical education intervention consisting of cognitively challenging physical activity games on school children’s executive functions and motivational regulations. Ninety-nine fourth- and fifth-grade children participated in this two-group, repeated measures, quasi-experimental study with a cross-over design. Children’s executive functions (measured with the design fluency and Stroop and flanker tests) and motivational regulations were measured pre- and post-intervention and one month later. At post-test, the experimental group children outperformed the waiting-list control group children in all design fluency test conditions and accuracy in the Stroop and flanker tests. Both groups improved from pre- to post-intervention their speed (reaction time) in the Stroop and flanker tests. The waiting-list control group children, after receiving the intervention, improved their performance in the executive function tests except for Stroop test accuracy and flanker test speed. The positive effects were reduced significantly one month after the end of the intervention but remained significantly higher compared to pre-intervention. No intervention effects were found for the motivational regulations. These results showed that the intervention had positive effects on children’s executive functions and supported the new shift of designing physical activity programs for developing combinedly children’s physical and cognitive development.

This study compared cognitively challenging physical activity games and health-related fitness activities in terms of their effects on students’ executive functions and situational interest in physical education. A total of 102 fourth- and fifth-grade students (56 boys, 46 girls) participated in this study. A group-randomized controlled trial design involving an acute experiment was used. Two intact classes of students (one fourth-grade and one fifth-grade) were randomly assigned to each one of the three groups. Students in Group 1 participated in cognitively challenging physical activity games, students in Group 2 participated in activities for developing their health-related fitness, and Group 3 students were the control group without physical education. Executive functions were measured pre- and post-intervention with the design fluency test, whereas situational interest was only measured post-intervention with the situational interest scale. Group 1 students who played cognitively challenging physical activity games had increased their executive functions’ scores more than the Group 2 students involved in health-related fitness activities. Students of both these groups outperformed control group students. Moreover, Group 1 students reported higher levels of instant enjoyment and total interest than Group 2 students. The results of this study suggest that cognitively challenging physical activity games can be an effective means for enhancing executive functions, and motivate students to be involved in interesting and enjoyable forms of physical activity.

Virtual reality is a computer-generated simulation of a real or imaginary three-dimensional environment that has entered our lives, particularly for gaming. Lately, it has been permeating into many aspects of our everyday life, such as exercise. It is important to ascertain whether exercise in an immersive virtual reality environment can be accepted from employees and lead to positive outcomes for them. The aim of this exploratory study was to examine the acceptance, future adoption, interest/enjoyment and usability of an immersive virtual reality system for exercise training by office workers during breaks within their working hours. A total of 40 female employees participated in the study with a mean age of 42.58 years (SD 10.77). Participants were requested to complete two sequential 15-min dual task cycling sessions corresponding to two experimental conditions. The first, condition A, involved cycling in a virtual environment, wearing a virtual reality head mounted display, and responding to cognitive tasks by answering multiple choice questions—on a screen, using a joystick. The second, condition B, involved cycling on a static bicycle and simultaneously responding to cognitive tasks by answering multiple choice questions in a real environment. After completion of the two conditions, participants responded to a series of scales regarding each of the experimental conditions and to a semi-structured interview. The results showed that participants noted a significant preference for the immersive virtual reality exercise, condition A, compared to condition B (bike only); and their acceptance, interest/enjoyment, usability and intention for future use were high. The qualitative data showed increased intention for future use, feelings of control and presence and most of the participants did not encounter any difficulties or require extra help to understand the immersive virtual reality system. Overall, exercising during working hours with an immersive virtual reality exercise system was well perceived by office workers and applicable. However, the effects of the immersive virtual reality training system on physical and mental health and the employees’ adherence to the exercise program should be tested with a longer intervention program.