虚拟现实运动游戏对认知功能障碍人群多维结局的影响：基于ICF框架的三水平Meta分析

doi:10.3969/j.issn.1006-9771.2026.09.002

Abstract

Abstract:

Objective To systematically quantify the multidimensional effect of virtual reality-based exergaming (VREG) on health outcomes among individuals with cognitive impairment under the framework of the International Classification of Functioning, Disability and Health (ICF).

Methods Meta-analysis was conducted in accordance with the PRISMA statement. PubMed, Cochrane Library, Embase, Scopus, Web of Science, CNKI, Wanfang Data and VIP were researched for randomized controlled trials (RCTs) investigating VREG for cognitive impairment, with the search deadline set on February 1, 2026. The Cochrane Risk of Bias 2.0 tool was adopted to evaluate the methodological quality of included studies. A three-level meta-analytic model was implemented with R 4.4.2. The GRADE framework was further used to rate the certainty of pooled evidence.

Results A total of 22 RCTs were included. VREG might improve global cognitive function (SMD = 0.69, 95%CI 0.11 to 1.28, P = 0.022), memory (SMD = 0.47, 95%CI 0.07 to 0.87, P = 0.023), attention (SMD = 0.62, 95%CI 0.23 to 1.01, P = 0.004), executive function (SMD = 0.42, 95%CI 0.09 to 0.75, P = 0.013), balance (SMD = 0.54, 95%CI 0.07 to 1.00, P = 0.027), muscle strength (SMD = 0.63, 95%CI 0.37 to 0.88, P = 0.001), mobility (SMD = 0.29, 95%CI 0.04 to 0.54, P = 0.024) and quality of life (SMD = 0.29, 95%CI 0.03 to 0.56, P = 0.029). No significant effect was observed for depressive symptoms, comprehensive physical fitness and fall risk (all P > 0.05). Subgroup and meta-regression analyses indicated that session duration < 45 minutes produced the largest improvement in attention (SMD = 0.95, 95%CI 0.55 to 1.34, P < 0.001); intervention cycles of twelve to 24 weeks were optimal for mobility (SMD = 0.85, 95%CI 0.44 to 1.25, P < 0.001); age negatively correlated to balance improvement (β = -0.11, 95%CI -0.20 to -0.02, P = 0.020), suggesting less intervention benefits among older participants.

Conclusion VREG is an effective non-pharmacological intervention to improve multidimensional physical and mental health in people with cognitive impairment. Protocols featuring short single sessions with long-term duration should be prioritized.

Key words: exergaming, virtual reality, exercise intervention, cognitive impairment, executive function, International Classification of Functioning, Disability and Health, meta-analysis

CLC Number:

R749.1

Jiang Yang, Peng Hao, Yin Xingxiao, Li Yanqi, Song Yanping, Yao Na, Shen Zhen, Chen Qigang. Effect of virtual reality-based exergaming on multidimensional outcomes in individuals with cognitive impairment: a three-level meta-analysis based on the ICF framework[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(9): 1003-1015.

Figures/Tables 7

Table 1

Figure 1

Figure 2

Figure 3

Table 2

Basic characteristics of included literatures"

