Restricted accessResearch articleFirst published online 2025-06
Comparison of the Acute Effects of Virtual Reality Exergames and Core Stability Exercises on Cognitive Factors,Pain,and Fear Avoidance Beliefs in People with Chronic Nonspecific Low Back Pain
In this study, we aimed to investigate and compare the acute effects of exergames (EXG) and core stability exercises (CSEs) on cognitive factors, pain, mood, and fear-avoidance beliefs (FAB) in individuals with chronic low back pain (CLBP).
Materials and Methods:
In a single-blinded clinical trial, 40 participants with CLBP were randomly assigned to either the EXG group or the CSEs group. The EXG group engaged in a single session of exergames using the Xbox Kinect device, while the CSEs group completed a single session of common core stability exercises. Measurements of attention, working memory, pain intensity, mood states, and FAB were taken before and after each intervention.
Results:
The results showed that a single session of EXG was significantly more effective than CSEs in improving cognitive reaction time, pain intensity, FAB, and positive mood states (P ≤ 0.05). Additionally, participants reported lower perceived exertion due to exercising following EXG compared with CSEs.
Conclusion:
EXG may have potential therapeutic advantages over traditional exercise interventions for CLBP.
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References
1.
BuchbinderR, BlythFM, MarchLM, et al.Placing the global burden of low back pain in context. Best Pract Res Clin Rheumatol, 2013; 27(5):575–589; doi: 10.1016/j.berh.2013.10.007
2.
NwodoOD, IbikunlePO, OgbonnaNL, et al.Review of core stability exercise versus conventional exercise in the management of chronic low back pain. Afr Health Sci, 2022; 22(4):148–167; doi: 10.4314/ahs.v22i4.19
3.
Van MiddelkoopM, RubinsteinSM, VerhagenAP, et al.Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol, 2010; 24(2):193–204; doi: 10.1016/j.berh.2010.01.002
4.
TaylorMJ, McCormickD, ShawisT, et al.Activity-promoting gaming systems in exercise and rehabilitation. J Rehabil Res Dev, 2011; 48(10):1171–1186.
5.
Suárez-IglesiasD, Martínez-de-QuelÓ, Marín MoldesJR, et al.Effects of videogaming on the physical, mental health, and cognitive function of people with intellectual disability: A systematic review of randomized controlled trials. Games Health J, 2021; 10(5):295–313; doi: 10.1089/g4h.2020.0138
6.
VianaRB, de OliveiraVN, DankelSJ, et al.The effects of exergames on muscle strength: A systematic review and meta-analysis. Scand J Med Sci Sports, 2021; 31(8):1592–1611; doi: 10.1111/sms.13964
7.
YenHY, ChiuHL. Virtual reality exergames for improving older adults’ cognition and depression: A systematic review and meta-analysis of randomized control trials. J Am Med Dir Assoc, 2021; 22(5):995–1002; doi: 10.1016/j.jamda.2021.03.009
8.
AhernMM, DeanLV, StoddardCC, et al.The effectiveness of virtual reality in patients with spinal pain: A systematic review and meta-analysis. Pain Pract, 2020; 20(6):656–675; doi: 10.1111/papr.12885
9.
SchiltenwolfM, AkbarM, NeubauerE, et al.The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy. Scand J Pain, 2017; 17:273–278; doi: 10.1016/j.sjpain.2017.07.019
10.
CortiEJ, GassonN, LoftusAM. Cognitive profile and mild cognitive impairment in people with chronic lower back pain. Brain Cogn, 2021; 151:105737; doi: 10.1016/j.bandc.2021.105737
11.
PanhaleVP, GuravRS, NaharSK. Association of physical performance and fear-avoidance beliefs in adults with chronic low back pain. Ann Med Health Sci Res, 2016; 6(6):375–379; doi: 10.4103/amhsr.amhsr_331_15
12.
VlaeyenJWS, LintonSJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 2000; 85(3):317–332; doi: 10.1016/s0304-3959(99)00242-0
13.
El-SayesJ, HarasymD, TurcoCV, et al.Exercise-induced neuroplasticity: A mechanistic model and prospects for promoting plasticity. Neuroscientist, 2019; 25(1):65–85; doi: 10.1177/1073858418771538
14.
GaoY, MandrykR. The acute cognitive benefits of casual exergame play. 2012.
15.
