***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Stepping impairments are associated with physical and cognitive decline in older adults and increased fall risk . Exercise interventions can reduce fall risk , but adherence is often low . A new exergame involving step training may provide an enjoyable exercise alternative for preventing falls in older people . Purpose To assess the feasibility and safety of unsupervised , home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people . Design Single-blinded two-arm r and omized controlled trial comparing step pad training with control ( no-intervention ) . Setting / Participants Thirty-seven older adults residing in independent-living units of a retirement village in Sydney , Australia . Intervention Intervention group ( IG ) participants were provided with a computerized step pad system connected to their TVs and played a step game as often as they liked ( with a recommended dose of 2–3 sessions per week for 15–20 minutes each ) for eight weeks . In addition , IG participants were asked to complete a choice stepping reaction time ( CSRT ) task once each week . Main Outcome Measures CSRT , the Physiological Profile Assessment ( PPA ) , neuropsychological and functional mobility measures were assessed at baseline and eight week follow-up . Results Thirty-two participants completed the study ( 86.5 % ) . IG participants played a median 2.75 sessions/week and no adverse events were reported . Compared to the control group , the IG significantly improved their CSRT ( F31,1 = 18.203 , p<.001 ) , PPA composite scores ( F31,1 = 12.706 , p = 0.001 ) , as well as the postural sway ( F31,1 = 4.226 , p = 0.049 ) and contrast sensitivity ( F31,1 = 4.415 , p = 0.044 ) PPA sub-component scores . In addition , the IG improved significantly in their dual-task ability as assessed by a timed up and go test/verbal fluency task ( F31,1 = 4.226 , p = 0.049 ) . Conclusions Step pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments . Trial Registration Australian New Zeal and Clinical Trials Registry ACTRN12611001081909 Different types of exercise training have the potential to induce structural and functional brain plasticity in the elderly . Thereby , functional brain adaptations were observed during cognitive tasks in functional magnetic resonance imaging studies that correlated with improved cognitive performance . This study aim ed to investigate if exercise training induces functional brain plasticity during challenging treadmill walking and elicits associated changes in cognitive executive functions . Forty-two elderly participants were recruited and r and omly assigned to either interactive cognitive-motor video game dancing ( DANCE ) or balance and stretching training ( BALANCE ) . The 8-week intervention included three sessions of 30 min per week and was completed by 33 participants ( mean age 74.9 ± 6.9 years ) . Prefrontal cortex ( PFC ) activity during preferred and fast walking speed on a treadmill was assessed applying functional near infrared spectroscopy pre- and post-intervention . Additionally , executive functions comprising shifting , inhibition , and working memory were assessed . The results showed that both interventions significantly reduced left and right hemispheric PFC oxygenation during the acceleration of walking ( p < 0.05 or trend , r = 0.25–0.36 ) , while DANCE showed a larger reduction at the end of the 30-s walking task compared to BALANCE in the left PFC [ F(1 , 31 ) = 3.54 , p = 0.035 , r = 0.32 ] . These exercise training induced modulations in PFC oxygenation correlated with improved executive functions ( p < 0.05 or trend , r = 0.31–0.50 ) . The observed reductions in PFC activity may release cognitive re sources to focus attention on other processes while walking , which could be relevant to improve mobility and falls prevention in the elderly . This study provides a deeper underst and ing of the associations  between exercise training , brain function during walking , and cognition in older adults Cognitive control is defined by a set of neural processes that allow us to interact with our complex environment in a goal -directed manner . Humans regularly challenge these control processes when attempting to simultaneously accomplish multiple goals ( multitasking ) , generating interference as the result of fundamental information processing limitations . It is clear that multitasking behaviour has become ubiquitous in today ’s technologically dense world , and substantial evidence has accrued regarding multitasking difficulties and cognitive control deficits in our ageing population . Here we show that multitasking performance , as assessed with a custom- design ed three-dimensional video game ( NeuroRacer ) , exhibits a linear age-related decline from 20 to 79 years of age . By playing an adaptive version of NeuroRacer in multitasking training mode , older adults ( 60 to 85 years old ) reduced multitasking costs compared to both an active control group and a no-contact control group , attaining levels beyond those achieved by untrained 20-year-old participants , with gains persisting for 6 months . Furthermore , age-related deficits in neural signatures of cognitive control , as measured with electroencephalography , were remediated by multitasking training ( enhanced midline frontal theta power and frontal – posterior theta coherence ) . Critically , this training result ed in performance benefits that extended to untrained cognitive control abilities ( enhanced sustained attention and working memory ) , with an increase in midline frontal theta power predicting the training-induced boost in sustained attention and preservation of multitasking improvement 6 months later . These findings highlight the robust plasticity of the prefrontal cognitive control system in the ageing brain , and provide the first evidence , to our knowledge , of how a custom- design ed video game can be used to assess cognitive abilities across the lifespan , evaluate underlying neural mechanisms , and serve as a powerful tool for cognitive enhancement Exergames are videogames that require gross motor activity , thereby combining gaming with physical activity . This study examined the role of competitive versus cooperative exergame play on short-term changes in executive function skills , following a 10-week exergame training intervention .  Fifty-four low-income overweight and obese African American adolescents were r and omly assigned to a competitive exergame condition , a cooperative exergame condition , or a no-play control group . Youths in the competitive exergame condition improved in executive function skills more than did those in the cooperative exergame condition and the no-play control group . Weight loss during the intervention was also significantly positively correlated with improved executive function skills . The findings link competitive exergame play to beneficial cognitive outcomes for at-risk ethnic minority adolescents Aging is usually accompanied with deterioration of physical abilities , such as muscular strength , sensory sensitivity , and functional capacity . Recently , intervention methods with virtual reality have been introduced , providing an enjoyable therapy for elderly . The aim of this study was to investigate whether a 3-D virtual reality kayak program could improve the cognitive function , muscle strength , and balance of community-dwelling elderly . Importantly , kayaking involves most of the upper body musculature and needs the balance control . Seventy-two participants were r and omly allocated into the kayak program group ( n = 36 ) and the control group ( n = 36 ) . The two groups were well matched with respect to general characteristics at baseline . The participants in both groups performed a conventional exercise program for 30 min , and then the 3-D virtual reality kayak program was performed in the kayak program group for 20 min , two times a week for 6 weeks . Cognitive function was measured using the Montreal Cognitive Assessment . Muscle strength was measured using the arm curl and h and grip strength tests . St and ing and sitting balance was measured using the Good Balance system . The post-test was performed in the same manner as the pre-test ; the overall outcomes such as cognitive function ( p < 0.05 ) , muscle strength ( p < 0.05 ) , and balance ( st and ing and sitting balance , p < 0.05 ) were significantly improved in kayak program group compared to the control group . We propose that the 3-D virtual reality kayak program is a promising intervention method for improving the cognitive function , muscle strength , and balance of elderly Background Cognitive impairment is a health problem that concerns almost every second elderly person .  Physical and cognitive training have differential positive effects on cognition , but have been rarely applied in combination . This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults . We hypothesized that simultaneous cognitive – physical components would add training specific cognitive benefits compared to exclusively physical training . Methods Seniors , older than 70 years , without cognitive impairment , were r and omly assigned to either : 1 ) virtual reality video game dancing ( DANCE ) , 2 ) treadmill walking with simultaneous verbal memory training ( MEMORY ) , or 3 ) treadmill walking ( PHYS ) . Each program was complemented with strength and balance exercises . Two 1-hour training sessions per week over 6 months were applied . Cognitive performance was assessed at baseline , after 3 and 6 months , and at 1-year follow-up . Multiple regression analyses with planned comparisons were calculated . Results Eighty-nine participants were r and omized to the three groups initially , 71 completed the training , while 47 were available at 1-year follow-up . Advantages of