Exergames and Neuropsychological Functions in Older Adults: An Experimental Approach



Digital games that combine physical exercise and cognitive activities, known in the literature as exergames, can improve players’ health and functional capacity. As exergames are becoming popular tools to enhance cognitive functions, we analyzed the neuropsychological performance of older adults who trained with games and others who performed traditional physical activities. We aimed to test if virtual training in multitasking games could result in better performance in brief neuropsychological time and place orientation, attention, memory, language, and arithmetic skills. The sample consisted of 31 independently living older adults. The virtual training group completed interactive activities in multitasking games, whereas the control group engaged in physical activities for aerobic resistance, speed, and balance. The NEUPSILIN Brief Neuropsychological Assessment Battery was used to assess cognitive functions. After 16 weeks of training, the performance of older adults who played games was significantly improved (p < 0.05) for attention, memory, and language. The performance of older adults in the control group was on average significantly improved for memory, language, and praxis (i.e., basic motor skills). This chapter reports on this study, but also reflects on research design and implementation issues considering the challenges and opportunities of experimental approaches and neuropsychological instruments to evaluate the bio-psychosocial impact of using exergames in later life.


Older adults Multitasking game Mental training Cognitive functions Physical exercises NEUPSILIN Brief Neuropsychological Assessment Battery 



This research and chapter were supported by the Coordination and Improvement of Higher Level or Education Personnel (Capes) BEX 2169/13-4 funded by the Brazilian government. The authors would like to thank participants, the recreational center, and the psychologist Mariane Luiza Mattjie for administering the NEUPSILIN Brief Neuropsychological Assessment Battery.


