Interactive video dance games for healthy older adults

A web step-based digital solution's impact on physical, cognitive and psychosocial functioning of community-dwelling older adults: A mixed methods randomized and controlled trial

Background

As the population ages, innovative responses are urgently needed to promote physical activity at scale. Thus, this study investigated whether a step-based activity mediated by a digital solution impacts the physical functioning of community-dwelling older adults. The secondary aims were to assess whether the same activity impacts cognitive and psychosocial functioning and explore participants' views towards the activity.

Methods

A mixed method, randomized, and controlled study with one group performing a step-based activity using DanceMove (recommended dosage: twice a week for 20 to 30 min for eight weeks) and the other their usual activities. DanceMove was used at the individuals' homes without any direct supervision. Clinical tests and questionnaires administered in person were used to assess participants at baseline, post-intervention, and three-month follow-up. The primary outcome of interest was gait velocity. Secondary outcomes were balance, pain intensity, cognitive functioning, self-efficacy, social support, loneliness, and quality of life. Also, at the end of the intervention, a semi-structured individual interview was conducted with participants in the experimental group.

Results

Seventy participants were randomized to the control (n = 37) and experimental (n = 33) groups. Of the 33 participants in the experimental group, four did not use the DanceMove at all and two used it for only 3 min. The remaining 26 participants used it for a total time over the eight weeks that varied between 15 and 991 min (mean ± SD = 306.55 ± 258.83 min). The step-based activity was not more effective than usual activities for any of the variables assessed (P > .05). Difficulties, positive and negative aspects regarding the digital solution, and reasons for not using it were identified in the interviews.

Conclusions

Eight weeks of a step-based activity mediated by a digital solution did not impact the physical, cognitive, and psychosocial functioning of community-dwelling healthy older adults. However, the activity was enjoyable and safe to be performed at home without direct supervision. Further studies are needed to explore aspects that could modulate the impact of this type of technology-mediated activity.

Trial registration

The study was registered at clinialtrials.gov (NCT05460039) before the enrolment of the first participant.

Experiences of older adults participating in dance exergames: A systematic review and meta-synthesis

BACKGROUND

Interventions to encourage adequate physical activity amongst older adults have had limited long-term success. Dancing and exergames, two beneficial and enjoyable physical activities for older adults, may make regular exercise more interesting and effective. Dance exergames are physical exercises that integrate sensory, cognitive, psychological, and physical functions by requiring users to interact with game scenarios through deliberate body motions and receive real-time feedback. They provide an inherently enjoyable gaming and workout experience, which may boost exercise adherence. However, little is known about older adults' experiences with dance exergames.

OBJECTIVE

To synthesise the qualitative experiences of older adults participating in dance exergames.

DESIGN

Systematic review and meta-synthesis.

METHODS

Dance exergame studies (peer-reviewed and grey literature) involving older adults in any setting published in English from inception to 17 August 2023 were included. Qualitative or mixed-method studies must use immersive or non-immersive virtual-reality platforms. PubMed, Scopus, CINAHL, The Cochrane Library, ProQuest Dissertations & Theses Global, Google Scholar, and reference lists of relevant studies and reviews were searched for eligible studies. The search strategy for Scopus was: (TITLE-ABS-KEY (danc*) AND TITLE-ABS-KEY (exergames OR exergame OR video AND games OR virtual AND reality) AND TITLE-ABS-KEY (older AND adults OR elderly OR seniors OR geriatrics)). Thematic synthesis by Thomas and Harden was used for meta-synthesis.

RESULTS

Eleven studies (n = 200 older adults) were included. Three themes and 14 subthemes were synthesised: 1) Dance exergames as dual-task training for physical, cognitive, and psychological well-being, 2) Concerns on usability issues, and 3) Possible enhancements of dance exergames. Older adults recognised that dance exergames could improve their physical, cognitive, and psychological well-being. Existing dance exergame systems had several usability issues. For example, some older adults were unfamiliar with using new technology and had trouble in navigating the game systems. The older adults also provided various suggestions for adaptation to their age group, such as ensuring a variety of dances, difficulty levels suited for older adults' cultural backgrounds, and physical and cognitive capabilities.

CONCLUSIONS

Dance exergames may be an attractive way to encourage older adults to exercise, but appropriate modifications are needed. When designing/selecting dance exergames for older persons, researchers, healthcare professionals, and senior care centres should consider using exergames that have simple designs, varied dances that are locally adapted, and appeal to a large proportion of older adults.

REGISTRATION

PROSPERO CRD42023395709.

Effects of twelve weeks of dance Exergames on the quality-of-life variables of elderly Brazilian women enrolled in a community program

BACKGROUND AND PURPOSE

Exercise-based interventions can be a safe alternative to improve and maintain physical and mental health during the aging process. The aim of the present study was to evaluate the effects of a 12-week training program with Dance Exergames on the mood and functional fitness profile of elderly women.

METHODS

The sample (n = 22) was divided into Exergames (EG, n = 9, 70.6 ± 1.6 years) and Control Groups (CG, n = 13, 73.6 ± 2.2 years). Evaluations were carried out before and after the interventions. Each participant played, in pairs, the electronic game Dance Central 3, with the XBOX 360 Kinect console (Slim, Microsoft, USA). The EG trained for 12 weeks (24 sessions), with two weekly sessions of 50 min and the CG performed manual activities workshops.

RESULTS

In functional fitness, both exercise training with exergame (EG) and the intervention model for the CG did not produce significant effects regarding interaction (group*time). Mood state presented significant effect of time intervention regarding tension (p = <0.001), depression (p = 0.001), anger (p = 0.030), fatigue (p = 0.001), and mental confusion (p = 0.004).

