Miki, E., Kataoka, T., & Okamura, H. (2014). Feasibility and efficacy of speed‐feedback therapy with a bicycle ergometer on cognitive function in elderly cancer patients in Japan. Psycho‐Oncology, 23, 906–913. 

To determine the feasibility and effectiveness of speed-feedback therapy on improving cognitive function in elderly patients with cancer

The intervention consisted of subjects pedaling for five minutes on a bicycle ergometer once per week for four weeks compared to usual daily life activities. The bicycle ergometer was linked to a computer with the screen displaying the target speed, revolutions per minute, and a changing path for the subjects to follow. Subject’s actual speed and revolutions were displayed as the subject tried to match the target speed and revolutions on the path on the screen. The exercise load was set at 20 W, and the maximum number of rotations was set at 80 revolutions per minute. Demographic data were collected at baseline. Cognitive function and other assessments were obtained at baseline and at week 4.

• N = 78 (38 intervention, 40 control)
• MEAN AGE = 74.24 years
• MALES: 45%, FEMALES: 55% 
• KEY DISEASE CHARACTERISTICS: All participants were diagnosed with either breast or prostate cancer irrespective of stage or treatment modalities. Most subjects were undergoing treatment (53% intervention, 70% control).
• OTHER KEY SAMPLE CHARACTERISTICS: Average education = 12.11 years

• SITE: Single-site    
• SETTING TYPE: Outpatient    
• LOCATION: Hiroshima University Hospital rehabilitation center, Japan

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Elder care  

Randomized, controlled trial design; outcomes evaluator blinded to group assignment

• Frontal Assessment Battery (FAB)
• Barthel Index (BI)
• Lawton and Brody Instrumental Activities of Daily Living (IADL)
• Functional Assessment of Cancer Therapy-General (FACT-G) version 4

There were more subjects who underwent radiation therapy in the intervention than the control group (p = .01). There were significant differences between groups in the FAB change score for time effect (F = 24.39, p < .001, partial ɳ² = .247), group effect (F = 9.26, p = .003, partial ɳ² = .109), and interaction (F = 7.88, p = .006, partial ɳ² = .094). Younger age was an independent factor associated with greater improvement in FAB scores (p = .018, β = -.264). There were no differences between groups for BI, IADL, or FACT-G scores at baseline or over time.

Findings from this study suggest that speed-feedback therapy may improve cognitive function. However, this intervention required a bicycle ergometer associated with a computer and training by professionals in a hospital setting, which may impact accessibility and costs. Additional studies in other cancer diagnoses with longitudinal follow-ups to demonstrate sustained cognitive improvements is warranted.

• Small sample (< 100)
• Intervention expensive, impractical, or training needs

Speed-feedback therapy with a bicycle ergometer may be a potential intervention to improve cognitive function, particularly sustained attention. Additional research with larger sample sizes and a longer follow-up period is needed to determine the effectiveness and the sustainability of any improvements in cognitive function.