纳入文献	国家	人群	n(男/女)		年龄/岁		干预措施		干预处方	结局指标(评估工具)
纳入文献	国家	人群	C	T	C	T	C	T	干预处方	结局指标(评估工具)
黄梅珍等^[16](2025)	中国	MCI	16/32	12/37	71.12±5.28	69.54±5.17	健康教育	沉浸式	每次30~45 min，每周3次，共12周	整体认知功能(a, b)、记忆功能(c)、注意力功能(d)、执行功能(d)、抑郁(v)
孙志成等^[17](2024)	中国	MCI	13/18	11/21	78.03±5.95	77.18±6.41	认知训练	非沉浸式	每次45 min，每周3次，共24周	整体认知功能(a)、记忆功能(e)、注意力功能(f, d)、执行功能(x, d)、步行(g, y)、肌肉力量功能(r)、生活质量(h)
孙志成等^[18](2021)	中国	MCI	10/19	11/17	77.14±4.01	77.33±4.06	健康教育	非沉浸式	每次50 min，每周3次，共24周	整体认知功能(a)、记忆功能(e)、注意力功能(f, d)、执行功能(d) 综合体适能(i)、步行(i)、平衡功能(i)、肌肉力量功能(i)、生活质量(h)
Li等^[19](2025)	中国	MCI	53/60	46/67	72.29±4.85	73.12±4.31	常规护理	非沉浸式	每次60 min，每周2次，共12周	整体认知功能(a, ac)、步行(ad)
Kwan等^[20](2024)	中国	MCI	28/119	36/110	73.9±6.6	75.2±7.1	常规护理	沉浸式	每次60 min，每周2次，共8周	整体认知功能(a)、记忆功能(ae)、执行功能(d, j)、步行(g)、综合体适能(af)
Baldimtsi等^[21](2023)	希腊	MCI	4/24	2/29	74.36±7.04	70.39±7.36	无干预	沉浸式	每次45 min，每周2~3次，共12周	整体认知功能(b)、记忆功能(c)、执行功能(d)
			4/20		70.96±7.95		运动训练
			7/21		66.07±10.04		认知训练
			6/5		73.00±8.54		运动-认知训练
Zheng等^[22](2022)	中国	痴呆	6/14	3/15	84.26±5.48	81.74±5.79	常规护理	非沉浸式	每次60 min，每周5次，共8周	整体认知功能(b)、生活质量(h)、抑郁(ag)
Liu等^[23](2022)	中国	MCI	6/11	4/12	73.4±6.5	74.6±6.1	无干预	非沉浸式	每次50 min，每周3次，共12周	整体认知功能(a) 记忆功能(c) 注意力功能(d) 执行功能(d, j) 步行(o)
Liu等^[23](2022)	中国	MCI	5/12	4/12	73.2±6.3	74.6±6.1	运动训练	非沉浸式	每次50 min，每周3次，共12周	整体认知功能(a) 记忆功能(c) 注意力功能(d) 执行功能(d, j) 步行(o)
Torpil等^[24](2021)	土耳其	MCI	14/17	11/19	70.30±2.73	70.12±2.57	认知训练	非沉浸式	每次45 min，每周2次，共12周	整体认知功能(k)、记忆功能(k)、注意力功能(k)、执行功能(k)、综合体适能(k)