CONCLUSION

Twelve weeks of training with a dance exergame (for, EG) and manual activities (for, CG) is enough to promote improvements in the mood state of healthy elderly women. This is an interesting result, as it shows that social interaction is as important a component as improving functional capacity.

The Effects of Dance Interventions on Depression in Older Adults: A Meta-Analysis

Meta-analyses of the effects of dance on depressive symptoms in older adults have shown contradictory results, but few primary studies were included (5 and 8 studies). We aimed to examine the effects of dance on depressive symptoms in older adults aged 60 years and older and to examine the moderator effects of the source, participants, methods, and intervention characteristics. We included 23 primary studies that compared depressive symptoms across dance and comparison/control groups of older adults (72 ± 6.7 years old) and were written in English (N = 1,398) participants. Dance groups showed significantly less depressive symptoms post-intervention than comparison groups (ES = 0.66, 95% CI [0.42, 0.91], p < .001, I2 = 76.80%). South America and Australia showed the greatest effects. Using quasi-experimental designs showed significant effect sizes compared to using randomized designs. Only one quality indicator, intention-to-treat, influenced effect size. Dance might be used as an alternative treatment to improve depression.

Efficacy and Moderators of Virtual Reality for Cognitive Training in People with Dementia and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

BACKGROUND

Mild cognitive impairment (MCI) and dementia result in cognitive decline which can negatively impact everyday functional abilities and quality of life. Virtual reality (VR) interventions could benefit the cognitive abilities of people with MCI and dementia, but evidence is inconclusive.

OBJECTIVE

To investigate the efficacy of VR training on global and domain-specific cognition, activities of daily living and quality of life. To explore the influence of priori moderators (e.g., immersion type, training type) on the effects of VR training. Adverse effects of VR training were also considered.

METHODS

A systematic literature search was conducted on all major databases for randomized control trial studies. Two separate meta-analyses were performed on studies with people with MCI and dementia.

RESULTS

Sixteen studies with people with MCI and four studies with people with dementia were included in each meta-analysis. Results showed moderate to large effects of VR training on global cognition, attention, memory, and construction and motor performance in people with MCI. Immersion and training type were found to be significant moderators of the effect of VR training on global cognition. For people with dementia, results showed moderate to large improvements after VR training on global cognition, memory, and executive function, but a subgroup analysis was not possible.

CONCLUSION

Our findings suggest that VR training is an effective treatment for both people with MCI and dementia. These results contribute to the establishment of practical guidelines for VR interventions for patients with cognitive decline.

Physical Activity and Exergames Among Older Adults: A Scoping Review

Recently, exergames have been widely applied as exercise platforms among older adults. However, studies on the influence of exergames on older adults' physical activity remain scarce. The review article highlights the potential benefit of exergames as a physical activity tool for older adults. The literature search followed the PRISMA guidelines on databases PubMed (Public/Publisher MEDLINE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, and Scopus. The literature included studies that evaluated the influence of exergames on older adults' physical activity. Articles were excluded if the mixed intervention was used, emphasizing specific limbs, improving specific tasks, or not mentioning intervention. The review article identified 25 studies that reported on 855 older adults 55 years of age and older. In addition, the common exergaming technology platforms examined were Microsoft Kinect™, Nintendo^® Wii™, cybercycling, and interactive video dance games. Meanwhile, 11 studies used a pretest/post-test design and randomized controlled trial design in 14 studies. The review found that exergames significantly impacted the older adults' physical activity level as participants experienced improved balance and cognitive function, and enjoyed playing exergame, thus prolonging their game engagement. Although research on exergames is still new, current evidence showed a significant potential benefit of exergames as a physical activity tool for older adults. To overcome the limitation on various parameters that showed different effects and outcomes of exergames, the study recommends implementing randomized controlled trials with long-term observation using a mixed-method approach. Moreover, a multidisciplinary method involving exercise and neuromotor control experts could determine potential mechanisms of action that benefited from the exercises.

The Effects of Exergames on Muscle Architecture: A Systematic Review and Meta-Analysis

Muscle architectural parameters play a crucial role in the rate of force development, strength, and sports performance. On the other hand, deteriorated muscle architectural parameters are associated with injuries, sarcopenia, mortality, falls, and fragility. With the development of technology, exergames have emerged as a complementary tool for physical therapy programs. The PRISMA 2020 statement was followed during the systematic review and meta-analysis. CENTRAL, CINAHL, PROQUEST, PubMed, and OpenGrey databases were searched last time on 22 September 2021. In total, five controlled trials were included in the systematic review. Twelve weeks of virtual dance exercise (Dance Central game for Xbox 360®) showed a medium effect on the improvement of hamstrings (g = 0.55, 95% CI (−0.03, 1.14), I2 = 0%) and the quadriceps femoris muscle cross-sectional area (g = 0.58, 95% CI (0.1, 1.00), I2 = 0%) in community-dwelling older women. Additionally, a four-week virtual balance-training program (the ProKin System) led to significant increments in the cross-sectional areas of individual paraspinal muscles (14.55–46.81%). However, previously investigated exergame programs did not show any medium or large effects on the architectural parameters of the medial gastrocnemius muscle in community-dwelling older women. Distinct exergame programs can be used as a complementary therapy for different prevention and rehabilitation programs.

