Background: Dementia cases may reach 100 million by 2050. Interventions are sought to curb or prevent cognitive decline. Exercise yields... » More

Background: Dementia cases may reach 100 million by 2050. Interventions are sought to curb or

prevent cognitive decline. Exercise yields cognitive benef?ts, but few older adults exercise. Virtual

reality–enhanced exercise or “exergames” may elicit greater participation.

Purpose: To test the following hypotheses: (1) stationary cycling with virtual reality tours (“cybercycle”)

will enhance executive function and clinical status more than traditional exercise; (2) exercise effort will

explain improvement; and (3) brain-derived neurotrophic growth factor (BDNF) will increase.

Design: Multi-site cluster randomized clinical trial (RCT) of the impact of 3 months of cybercycling

versus traditional exercise, on cognitive function in older adults. Data were collected in 2008–2010;

analyses were conducted in 2010–2011.

Setting/participants: 102 older adults from eight retirement communities enrolled; 79 were

randomized and 63 completed.

Interventions: A recumbent stationary ergometer was utilized; virtual reality tours and competitors

were enabled on the cybercycle.

Main outcome measures: Executive function (Color Trails Difference, Stroop C, Digits Backward);

clinical status (mild cognitive impairment; MCI); exercise effort/f?tness; and plasma BDNF.

Results: Intent-to-treat analyses, controlling for age, education, and cluster randomization, revealed

a signif?cant group X time interaction for composite executive function (p
0.002). Cybercycling

yielded a medium effect over traditional exercise (d
0.50). Cybercyclists had a 23% relative

risk reduction in clinical progression to MCI. Exercise effort and f?tness were comparable, suggesting

another underlying mechanism.Asignif?cant groupXtime interaction forBDNF(p
0.05) indicated

enhanced neuroplasticity among cybercyclists.

Conclusions: Cybercycling older adults achieved better cognitive function than traditional exercisers,

for the same effort, suggesting that simultaneous cognitive and physical exercise has greater

potential for preventing cognitive decline.

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