  1. Allaire, J. C., McLaughlin, A. C., Trujillo, A., Whitlock, L. A., LaPorte, L., & Gandy, M. (2013). Successful aging through digital games: Socioemotional differences between older adult gamers and non-gamers. Computers in Human Behavior, 29(4), 1302–1306. Scholar
  2. Anguera, J. A., Boccanfuso, J., Rintoul, J. L., Al-Hashimi, O., Faraji, F., Janowich, J., … Gazzaley, A. (2013). Video game training enhances cognitive control in older adults. Nature, 501(7465), 97–101. Scholar
  3. Buman, M. P., Hekler, E. B., Haskell, W. L., Pruitt, L., Conway, T. L., Cain, K. L., … King, A. C. (2010). Objective light-intensity physical activity associations with rated health in older adults. American Journal of Epidemiology, 172(10), 1155–1165. Scholar
  4. Cai, L., Chan, J. S. Y., Yan, J. H., & Peng, K. (2014). Brain plasticity and motor practice in cognitive aging. Frontiers in Aging Neuroscience, 6(31), 1–12.
  5. Calero-García, M. D., Navarro-González, E., & Muñoz-Manzano, L. (2007). Influence of level of activity on cognitive performance and cognitive plasticity in elderly persons. Archives of Gerontology and Geriatrics, 45(3), 307–318. Scholar
  6. Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., Salem, G. J., et al. (2009). Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise, 41(7), 1510–1530. Scholar
  7. Colcombe, S., & Kramer, A. F. (2003). Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychological Science, 14(2), 125–130. Scholar
  8. Cornwell, E. Y., & Waite, L. J. (2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50(1), 31–48.CrossRefGoogle Scholar
  9. Dai, C.-T., Chang, Y.-K., Huang, C.-J., & Hung, T.-M. (2013). Exercise mode and executive function in older adults: An ERP study of task-switching. Brain and Cognition, 83(2), 153–162. Scholar
  10. Fonseca, R. P., de Salles, J. F., & de Parente, M. A. M. P. (2008). Development and content validity of the Brazilian Brief Neuropsychological Assessment Battery Neupsilin. Psychology and Neuroscience, 1(1), 55–62. Scholar
  11. Fonseca, R. P., de Salles, J. F., & de Parente, M. A. M. P. (2009). NEUPSILIN: Instrumento de Avaliação Neuropsicológica Breve. Vetor Editora (1st ed.). São Paulo: Vetor.Google Scholar
  12. Gerling, K., & Masuch, M. (2011). When gaming is not suitable for everyone: playtesting Wii games with frail elderly. In 1st Workshop on Game Accessibility: Xtreme Interaction Design (FDG 2011), Bordeaux, France. Retrieved from
  13. Guerin, M., Mackintosh, S., & Fryer, C. (2008). Exercise class participation among residents in low-level residential aged care could be enhanced: a qualitative study. The Australian Journal of Physiotherapy, 54(2), 111–117. Scholar
  14. Harvey, P. D. (2012). Clinical applications of neuropsychological assessment. Dialogues in Clinical Neuroscience, 14(1), 91–9. Retrieved from
  15. Hsieh, W., Chen, C., Wang, S., Chen, Y., Hwang, Y., & Lai, J. (2013). Combination of the Kinect with virtual reality in balance training for the elderly. Engineering, 5(10B), 171–175. Scholar
  16. Kimura, K., Yasunaga, A., & Wang, L.-Q. (2013). Correlation between moderate daily physical activity and neurocognitive variability in healthy elderly people. Archives of Gerontology and Geriatrics, 56(1), 109–117. Scholar
  17. Kramer, A. F., Erickson, K. I., & Colcombe, S. J. (2006). Exercise, cognition, and the aging brain. Journal of Applied Physiology, 101(4), 1237–1242. Scholar
  18. Lam, J. W. K., Sit, C. H. P., & McManus, A. M. (2011). Play pattern of seated video game and active “exergame” alternatives. Journal of Exercise Science & Fitness, 9(1), 24–30. Scholar
  19. Microsoft. (2013). Kinect for Windows. Retrieved from
  20. Naqvi, R., Liberman, D., Rosenberg, J., Alston, J., & Straus, S. (2013). Preventing cognitive decline in healthy older adults. Canadian Medical Association Journal, 185(10), 881–885. Scholar
  21. Neves, B. B., Amaro, F., & Fonseca, J. R. S. (2013). Coming of (old) age in the digital age: ICT usage and non-usage among older adults. Sociological Research Online, 18(2), 1–14. Scholar
  22. Neves, B. B., Franz, R., Judges, R., Beermann, C., & Baecker, R. (2017). Can digital technology enhance social connectedness among older adults? A feasibility study. Journal of Applied Gerontology, 0733464817741369.Google Scholar
  23. Neves, B. B., Fonseca, J., Amaro, F., & Pasqualotti, A. (2018). Social capital and Internet use in an age-comparative perspective with a focus on later life.Google Scholar
  24. Neves, B. B., Waycott, J., & Malta, S. (2018). Old and afraid of new communication technologies? Reconceptualising and contesting the ‘age-based digital divide’. Journal of Sociology, 1440783318766119.Google Scholar
  25. Newsom, J. T., & Schulz, R. (1996). Social support as a mediator in the relation between functional status and quality of life in older adults. Psychology and Aging, 11(1), 34–44.CrossRefGoogle Scholar
  26. Nolan, M., Nitz, J., Choy, N. L., & Illing, S. (2010). Age-related changes in musculoskeletal function, balance and mobility measures in men aged 30–80 years. The Aging Male, 13(3), 194–201. Scholar
  27. OECD. (2017). Education at a Glance 2017: OECD indicators. Paris: OECD Publishing. Scholar