Effect of a Training Protocol on Movement Function in Men with Cerebrovascular Accident

: Cerebrovascular accident (CVA) refers to any kind of damage caused by direct or indirect damage to the brain and its related elements. It is estimated that about 60% of brain injury victims have a permanent disorder. The consequences of CVA include reduced movement speed, weakness, functional impairment, reduced power, and balance. The purpose of this study was to investigate the effect of a 12-week selected training protocol on motor function following brain injury. In a semi-experimental study, 30 male subjects with a mean and standard deviation of 52.2 ± 5.4 years, weight 173.2 ± 4.2 kg, and height of 78.8 ± 5.3 cm were selected purposefully and accessible with inclusion and exclusion criteria. The participants were randomly divided into experimental (n = 15) and control groups (n = 15). In order to evaluate the physical-motor performance, 10-meter walking tests, get up and go tests, and climbing stairs tests were used. The training program lasted for 12 weeks, three sessions per week, and each session for 30 - 60 minutes. Data were analyzed by independent t-test and dependent t-test using SPSS-21 software at P ≤ 0.05 level. Based on dependent t-test and covariance test, there were significant differences in all three components of motor function (10 m walk time tests, get up and go test, and stair climbing test), there was a significant increase after training in men with CVA (P = 0.00). From the findings of this study, it can be concluded that the special exercises of the present study have a positive effect on motor function parameters of male patients with CVA, so it can be recommended as one of the most important rehabilitation strategies for these patients.

The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial

BACKGROUND

Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate.

METHODS

Fifty four older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-min exercise sessions for 6 weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions.

RESULTS

The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups.

CONCLUSION

Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019).

Beneficial Influence of Mindfulness Training Promoted by Text Messages on Self-Reported Aerobic Physical Activity in Older Adults: A Randomized Controlled Study

Inactivity is known to have harmful effects on the physical and mental health of older adults. This study used a randomized, parallel trial design to evaluate whether daily text prompts to practice mindfulness would have a positive impact on the time that adults aged 50 years or older spend in aerobic physical activity. The participants were recruited from a certified fitness center and divided into mindfulness and control groups. For 4 weeks, they were exposed to the experimental conditions, with or without the morning text message. In the morning message condition, the mindfulness groups received a text message with the instruction to practice audio-guided mindfulness for 10 min, and the control group received a placebo message. The participants practicing mindfulness reported significantly more weekly minutes of aerobic physical activity and higher intrinsic motivation than the control participants. Mindfulness training was effective at increasing aerobic physical activity duration and might complement physical activity programs.

CORRELATING COMMON CLINICAL POSTURAL STABILITY MEASUREMENTS WITH BALANCE ASSESSMENTS

Postural stability assessments are typically used for training and tracking. The training results of stroke patients are investigated in terms of task execution and experimental methods. However, the selection of evaluation and training tools has not been discussed in depth. To explore the postural stability evaluation index, we used a range of widely applied assessment tools in occupational therapy. Methods: We studied the rehabilitation of 15 patients who had suffered chronic strokes for at least two years. The tools include the Timed Up and Go Test, which is used by rehabilitation professionals in postural stability evaluations, the biodex balance evaluation instrument, and a Kinect game developed for virtual reality therapy. Results: We propose an active and a passive assessment model. For training, we recommend combining active and passive assessments for confirmations. For assessments, the evaluation tool should be selected according to the postural stability task (active or passive). In the predictive models, if the different tools are considered simultaneously, static postural stability should be used as the main investigation. We suggest that by first studying the tools used to investigate postural stability assessments, balance assessments in stroke patients can also be improved.

A Systematic Review on the Cognitive Benefits and Neurophysiological Correlates of Exergaming in Healthy Older Adults

Human aging is associated with structural and functional brain deteriorations and a corresponding cognitive decline. Exergaming (i.e., physically active video-gaming) has been supposed to attenuate age-related brain deteriorations and may even improve cognitive functions in healthy older adults. Effects of exergaming, however, vary largely across studies. Moreover, the underlying neurophysiological mechanisms by which exergaming may affect cognitive and brain function are still poorly understood. Therefore, we systematically reviewed the effects of exergame interventions on cognitive outcomes and neurophysiological correlates in healthy older adults (>60 years). After screening 2709 studies (Cochrane Library, PsycINFO, Pubmed, Scopus), we found 15 eligible studies, four of which comprised neurophysiological measures. Most studies reported within group improvements in exergamers and favorable interaction effects compared to passive controls. Fewer studies found superior effects of exergaming over physically active control groups and, if so, solely for executive functions. Regarding individual cognitive domains, results showed no consistence. Positive effects on neurophysiological outcomes were present in all respective studies. In summary, exergaming seems to be equally or slightly more effective than other physical interventions on cognitive functions in healthy older adults. Tailored interventions using well-considered exergames and intervention designs, however, may result in more distinct effects on cognitive functions.

Effects of Interactive Video Game-Based Exercise on Balance in Diabetic Patients with Peripheral Neuropathy: An Open-Level, Crossover Pilot Study

Purpose. This study evaluated the effects of interactive video game-based (IVGB) exercise on balance in diabetic patients with peripheral neuropathy. Materials and Methods. Twenty-four patients were randomly assigned to two groups (12 participants per group). Group A received IVGB training for the first 6 weeks, with no exercise in the subsequent 6 weeks. Group B had no exercise for the first 6 weeks and then underwent IVGB training in the subsequent 6 weeks. For all participants, the Modified Falls Efficacy Scale (MFES), Time Up and Go (TUG) test, Berg Balance Scale (BBS), and Unipedal Stance Test (UST) were employed at weeks 0, 6, and 12 of the experiment. Results. BBS, right-leg UST, and TUG test scores significantly improved after IVGB intervention, whereas MFES and left-leg UST tended to improve after IVGB intervention. Conclusions. This study revealed that 6-week balance-based exercise training using the IVGB system exerted positive effects on functional balance in patients with diabetic peripheral neuropathy (DPN).

