Exergaming Improves Executive Functions in Patients With Metabolic Syndrome

Introduction In recent years, the relationship between cognitive function and metabolic syndrome has been widely studied. Metabolic syndrome (MetS) has been shown to be associated with a decline in executive function due to multiple risk factors, including hypertension, dyslipidemia, impaired glucose homeostasis, and abdominal obesity. Executive functions include basic cognitive processes such as attentional control, cognitive inhibition, inhibitory control, working memory, and cognitive flexibility.

Cognitive neuroscience is using Stroop tasks to measure selective attention capacity and skills, as well as processing speed ability, indicating executive functions. Electroencephalographic (EEG) activity using event-related positioning technology P300 and N200 has been widely used to measure selective attention capacity and skills, and a behavioral performance such as reaction time (RT) is commonly used to measure processing speed ability. N200 negativity (200~350 ms post-stimulus) is an event-related potential (ERP), which indicates attentional capacity that is usually induced before motion response control and is related to the cognitive processes of stimulus recognition and differentiation. P300 positivity (300~600 ms post-stimulus) is another ERP, reflecting memory-related neural processing that is involved in categorizing incoming information and updating the context of the working memory (e.g., encoding, rehearsal, recognition, and retrieval).

It is well known that aerobic exercise training provides various beneficial clinical outcomes in metabolic disease patients. Its effects on cognitive function, especially executive function, also have been reported. Furthermore, recent studies reported that both aerobic and resistance exercise training facilitate overall electrophysiological effects (e.g., increased ERP P300 amplitudes) and behavior index (e.g., faster RT) in healthy elderly people. In addition, aerobic exercise has also been reported to improve cognitive processes in cortical cognitive control (P300 amplitude) in studies of chronic stroke patients.

Recently, exergaming (a combination of "exercise" and "gaming") has attracted much attention as a novel exercise method to improve cognitive function because it utilizes video games that require body movements while simultaneously presenting the user with a cognitively challenging environment. Along with its popular usage for leisure and entertainment, there is a growing interest in the application of exergaming to improve clinical outcomes. Recent studies using exergaming showed beneficial effects on cognitive and dual-task functions, which reduced falls in older adults as well as cardiovascular disease risks such as body fat, serum adipokine levels, and lipid profiles. Exergaming also promoted executive functions and cognitive processing speed in elderly and children. This growing evidence suggests that exergaming's have the benefit of improving cognitive and physical functions.

Although many previous studies have reported improvements in cognitive function following exergaming, it is not clear whether this benefit is due to an exercise effect or video game effect. In addition, all of these studies measured RT, instead of ERP using EEG, which limits to illuminate brain activities. Considering that EEG can measure electrical activities in various cortex areas in the brain, it is necessary to investigate ERP using EEG to evaluate executive function. Therefore, we examined the benefits of exergaming compared to normal exercise and investigated executive function by measuring RT as well as N200 and P300 in three cortex areas during Stroop tasks in patients with MetS.