Monteiro-JuniorRS, VaghettiCA, NascimentoOJ, et al.Exergames: Neuroplastic hypothesis about cognitive improvement and biological effects on physical function of institutionalized older persons. Neural Regen Res, 2016; 11(2):201–204; doi: 10.4103/1673-5374.177709
16.
Anderson-HanleyC, ArcieroPJ, BrickmanAM, et al.Exergaming and older adult cognition: A cluster randomized clinical trial. Am J Prev Med, 2012; 42(2):109–119; doi: 10.1016/j.amepre.2011.10.016
17.
Monteblanco CavalcanteM, FragaI, DalboscoB, et al.Exergame training-induced neuroplasticity and cognitive improvement in institutionalized older adults: A preliminary investigation. Physiol Behav, 2021; 241:113589; doi: 10.1016/j.physbeh.2021.113589
18.
DimmekDJ, KorallusC, BuynyS, et al.Brain-derived neurotrophic factor and immune cells in osteoarthritis, chronic low back pain, and chronic widespread pain patients: Association with anxiety and depression. Medicina (Kaunas), 2021; 57(4); doi: 10.3390/medicina57040327
19.
MüllerG, LyssenkoL, GiurgiuM, et al.How effective and efficient are different exercise patterns in reducing back pain? Eur J Phys Rehabil Med, 2020; 56(5):585–593; doi: 10.23736/s1973-9087.20.05975-4
20.
KinnafickFE, Thøgersen-NtoumaniC, ShepherdSO, et al.In it together: A qualitative evaluation of participant experiences of a 10-week, group-based, workplace HIIT program for insufficiently active adults. J Sport Exerc Psychol, 2018; 40(1):10–19; doi: 10.1123/jsep.2017-0306
21.
MoraisNS, VianaRB, SilvaWF, et al.Effect of both dance exergame and a traditional exercise on state anxiety and enjoyment in women. J Sports Med Phys Fitness, 2022; 62(4):560–567; doi: 10.23736/s0022-4707.21.12237-6
22.
BonnechereB, JansenB, OmelinaL, et al.The use of commercial video games in rehabilitation: A systematic review. Int J Rehabil Res, 2016; 39(4):277–290; doi: 10.1097/mrr.0000000000000190
23.
Collado-MateoD, Lavín-PérezAM, PeñacobaC, et al.Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults: An umbrella review. Int J Environ Res Public Health, 2021; 18(4); doi: 10.3390/ijerph18042023
24.
MatheveT, BogaertsK, TimmermansA. Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: A randomized controlled trial. J Neuroeng Rehabil, 2020; 17(1):55; doi: 10.1186/s12984-020-00688-0
25.
DeyoRA, DworkinSF, AmtmannD, et al.Report of the NIH Task Force on research standards for chronic low back pain. J Pain, 2014; 15(6):569–585; doi: 10.1016/j.jpain.2014.03.005
26.
LövdénM, FratiglioniL, GlymourMM, et al.Education and cognitive functioning across the life span. Psychol Sci Public Interest, 2020; 21(1):6–41; doi: 10.1177/1529100620920576
27.
NejatiV. Correlation of risky decision making with executive function of brain in adolescences %. J Journal of Research in Behavioural Sciences, 2013; 11(4):270–278.
28.
JaeggiSM, BuschkuehlM, PerrigWJ, et al.The concurrent validity of the N-back task as a working memory measure. Memory, 2010; 18(4):394–412; doi: 10.1080/09658211003702171
29.
FriedmanNP, MiyakeA, CorleyRP, et al.Not all executive functions are related to intelligence. Psychol Sci, 2006; 17(2):172–179; doi: 10.1111/j.1467-9280.2006.01681.x
30.
StraussE, ShermanEMS, SpreenO. A Compendium of Neuropsychological Tests: Administration, Norms, And Commentary Oxford University Press. (3rd ed.) Oxford University Press; 2006.
JafariH, EbrahimiI, SalavatiM, et al.Psychometric properties of Iranian version of Tampa scale for kinesiophobia in low back pain patients %. J Archives of Rehabilitation, 2010; 11(1):0–0.
33.
Farokhi AhmadME, ZeydabadyR. Validity and reliability of Persian version of Brunel mood scale 32 items. Motor Behavior (Research on Sport Science), 2013; 5(13):15–40. Available form: https://sidir/paper/232932/en
34.