Exercise Videogames, Physical Activity, and Health: Wii Heart Fitness: A Randomized Clinical Trial

INTRODUCTION

Adults who engage in regular physical activity have lower rates of morbidity and mortality than those who do not. Exercise videogames may offer an attractive, sustainable alternative or supplement to traditional modes of exercise. This study compared exercise videogames with standard exercise modalities for improving uptake and maintenance of moderate to vigorous physical activity, and health risk indices.

STUDY DESIGN

A three-arm clinical RCT including 12 weeks of supervised laboratory-based moderate to vigorous physical activity followed by 6 months follow-up.

SETTING/PARTICIPANTS

This study was conducted at a university affiliated hospital research lab. Healthy, sedentary adults were eligible.

INTERVENTIONS

This study compared a 12-week program of supervised exercise videogames versus standard exercise (e.g., treadmill) versus control. Data were collected from January 2012 to September 2017 and analyzed in 2018.

MAIN OUTCOME MEASURES

The primary outcome was weekly minutes of moderate to vigorous physical activity at end of treatment, assessed at 3 and 6 months post-intervention by using self-report and accelerometer data. Health risk indices (e.g., HbA1c, lipids) were also assessed.

RESULTS

Participants (N=283) had an average age of 46.2 ±13.5 years; 79% were female. At end of treatment, those in the exercise videogame arm engaged in 30 minutes/week more moderate to vigorous physical activity compared with standard exercise and 85 more minutes/week than controls (all p<0.05). Exercise videogame participants had greater reductions in cholesterol, HbA1c, and body fat versus other groups. Reductions in cholesterol were twice as large in exercise videogame versus standard participants.

CONCLUSIONS

Exercise videogames produced greater uptake and maintenance of moderate to vigorous physical activity compared with standard exercise and improvements in multiple health risk indices. Exercise videogames may promote sustainable physical activity with significant health benefits.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT03298919.

Gaming- a bane or a boon-a systematic review

Recent trends show online/video games, have shifted from being just recreational in nature, to hazardous even resulting in the gamer's death like the blue whale game. The aim of the study is to examine associations between video/online gaming and its implication on the biopsychosocial domains of the user. Online databases were studied on gaming and its effect on behaviour, general and mental health from 1997-2017. The PICO guidelines, PRISMA flow diagram and the Rayyan software was used in identifying relevant studies. Cross referencing was done with the co-authors. A total of 41 studies were included in the final analysis. The choice of the video game is influenced by age, gender, parental mediation, as well as the players' and the game's characteristics. Excessive gaming affects both the individual himself and their interpersonal relationships, with 'internet addiction' being added as a diagnosis under DSM V. Despite its several negative consequences, over the past decade, researchers have now started to acknowledge the benefits of gamification in social, educational and even in the health sector, irrespective of the individual's age. There is a need to develop cross cultural database to understand the impact of addictive and/or promotive use of games on the biopsychosocial factors of the gamer.

Effects of virtual dance exercise on skeletal muscle architecture and function of community dwelling older women

OBJECTIVES

The aim of this study was to analyze the effects of virtual dance exercise on skeletal muscle architecture and function in community-dwelling older women.

METHODS

Forty-two moderately active older women participated in this study and chose to join either the control group (CG; n=20; 70.3 ± 5.6 years) or exercise group (EG; n=22; 69.3 ± 3.7 years). Participants in the CG maintained their lifestyle and those in the EG performed group dance exercise using Dance Central game for Xbox 360® and Kinect for 40 min, 3 times/week, for 12 weeks. The primary outcomes were: ankle plantar flexion and dorsiflexion peak torque (PT), medial gastrocnemius muscle thickness (MT), fascicle length (FL), and pennation angle (PA). The secondary outcomes were: lower limbs range of motion (ROM), calf circumference (CC), 6 m customary gait speed, and handgrip strength. Data were analyzed using an ANOVA mixed model test (p<0.05).

RESULTS

EG participants improved plantar flexion PT at 60°/s (16.3%; p<0.01), MT (8.7%; p<0.01) and ankle dorsiflexion ROM (5.1%; p=0.04) when compared to baseline, and exhibited enhanced CC values compared to CG (1.7%; p=0.03).

CONCLUSIONS

Virtual dance exercise can be recommended to increase muscle mass. Moreover, ankle plantar flexion strength and dorsiflexion ROM gains may contribute to improve functionality and fall avoidance in moderately active older women.

Text Messages Promoting Mental Imagery Increase Self-Reported Physical Activity in Older Adults: A Randomized Controlled Study

OBJECTIVE

This study tested whether text messages prompting adults 50 years of age and older to perform mental imagery would increase aerobic physical activity (APA) duration using a randomized parallel trial design.

METHOD

Participants were assigned to an Imagery 1, Imagery 2, or placebo group. For 4 weeks, each group was exposed to two conditions (morning text message vs. no morning text message). In the morning message condition, the imagery groups received a text message with the instruction to mentally imagine performing an APA, and the placebo group received a placebo message. All participants received an evening text message of "Did you do your cardio today? If yes, what did you do?" for 3 days per week.

RESULTS

Participants of the imagery groups reported significantly more weekly minutes of APA in the morning text message condition compared with the no morning message condition.