Van Santen等^[25](2020)	荷兰	痴呆	23/16	37/36	79.0±7.0	79.0±6.0	健康教育	非沉浸式	每次60 min，每周5次，共24周	整体认知功能(b)、注意力功能(d)、执行功能(d)、综合体适能(i) 跌倒风险(t)、生活质量(ah)
Park等^[26](2020)	韩国	MCI	7/10	10/8	77.2±7.2	75.8±8.5	认知训练	非沉浸式	每次30 min，每周5次，共6周	整体认知功能(a)、记忆功能(ai)、注意力功能(d)、执行功能(d)
Thapa等^[27](2020)	韩国	MCI	10/24	6/28	72.7±5.6	72.6±5.4	健康教育	沉浸式	每次60 min，每周3次，共8周	整体认知功能(b)、注意力功能(d)、执行功能(d, aj)、步行(g, o)、肌肉力量功能(p)
Liao等^[28](2020)	中国	MCI	4/12	7/11	73.1±6.8	75.5±5.2	运动-认知训练	沉浸式	每次60 min，每周3次，共12周	整体认知功能(a)、记忆功能(c)、执行功能(w)、生活质量(n)
Choi等^[29](2019)	韩国	MCI	4/26	5/25	75.37±3.97	77.27±4.37	运动训练	非沉浸式	每次60 min，每周2次，共6周	整体认知功能(a, u)、步行(g)、肌肉力量功能(p, n)、平衡功能(q, z, aa, l)
Liao等^[30](2019)	中国	MCI	4/12	7/11	73.1±6.8	75.5±5.2	运动-认知训练	沉浸式	每次60 min，每周3次，共12周	注意力功能(d)、执行功能(d, j)、步行(o)
Amjad等^[31](2019)	巴基斯坦	MCI	18	20			运动训练	非沉浸式	每次25~30 min，每周5次，共6周	整体认知功能(a, b)、注意力功能(d)、执行功能(d)
Anderson-Hanley等^[32](2018)	希腊	MCI	3/4	4/3	80.9±12.3	75.4±9.8	运动-认知训练	非沉浸式	每次20~45 min，每周3~5次，共24周	记忆功能(ak)、执行功能(j)、步行(g)
Padala等^[33](2017)	美国	AD	9/6	10/5	73.9±7.1	72.1±5.3	运动训练	非沉浸式	每次30 min，每周5次，共8周	整体认知功能(b)、平衡功能(l)、跌倒风险(ab)、生活质量(s, n, h)
Delbroek等^[34](2017)	比利时	MCI	5/5	2/8	87.5±6.6	86.9±5.6	无干预	非沉浸式	每次18~30 min，每周2次，共6周	整体认知功能(a)、平衡功能(m)、步行(g)
Schwenk等^[35](2016)	美国	MCI	5/5	5/7	79.0±10.4	77.8±6.9	无干预	非沉浸式	每次45 min，每周2次，共4周	整体认知功能(a)、注意力功能(d)、执行功能(d)、平衡功能(q)、步行(o)、跌倒风险(ab)
Hughes等^[36](2014)	美国	MCI	4/6	2/8	76.2±4.3	78.5±7.1	健康教育	非沉浸式	每次90 min，每周1次，共24周	整体认知功能(al)、注意力功能(d)、执行功能(d)、步行(o)、生活质量(n)
Padala等^[37](2012)	美国	AD	3/8	3/8	81.6±5.2	79.3±9.8	运动训练	非沉浸式	每次30 min，每周5次，共8周	整体认知功能(b)、平衡功能(l, m)、步行(g)、生活质量(s, n, h)