the simultaneous cognitive – physical programs were found in two dimensions of executive function . “ Shifting attention ” showed a time × intervention interaction in favor of DANCE/MEMORY versus PHYS ( F[2 , 68 ] = 1.95 , trend P=0.075 , r=0.17 ) ; and “ working memory ” showed a time × intervention interaction in favor of DANCE versus MEMORY ( F[1 , 136 ] = 2.71 , trend P=0.051 , R2=0.006 ) . Performance improvements in executive functions , long-term visual memory ( episodic memory ) , and processing speed were maintained at follow-up in all groups . Conclusion Particular executive functions benefit from simultaneous cognitive – physical training compared to exclusively physical multicomponent training . Cognitive – physical training programs may counteract widespread cognitive impairments in the elderly Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The hippocampus shrinks in late adulthood , leading to impaired memory and increased risk for dementia . Hippocampal and medial temporal lobe volumes are larger in higher-fit adults , and physical activity training increases hippocampal perfusion , but the extent to which aerobic exercise training can modify hippocampal volume in late adulthood remains unknown . Here we show , in a r and omized controlled trial with 120 older adults , that aerobic exercise training increases the size of the anterior hippocampus , leading to improvements in spatial memory .  Exercise training increased hippocampal volume by 2 % , effectively reversing age-related loss in volume by 1 to 2 y. We also demonstrate that increased hippocampal volume is associated with greater serum levels of BDNF , a mediator of neurogenesis in the dentate gyrus . Hippocampal volume declined in the control group , but higher preintervention fitness partially attenuated the decline , suggesting that fitness protects against volume loss . Cau date nucleus and thalamus volumes were unaffected by the intervention . These theoretically important findings indicate that aerobic exercise training is effective at reversing hippocampal volume loss in late adulthood , which is accompanied by improved memory function BACKGROUND Age-associated motor and cognitive deficits increase the risk of falls , a major cause of morbidity and mortality . Because of the significant ramifications of falls , many interventions have been proposed , but few have aim ed to prevent falls via an integrated approach targeting both motor and cognitive function . We aim ed to test the hypothesis that an intervention combining treadmill training with non-immersive virtual reality ( VR ) to target both cognitive aspects of safe ambulation and mobility would lead to fewer falls than would treadmill training alone . METHODS We carried out this r and omised controlled trial at five clinical centres across five countries ( Belgium , Israel , Italy , the Netherl and s , and the UK ) . Adults aged 60 - 90 years with a high risk of falls based on a history of two or more falls in the 6 months before the study and with varied motor and cognitive deficits were r and omly assigned by use of computer-based allocation to receive 6 weeks of either treadmill training plus VR or treadmill training alone . R and omisation was stratified by subgroups of patients ( those with a history of idiopathic falls , those with mild cognitive impairment , and those with Parkinson 's disease ) and sex , with stratification per clinical site . Group allocation was done by a third party not involved in onsite study procedures . Both groups aim ed to train three times per week for 6 weeks , with each session lasting about 45 min and structured training progression individualised to the participant 's level of performance . The VR system consisted of a motion-capture camera and a computer-generated simulation projected on to a large screen , which was specifically design ed to reduce fall risk in older adults by including real-life challenges such as obstacles , multiple pathways , and distracters that required continual adjustment of steps . The primary outcome was the incident rate of falls during the 6 months after the end of training , which was assessed in a modified intention-to-treat population . Safety was assessed in all patients who were assigned a treatment . This study is registered with Clinical Trials.gov , NCT01732653 . FINDINGS Between Jan 6 , 2013 , and April 3 , 2015 , 30 
    Output:
    
Exergames  improved cognition in both clinical and non‐ clinical population s .
Significant effects were found executive functions , attention and visuospatial skills .
Significant effects still existed when excluding waitlist‐only controlled studies , and when comparing to physical activity interventions .
Domain‐specific analyses found exergames  improved executive functions , attentional processing and visuospatial skills .
The findings present the first meta‐analytic evidence for effects of exergames on cognition .