CONCLUSION

Electronic messages were effective at increasing minutes of APA.

Balance and Gait Impairment: Sensor-Based Assessment for Patients With Peripheral Neuropathy

BACKGROUND

Individuals with peripheral neuropathy (PN) frequently experience balance and gait impairments that can lead to poor physical function, falls, and injury. Nurses are aware that patients with cancer experience balance and gait impairments but are unsure of optimal assessment and management strategies.

OBJECTIVES

This article reviews options for balance and gait assessment for patients diagnosed with cancer experiencing PN, describes advantages and limitations of the various options, and highlights innovative, clinically feasible technologies to improve clinical assessment and management.

METHODS

The literature was reviewed to identify and assess the gold standard quantitative measures for assessing balance and gait.

FINDINGS

Gold standard quantitative measures are burdensome for patients and not often used in clinical practice. Sensor-based technologies improve balance and gait assessment options by calculating precise impairment measures during performance of simple clinical tests at the point of care.

Does cognition-specific computer training have better clinical outcomes than non-specific computer training? A single-blind, randomized controlled trial

Objective:

The purpose of this study was to investigate differences between non-specific computer training (NCT) and cognition-specific computer training (CCT).

Design:

Randomized controlled experimental study.

Setting:

Local community welfare center.

Subjects:

A total of 78 subjects with mild cognitive impairment (MCI) were randomly assigned to the NCT ( n = 39) or CCT group ( n = 39).

Intervention:

The NCT group underwent NCT using Nintendo Wii for improving functional performance, while the CCT group underwent CCT using CoTras for improving function of the cognitive domain specifically. Subjects in both groups received 30-minute intervention three times a week for 10 weeks.

Main measures:

To identify effects on cognitive function, the Wechsler Adult Intelligence Scale (WAIS) digit span subtests, Rey Auditory Verbal Learning Test (RAVLT), Trail Making Test–Part B (TMT-B), Rey–Osterrieth Complex Figure Test, and Modified Taylor Complex Figure (MTCF) were used. Health-related quality of life (HRQoL) was assessed using the Short-Form 36-item questionnaire.

Results:

After 10 weeks, the WAIS subtests (digit span forward: 0.48 ± 0.08 vs. 0.12 ± 0.04; digit span backward: 0.46 ± 0.09 vs. 0.11 ± 0.04) and HRQoL (vitality: 9.05 ± 1.17 vs. 2.69 ± 1.67; role-emotional: 8.31 ± 1.20 vs. 4.15 ± 0.71; mental health: 11.62 ± 1.63 vs. 6.95 ± 1.75; bodily pain: 4.21 ± 2.17 vs. 0.10 ± 0.38) were significantly higher in the NCT group ( P < 0.05).

Conclusion:

NCT was superior to CCT for improving cognitive function and HRQoL of elderly adults with MCI.

Effects of Exergaming on Physical Activity in Overweight Individuals

BACKGROUND

The majority of patients with overweight and type 2 diabetes show insufficient levels of daily physical activity (PA) and usually are among the least likely to engage in or adhere to any form of generic PA. Active video games (exergames) may be a solution to motivate these individuals to overcome their sedentary lifestyle.

OBJECTIVES

This systematic review was conducted to review the current evidence for the effectiveness of exergaming in overweight and type 2 diabetes mellitus and thus to evaluate the suitability of these games to be used as tools for exercise promotion that meet current PA guidelines.

METHODS

We searched electronic bibliographic databases (PubMed, Embase, Web of Science, OpenGrey, and the Cochrane Central Register of Controlled Trials) up to March 2015. Randomized controlled trials (RCT) and cross-sectional studies published in English in a peer-reviewed journal and analyzing the effects of exergames on objectively measured intensity parameters of PA in overweight (body mass index [BMI] ≥25 kg/m(2)) adults (mean age ≥18 years) with and without type 2 diabetes were included. Study selection, data extraction, and quality assessment were performed independently by two review authors. Primary outcomes included changes in oxygen uptake (VO2), energy expenditure (EE), heart rate (HR), or activity counts. Secondary outcomes were enjoyment of treatment, exercise adherence, ratings of perceived exertion (RPE), changes in body composition, and changes in blood parameters (serum glucose, long-term blood glucose, blood cholesterol, triglycerides, or serum lactate).

RESULTS

Of 2845 records, 14 publications (11 studies) met the inclusion criteria. All included studies (ten experimental, cross-sectional laboratory studies and one RCT) were able to show increases in either VO2, EE, HR, or activity counts. However, effects of exergaming in terms of changes in these intensity parameters varied significantly between game modes and consoles as well as because of the vastly differing durations of exergame activity between studies. One of the included studies had a low risk of bias, and three had a high risk of bias; seven studies had an unclear risk of bias as the study description was insufficient. No studies were found investigating the changes in objectively measured PA intensity parameters in patients with type 2 diabetes.

CONCLUSION

This review suggests that exergames are able to increase PA among overweight individuals. However, the inconsistent results and the overall poor or moderate methodological quality do not permit judgment on whether exergames are suitable to meet PA guidelines in this target group. The lack of research regarding the effects of exergames in type 2 diabetes indicates a great need for future research.

Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy

BACKGROUND

This study compared the effects of Nintendo Wii-Fit^® balance-based video games and conventional balance training in children with mild cerebral palsy (CP).