BorgGA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 1982; 14(5):377–381.
35.
LiguoriG, Medicine ACoS. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins; 2020.
36.
NgSK, UrquhartDM, FitzgeraldPB, et al.The relationship between structural and functional brain changes and altered emotion and cognition in chronic low back pain brain changes: A Systematic review of MRI and fMRI studies. Clin J Pain, 2018; 34(3):237–261; doi: 10.1097/ajp.0000000000000534
37.
DamrongthaiC, KuwamizuR, SuwabeK, et al.Benefit of human moderate running boosting mood and executive function coinciding with bilateral prefrontal activation. Sci Rep, 2021; 11(1):22657; doi: 10.1038/s41598-021-01654-z
38.
ColcombeSJ, KramerAF, EricksonKI, et al.Cardiovascular fitness, cortical plasticity, and aging. Proceedings of the National Academy of Sciences of the United States of America, 2004; 101(9):3316–3321; doi: 10.1073/pnas.0400266101
39.
SuwabeK, HyodoK, FukuieT, et al.Positive mood while exercising influences beneficial effects of exercise with music on prefrontal executive function: A functional NIRS study. Neuroscience, 2021; 454:61–71; doi: 10.1016/j.neuroscience.2020.06.007
40.
VernalekenI, BuchholzHG, KumakuraY, et al.‘Prefrontal’ cognitive performance of healthy subjects positively correlates with cerebral FDOPA influx: An exploratory [18F]-fluoro-L-DOPA-PET investigation. Hum Brain Mapp, 2007; 28(10):931–939; doi: 10.1002/hbm.20325
41.
Nagano-SaitoA, LeytonM, MonchiO, et al.Dopamine depletion impairs frontostriatal functional connectivity during a set-shifting task. J Neurosci, 2008; 28(14):3697–3706; doi: 10.1523/jneurosci.3921-07.2008
42.
KherdkarnP, SiripornpanichV, AjjimapornA, et al.The acute effect of exergame on brain waves and response time in active and sedentary young adults. 2017;55-67.
43.
AlvesMR, EngedalK, LaksJ, et al.Acute response of prefrontal cortex in institutionalized older adults undergoing a single exergames session. IBRO Neurosci Rep, 2021; 11:8–12; doi: 10.1016/j.ibneur.2021.04.001
44.
MoretB, NucciM, CampanaG. Effects of exergames on mood and cognition in healthy older adults: A randomized pilot study. Front Psychol, 2022; 13:1018601; doi: 10.3389/fpsyg.2022.1018601
45.
WongKP, TseMMY, QinJ. Effectiveness of virtual reality-based interventions for managing chronic pain on pain reduction, anxiety, depression and mood: A systematic review. Healthcare (Basel), 2022; 10(10); doi: 10.3390/healthcare10102047
46.
BairMJ, RobinsonRL, KatonW, et al.Depression and pain comorbidity: A literature review. Arch Intern Med, 2003; 163(20):2433–2445; doi: 10.1001/archinte.163.20.2433
47.
MestreDR, DagonneauV, MercierC-S. Does virtual reality enhance exercise performance, enjoyment, and dissociation? An exploratory study on a stationary bike apparatus. Presence: Teleoperators Virtual Environ, 2011; 20(1):1–14.
48.
NambiG, AbdelbassetWK, AlsubaieSF, et al.Short-term psychological and hormonal effects of virtual reality training on chronic low back pain in soccer players. J Sport Rehabil, 2021; 30(6):884–893; doi: 10.1123/jsr.2020-0075
49.
JenkinsTA, NguyenJC, PolglazeKE, et al.Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis. Nutrients, 2016; 8(1):56.
50.
ThomasJS, FranceCR, LavenderSA, et al.Effects of fear of movement on spine velocity and acceleration after recovery from low back pain. Spine (Phila Pa 1976), 2008; 33(5):564–570; doi: 10.1097/BRS.0b013e3181657f1a
51.
HedayatiR, KahriziS, ParnianpourM, et al.Stabilization exercises and their effect on fear-avoidance belief and disability in patients with recurrent nonspecific low back. Pain J Koomesh, 2015; 17(1):142–151.
52.
NeumannDL, MoffittRL. Affective and attentional states when running in a virtual reality environment. Sports (Basel), 2018; 6(3); doi: 10.3390/sports6030071
