Brain modulation after exergaming training in advanced forms of Parkinson's disease: a randomized controlled study.

Nine people in the active group and eight in the control group is a very small sample, and the authors note this limits generalizability. The control group started with more severe upper-limb motor signs than the active group (MDS-UPDRS upper limb 15.2 versus 8.4), a baseline difference the authors addressed statistically but which a reader should keep in mind. Both groups played the same game with the same cues and feedback, so the study cannot separate the effect of physical movement from the effect of gaming, virtual reality, or attentional engagement. The MRI substudy was done at a single site (Paris), and three patients were excluded from the imaging analysis for head motion or prior deep brain stimulation lesions. The small number of patients made it difficult to link the brain connectivity changes to the clinical improvements within the same individuals.

Funded by the Fondation d'entreprise IRCEM, Association France Parkinson, Eurostars, Agence Nationale de la Recherche, and INSERM. No industry sponsor that manufactures or sells the exergame is named. The game was designed by the research team as part of the Parkgame II project.

Do not read the gait improvement as proof that exergaming works for PD. The active group had 9 people, the gait measure was a secondary outcome, the primary outcome of brain volume was null, and the control group also showed brain connectivity changes, just different ones. The improvement may reflect the standing full-body movement rather than the game or the virtual-reality element, because both groups played the same game.