METHODS

This randomized controlled trial involved 30 ambulatory pediatric patients (aged 5-18 years) with CP. Participants were randomized to either conventional balance training (control group) or to Wii-Fit balance-based video games training (Wii group). Both group received neuro-developmental treatment (NDT) during 24 sessions. In addition, while the control group received conventional balance training in each session, the Wii group played Nintendo Wii Fit games such as ski slalom, tightrope walk and soccer heading on balance board. Primary outcomes were Functional Reach Test (forward and sideways), Sit-to-Stand Test and Timed Get up and Go Test. Nintendo Wii Fit balance, age and game scores, 10 m walk test, 10-step climbing test and Wee-Functional Independence Measure (Wee FIM) were secondary outcomes.

RESULTS

After the treatment, changes in balance scores and independence level in activities of daily living were significant (P < 0.05) in both groups. Statistically significant improvements were found in the Wii-based game group compared with the control group in all balance tests and total Wee FIM score (P < 0.05).

CONCLUSION

Wii-fit balance-based video games are better at improving both static and performance-related balance parameters when combined with NDT treatment in children with mild CP.

Short and long-term effects of exergaming for the elderly

Objective

Exergaming has been introduced in safe and beneficial intervention for the elderly. However, no study has examined exergaming-based interventions for the elderly that last several years. Therefore, we investigated the effectiveness and safety of a 12-week intervention using step training with exergaming for the elderly (12-week study). Moreover, we conducted an exergaming-based intervention for 3 years (3-year study).

Materials and methods

12-week study: Forty-two elderly persons participated in this study. Using an in-house developed exergaming protocol, a step training was performed for 15 min/session twice a week for 12 weeks. We investigated post-intervention changes in motor functions, successful step-rate, the intensity of exercise, which was evaluated using Borg scale (Rating of Perceived Exertion). 3-year study: An intervention using exergaming was conducted for 12 weeks by 20 elderly participants. Two courses/year of exercise were performed at 3-month intervals. This was continued for 3 years. The exercise continuation rate, its influence on motor functions were investigated.

Results

12-week study: Lower-limb muscle strength, balancing capacity, and whole body reaction time significantly improved in the exercise group. The mean score on Borg scale was 12 ± 2 on the first day of the step exercise and 9 ± 2 on the final day. 3-year study: Exercise was continued in 16 out of the 20 subjects. The Timed Up and Go Test, duration of one-footed standing, and quadriceps strength significantly improved.

Conclusion

The results of the present study showed that exergaming provided an appropriate exercise intensity for the elderly and safely improved motor functions. The exercise continuation rate in the 3-year study was high. Improvements in motor functions may contribute to the prevention of falls.

Xbox Kinect training to improve clinical measures of balance in older adults: a pilot study

BACKGROUND

Falls are a leading cause of injury and death for old adults, with one risk factor for falls being balance deficits. The low cost (<400 USD), wide availability, and ability to incorporate multiple training paradigms make gaming systems appealing as possible balance intervention tools.

AIMS

To investigate the feasibility of using the Xbox Kinect for training to improve clinical measures of balance in old adults and retain improvements after a period of time.

METHODS

Thirteen healthy old adults (aged 70+ years) were randomly divided into two groups. The experimental group completed Kinect training three times a week for 3 weeks while the control group continued with normal activities. Four clinical measures of balance were assessed before training, 1 week and 1 month after training: Berg balance scale (BBS), Fullerton advanced balance (FAB) scale, functional reach (FR), and timed up and go (TUG).

RESULTS

The ability to implement the training program was successful. The experimental group significantly increased their BBS and FAB after training while the control group did not. There was no significant change for either groups with FR and TUG.

CONCLUSION

A training program using the Kinect with commercially available games was feasible with old adults. Kinect training may be an inexpensive way for old adults to receive helpful feedback encouraging them to continue with balance training program in their home.

Novel physical activity interventions for older patients with prostate cancer on hormone therapy: A pilot randomized study

BACKGROUND

Androgen deprivation therapy (ADT) can decrease the physical performance (PP) of older men with prostate cancer (PC).

METHODS

We conducted a three-arm randomized pilot study (n=19) comparing a home-based walking and resistance intervention (EXCAP) and a technology-mediated walking and resistance intervention using Wii-Fit to a usual-care arm in men ≥70 years with PC receiving ADT. The intervention lasted for 6 weeks, with follow-up at 12 weeks. The primary pre-specified outcome was change in Short Physical Performance Battery (SPPB) score. Mixed effects regression models were used to assess change in outcomes over time.

RESULTS

Mean participant age was 70 years (range: 67-93). Eight patients were randomized to the Wii-Fit arm, 6 to the EXCAP arm, and 5 to the usual-care arm. SPPB scores remained nearly constant in the usual-care arm (β=-0.12; p=0.79), while individuals in the EXCAP arm had on average a 1.2 point increase at each follow-up (β=1.20; 95% CI: 0.36, 2.06). The Wii-fit arm had a non-significant increase in SPPB score over time relative to usual-care (β=0.32; 95% CI -0.43, 1.06; p=0.46). Individuals in the EXCAP arm had an increase in steps per day over time compared to the usual-care arm (p-value=0.006); the EXCAP arm had an increase of 2720 steps (95% CI: 1313, 4128) while the usual-care arm had an increase of 97 steps (95% CI: -1140, 1333). Participants in the Wii-Fit arm had an increase of 1020 steps (95% CI: -474, 1238, p=0.710). Other outcomes (i.e., handgrip strength, lean muscle mass, and chest press repetitions) were not statistically significant.

CONCLUSIONS

A home-based aerobic and resistance exercise program, EXCAP, shows promise for improving PP in older men with PC on ADT.