Table 2

Table 3

Table 4

Results of subgroup and meta-regression analysis"

调节变量	整体认知功能	记忆功能	注意力功能	执行功能	平衡功能	步行	生活质量
对照形式
被动	0.54(-0.10~1.18)	0.53(-0.01~1.07)	0.42(0.05~0.78)	0.42(0.02~0.81)	0.39(-0.40~1.17)	0.20(-0.10~0.50)	0.32(-0.06~0.70)
主动	0.85(0.20~1.50)	0.43(-0.05~0.90)	0.87(0.47~1.27)	0.44(0.03~0.84)	0.70(-0.07~1.46)	0.41(0.08~0.75)	0.28(-0.08~0.64)
P_交互值	0.286	0.719	0.034	0.928	0.563	0.272	0.877
沉浸度
沉浸式	0.36(-0.82~1.54)	0.35(-0.25~0.96)	0.26(-0.45~0.97)	0.36(-0.21~0.94)			0.51(-0.40~1.42)
非沉浸式	0.81(0.11~1.50)	0.58(-0.00~1.15)	0.76(0.31~1.21)	0.48(0.02~0.94)			0.28(-0.01~0.56)
P_交互值	0.512	0.585	0.222	0.762			0.608
干预时间
< 45 min	1.01(0.29~1.73)	0.52(-0.01~1.05)	0.95(0.55~1.34)	0.61(0.14~1.07)	0.54(-0.17~1.24)	0.59(0.19~0.98)	0.25(-0.15~0.65)
45~60 min	0.34(-0.42~1.09)	0.39(-0.22~1.01)	0.35(-0.04~0.75)	0.28(-0.21~0.78)	0.57(-0.35~1.49)	0.19(-0.10~0.49)	0.39(0.02~0.76)
> 60 min	0.57(-2.22~3.37)		0.00(-1.28~1.28)	0.00(-1.59~1.59)		-0.50(-1.68~0.68)	-0.09(-1.19~1.00)
P_交互值	0.235	0.733	0.030	0.463	0.948	0.096	0.626
干预频率
每周1~2次	0.37(-0.56~1.30)	0.17(-0.51~0.86)	0.92(0.11~1.73)	0.21(-0.40~0.82)	0.42(-0.35~1.19)	0.20(-0.18~0.58)	-0.09(-1.17~0.99)
每周3~5次	0.91(0.14~1.67)	0.62(0.13~1.10)	0.53(0.09~0.97)	0.54(0.11~0.96)	0.69(-0.11~1.49)	0.36(0.01~0.70)	0.32(0.04~0.60)
P_交互值	0.371	0.286	0.373	0.379	0.619	0.539	0.443
干预周期
4~< 8周	0.71(-0.12~1.53)	0.24(-0.53~1.01)	0.70(-0.03~1.43)	0.66(0.18~1.14)	0.55(-0.06~1.16)	0.21(-0.06~0.48)	0.23(-0.20~0.67)
8~< 12周	0.60(-0.32~1.52)	0.38(-0.11~0.87)	0.55(-0.01~1.10)	0.26(-0.18~0.71)		0.21(-0.06~0.47)	0.35(-0.11~0.80)
12~24周	0.88(-0.18~1.95)	1.04(0.20~1.89)	0.63(0.00~1.25)	0.32(-0.21~0.85)	0.54(-0.81~1.90)	0.85(0.44~1.25)	0.35(-0.06~0.76)
P_交互值	0.771	0.300	0.912	0.416	0.992	0.024	0.912
人群
MCI	0.89(0.19~1.58)		0.67(0.25~1.10)	0.48(0.14~0.82)	0.45(-0.22~1.12)	0.32(0.07~0.58)	0.50(0.06~0.93)
痴呆	0.28(-1.59~2.15)		0.19(-1.02~1.40)	-0.18(-1.32~0.96)			0.33(-0.08~0.74)
AD	-0.03(-1.62~1.55)				0.77(-0.23~1.76)	-0.16(-1.08~0.76)	0.05(-0.36~0.47)
P_交互值	0.499		0.436	0.268	0.586	0.305	0.311
年龄	-0.03(-0.09~0.03) t = -1.02, P = 0.327	0.06(-0.06~0.18) t = 1.04, P = 0.292	-0.08(-0.21~0.06) t = -1.27, P = 0.236	-0.04(-0.10~0.02) t = -1.36, P = 0.191	-0.11(-0.20~-0.02) t = -2.55, P = 0.020	-0.02(-0.09~0.05) t = -0.59, P = 0.550	0.01(-0.09~0.12) t = 0.20, P = 0.764

Table 4

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结局指标	k(n)	Meta分析		效应模型	异质性检验		证据等级
结局指标	k(n)	SMD(95%CI)	P值	效应模型	研究内I² (研究间I²)/%	P值	证据等级
整体认知功能	30(20)	0.69(0.11~1.28)	0.022	REML	2.48(93.17)	< 0.001	极低
记忆功能	22(10)	0.47(0.07~0.87)	0.023	REML	29.51(53.64)	< 0.001	低
注意力功能	16(12)	0.62(0.23~1.01)	0.004	REML	0(78.07)	< 0.001	低
执行功能	35(16)	0.42(0.09~0.75)	0.013	REML	17.25(63.24)	< 0.001	低
抑郁	2(2)	-0.81(-5.38~3.77)	0.267	REML	(34.19)	0.075	中等
综合体适能	5(4)	0.40(-0.12~0.93)	0.098	REML	0(72.71)	0.058	中等
平衡功能	22(6)	0.54(0.07~1.00)	0.027	REML	0(67.79)	0.163	中等
肌肉力量功能	7(4)	0.63(0.37~0.88)	0.001	REML	0(10.52)	0.359	中等
步行	25(13)	0.29(0.04~0.54)	0.024	REML	22.34(40.22)	< 0.001	中等
跌倒风险	4(3)	-0.77(-1.89~0.34)	0.115	REML	5.76(71.88)	0.037	低
生活质量	18(8)	0.29(0.03~0.56)	0.029	REML	0(37.25)	0.271	中等

Effect of virtual reality-based exergaming on multidimensional outcomes in individuals with cognitive impairment: a three-level meta-analysis based on the ICF framework

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