  28. Park, N. S. (2009). The relationship of social engagement to psychological well-being of older adults in assisted living facilities. Journal of Applied Gerontology, 28(4), 461–481.CrossRefGoogle Scholar
  29. Park, D. C., & Bischof, G. N. (2013). The aging mind: Neuroplasticity in response to cognitive training. Dialogues in Clinical Neuroscience, 15(1), 109–119. Retrieved from
  30. Pasqualotti, A., Barone, D. A. C., & Doll, J. (2012). Communication, technology and ageing: Elderly, senior citizen groups and interaction process in the information age. Saude e Sociedade, 21(2), 435–445. Scholar
  31. Paula, J. J., Bertola, L., Ávila, R. T., Moreira, L., Coutinho, G., de Moraes, E. N., … Malloy-Diniz, L. F. (2013). Clinical applicability and cutoff values for an unstructured neuropsychological assessment protocol for older adults with low formal education. PloS One, 8(9), e73167. Scholar
  32. Pawlowski, J., Trentini, C. M., & Bandeira, D. R. (2007). Discutindo procedimentos psicométricos a partir da análise de um instrumento de avaliação neuropsicológica breve. Psico-USF, 12(2), 211–219. Retrieved from Scholar
  33. Peng, W., & Hsieh, G. (2012). The influence of competition, cooperation, and player relationship in a motor performance centered computer game. Computers in Human Behavior, 28(6), 2100–2106. Scholar
  34. Robinson, L., Cotten, S. R., Ono, H., Quan-Haase, A., Mesch, G., Chen, W., … Stern, M. J. (2015). Digital inequalities and why they matter. Information, Communication & Society, 18(5), 569–582. Scholar
  35. Schwab, K. (2016). The fourth industrial revolution. Geneva: World Economic Forum.Google Scholar
  36. Sin, H., & Lee, G. (2013). Additional virtual reality training using Xbox Kinect in stroke survivors with hemiplegia. American Journal of Physical Medicine & Rehabilitation, 92(10), 871–880. Scholar
  37. Sinclair, J., Hingston, P., & Masek, M. (2007). Considerations for the design of exergames. In Proceedings of the 5th International Conference on Computer Graphics and Interactive Techniques in Australia and Southeast Asia—GRAPHITE’07 (p. 289). New York, New York, USA: ACM Press.
  38. Singh, M. A. F. (2002). Exercise comes of age: Rationale and recommendations for a geriatric exercise prescription. The Journals of Gerontology Series A, Biological Sciences and Medical Sciences, 57(5), M262–M282. Scholar
  39. Staiano, A. E., Abraham, A. A., & Calvert, S. L. (2013). Adolescent exergame play for weight loss and psychosocial improvement: A controlled physical activity intervention. Pediatric Obesity, 21(3), 598–601. Scholar
  40. Staiano, A. E., & Calvert, S. L. (2011). Exergames for physical education courses: physical, social, and cognitive benefits. Child Development Perspectives, 5(2), 93–98. Scholar
  41. Sun, H. (2013). Impact of exergames on physical activity and motivation in elementary school students: A follow-up study. Journal of Sport and Health Science, 2(3), 138–145. Scholar
  42. Tanaka, K., De Quadros, A. C., Santos, R. F., Stella, F., Gobbi, L. T. B., & Gobbi, S. (2009). Benefits of physical exercise on executive functions in older people with Parkinson’s disease. Brain and Cognition, 69(2), 435–441. Scholar
  43. Tian, Q., Erickson, K. I., Simonsick, E. M., Aizenstein, H. J., Glynn, N. W., Boudreau, R. M., … Rosano, C. (2014). Physical activity predicts microstructural integrity in memory-related networks in very old adults. The Journals of Gerontology. Series A. Biological Sciences and Medical Sciences, 69(3), 1284–1290. Scholar
  44. Valeria Perasso. (2016). Qué es la cuarta revolución industrial (y por qué debería preocuparnos). BBC Mundo. Retrieved from
  45. Vries, N. M., van Ravensberg, C. D., Hobbelen, J. S. M., Olde Rikkert, M. G. M., Staal, J. B., & Nijhuis-van der Sanden, M. W. G. (2012). Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis. Ageing Research Reviews, 11(1), 136–149. Scholar
  46. Wollersheim, D., Merkes, M., Shields, N., Liamputtong, P., Wallis, L., Reynolds, F., & Koh, L. (2010). Physical and psychosocial effects of Wii video game use among older women physical and psychosocial effects of Wii video game use among older women introduction. International Journal of Emerging Technologies and Society, 8(2), 85–98. Retrieved from
  47. Yaffe, K., Barnes, D., Nevitt, M., Lui, L.-Y., & Covinsky, K. (2001). A prospective study of physical activity and cognitive decline in elderly women: women who walk. Archives of Internal Medicine, 161(14), 1703–1708. Scholar
  48. Zhang, S., Grenhart, W. C. M., McLaughlin, A. C., & Allaire, J. C. (2017). Predicting computer proficiency in older adults. Computers in Human Behavior, 67, 106–112. Scholar
  49. Zhao, E., Tranovich, M. J., & Wright, V. J. (2014). The role of mobility as a protective factor of cognitive functioning in aging adults: A review. Sports Health, 6(1), 63–69. Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.University of Passo FundoPasso FundoBrazil
  2. 2.University of LisbonLisbonPortugal
  3. 3.Atlântica UniversityOeirasPortugal
  4. 4.The University of MelbourneMelbourneAustralia

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