Exergames for unsupervised balance training at home: A pilot study in healthy older adults

Exercise videogames (exergames) are gaining popularity as tools for improving balance ability in older adults, yet few exergames are suitable for home-based use. The purpose of the current pilot study was to examine the effects of a 6-week unsupervised home-based exergaming training program on balance performance. Ten community dwelling healthy older adults (age: 75.9 ± 7.2 years) played a newly developed ice skating exergame for six weeks at home. In the game, the speed and direction of a virtual ice skater on a frozen canal were controlled using lateral weight shifts, which were captured using Kinect. Sway characteristics during quiet standing in eyes open (EO), eyes closed (EC) and dual task (DT) conditions were assessed in time and frequency domain before, and after two, four and six weeks of training. Balance was also evaluated using the narrow ridge balance test (NRBT). Multilevel modeling was applied to examine changes in balance ability. Participants played 631 (± 124)min over the intervention period and no subjects dropped out. Balance in terms of sway characteristics improved on average by 17.4% (EO) and 23.3% (EC) after six weeks of training (p<0.05). Differences in rate of improvement (p<0.05) were observed between participants. No intervention effects were found for quiet standing in DT conditions and on the NRBT. In conclusion, the pilot study showed that unsupervised home-based exergaming is feasible in community dwelling older adults, but also that participants do not benefit equally from the program, thereby emphasizing the need for more personalized exergame training programs.

Interactive Cognitive-Motor Step Training Improves Cognitive Risk Factors of Falling in Older Adults - A Randomized Controlled Trial

Purpose

Interactive cognitive-motor training (ICMT) requires individuals to perform both gross motor movements and complex information processing. This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults.

Methods

A single-blinded randomized controlled trial was conducted in community-dwelling older adults (N = 90, mean age 81.5±7) without major cognitive impairment. Participants in the intervention group (IG) played four stepping games that required them to divide attention, inhibit irrelevant stimuli, switch between tasks, rotate objects and make rapid decisions. The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home. Participants in the control group (CG) received an evidence-based brochure on fall prevention. Measures of processing speed, attention/executive function (EF), visuo-spatial ability, concerns about falling and depression were assessed before and after the intervention.

Results

Eighty-one participants (90%) attended re-assessment. There were no improvements with respect to the Stroop Stepping Test (primary outcome) in the intervention group. Compared to the CG, the IG improved significantly in measures of processing speed, visuo-spatial ability and concern about falling. Significant interactions were observed for measures of EF and divided attention, indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance. The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline. Additionally, low and high-adherer groups differed in their baseline performance and responded differently to the intervention. Compared to high adherers, low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF.

Conclusions

This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people. Low adherers improved in less complex functions while high-adherers improved in EF.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12613000671763

Effects of Balance Control Training on Functional Outcomes in Subacute Hemiparetic Stroke Patients

OBJECTIVE

To investigate the efficacy of balance control training using a newly developed balance control trainer (BalPro) on the balance and gait of patients with subacute hemiparetic stroke.

METHODS

Forty-three subacute stroke patients were assigned to either a balance control training (BCT) group or a control group. The BCT group (n=23) was trained with BalPro for 30 minutes a day, 5 days a week for 2 weeks, and received one daily session of conventional physical therapy. The control group (n=20) received two sessions of conventional physical therapy every day for 2 weeks. The primary outcome was assessment with the Berg Balance Scale (BBS). Secondary outcomes were Functional Ambulation Category (FAC), the 6-minute walking test (6mWT), Timed Up and Go (TUG), the Korean version of Modified Barthel Index (K-MBI), and the manual muscle test (MMT) of the knee extensor. All outcome measures were evaluated before and after 2 weeks of training in both groups.

RESULTS

There were statistically significant improvements in all parameters except MMT and FAC after 2 weeks of treatment in both groups. After training, the BCT group showed greater improvements in the BBS and the 6mWT than did the control group.

CONCLUSION

Balance control training using BalPro could be a useful treatment for improving balance and gait in subacute hemiparetic stroke patients.

Successful aging: Advancing the science of physical independence in older adults

The concept of 'successful aging' has long intrigued the scientific community. Despite this long-standing interest, a consensus definition has proven to be a difficult task, due to the inherent challenge involved in defining such a complex, multi-dimensional phenomenon. The lack of a clear set of defining characteristics for the construct of successful aging has made comparison of findings across studies difficult and has limited advances in aging research. A consensus on markers of successful aging is furthest developed is the domain of physical functioning. For example, walking speed appears to be an excellent surrogate marker of overall health and predicts the maintenance of physical independence, a cornerstone of successful aging. The purpose of the present article is to provide an overview and discussion of specific health conditions, behavioral factors, and biological mechanisms that mark declining mobility and physical function and promising interventions to counter these effects. With life expectancy continuing to increase in the United States and developed countries throughout the world, there is an increasing public health focus on the maintenance of physical independence among all older adults.

Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy

BACKGROUND

There has been a rapid increase in research on the use of virtual reality (VR) and gaming technology as a complementary tool in exercise and rehabilitation in the elderly population. Although a few recent studies have evaluated their efficacy, there is currently no in-depth description and discussion of different game technologies, physical functions targeted, and safety issues related to older adults playing exergames.

OBJECTIVES

This integrative review provides an overview of the technologies and games used, progression, safety measurements and associated adverse events, adherence to exergaming, outcome measures used, and their effect on physical function.

METHODS

We undertook systematic searches of SCOPUS and PubMed databases. Key search terms included "game", "exercise", and "aged", and were adapted to each database. To be included, studies had to involve older adults aged 65 years or above, have a pre-post training or intervention design, include ICT-implemented games with weight-bearing exercises, and have outcome measures that included physical activity variables and/or clinical tests of physical function.

RESULTS

Sixty studies fulfilled the inclusion criteria. The studies had a broad range of aims and intervention designs and mostly focused on community-dwelling healthy older adults. The majority of the studies used commercially available gaming technologies that targeted a number of different physical functions. Most studies reported that they had used some form of safety measure during intervention. None of the studies reported serious adverse events. However, only 21 studies (35%) reported on whether adverse events occurred. Twenty-four studies reported on adherence, but only seven studies (12%) compared adherence to exergaming with other forms of exercise. Clinical measures of balance were the most frequently used outcome measures. PEDro scores indicated that most studies had several methodological problems, with only 4 studies fulfilling 6 or more criteria out of 10. Several studies found positive effects of exergaming on balance and gait, while none reported negative effects.

CONCLUSION

Exergames show promise as an intervention to improve physical function in older adults, with few reported adverse events. As there is large variability between studies in terms of intervention protocols and outcome measures, as well as several methodological limitations, recommendations for both practice and further research are provided in order to successfully establish exergames as an exercise and rehabilitation tool for older adults.

Age and education influence the performance of elderly women on the dual-task Timed Up and Go test

Gait variability is related to functional decline in the elderly. The dual-task Timed Up and Go Test (TUG-DT) reflects the performance in daily activities. Objective To evaluate the differences in time to perform the TUG with and without DT in elderly women with different ages and levels of education and physical activity. Method Ninety-two elderly women perfomed the TUG at usual and fast speeds, with and without motor and cognitive DT. Results Increases in the time to perform the TUG-DT were observed at older ages and lower educational levels, but not at different levels of physical activity. More educated women performed the test faster with and without DT at both speeds. When age was considered, significant differences were found only for the TUG-DT at both speeds. Conclusion Younger women with higher education levels demonstrated better performances on the TUG-DT.

Using commercial video games for falls prevention in older adults: the way for the future?

BACKGROUND AND PURPOSE

Falls in older adults are an increasingly costly public health issue. There are many fall prevention strategies that are effective. However, with an increasing population of older people and ever-decreasing availability of health practitioners and health funding, novel modes of intervention are being developed, including those relying on computer technologies.The aim of this article was to review the literature on the use of exergaming to prevent falls in older adult persons living in the community.

METHODS

The Cochrane, Medline, and Embase databases were searched using prespecified search terms. To be included, studies had to investigate the effect of using commercially available consoles and video games on outcome measures such as a decrease in falls, improvements in balance control or gait parameters, decreased fear of falling, and attitude to exercise in older adult persons living in the community. All study designs with the exception of single-person case studies were included. Articles had to be published in peer-reviewed journals in the English language.

RESULTS

Nineteen studies fulfilled the inclusion criteria. The following outcomes were observed: (1) using computer-based virtual reality gaming for balance training in older adults was feasible; (2) the majority of studies showed a positive effect of exergaming on balance control; (3) some studies showed a positive effect on balance confidence and gait parameters; (4) the effect was seen across the age and sex spectrum of older adults, including those with and without balance impairment.

CONCLUSIONS

There is as yet no evidence that using virtual reality games will prevent falls, but there is an indication that their use in balance training may improve balance control, which in turn may lead to falls prevention.

Exercise videogames for physical activity and fitness: Design and rationale of the Wii Heart Fitness trial

INTRODUCTION

Despite numerous health benefits, less than half of American adults engage in regular physical activity. Exercise videogames (EVG) may be a practical and attractive alternative to traditional forms of exercise. However there is insufficient research to determine whether EVG play alone is sufficient to produce prolonged engagement in physical activity or improvements in cardiovascular fitness and overall health risk. The goal of the present study is to test the efficacy of exercise videogames to increase time spent in moderate to vigorous physical activity (MVPA) and to improve cardiovascular risk indices among adults.

METHODS

Wii Heart Fitness is a rigorous 3-arm randomized controlled trial with adults comparing three 12-week programs: (1) supervised EVGs, (2) supervised standard exercise, and (3) a control condition. Heart rate is monitored continuously throughout all exercise sessions. Assessments are conducted at baseline, end of intervention (week 12), 6 and 9 months. The primary outcome is time spent in MVPA physical activity. Secondary outcomes include changes in cardiovascular fitness, body composition, blood lipid profiles and maintenance of physical activity through six months post-treatment. Changes in cognitive and affective constructs derived from Self Determination and Social Cognitive Theories will be examined to explain the differential outcomes between the two active treatment conditions.

CONCLUSION

The Wii Heart Fitness study is designed to test whether regular participation in EVGs can be an adequate source of physical activity for adults. This study will produce new data on the effect of EVGs on cardiovascular fitness indices and prolonged engagement with physical activity.

Physical and Cognitive Impacts of Digital Games on Older Adults: A Meta-Analytic Review

The purpose of this study is to examine the physical and cognitive impacts of digital games on older adults. We conducted five independent meta-analyses by reporting 58 effect sizes generated from 36 studies. Results suggested that playing digital games is effective in improving older adults' physical balance (g = 0.67), balance confidence (g = 0.46), functional mobility (g = 0.53), executive function (g = 0.76), and processing speed (g = 0.54). Based on the results of heterogeneity analysis, we conducted moderator analyses for physical balance and processing speed. Key findings included the following: Playing digital games can not only improve the physical balance of older adults living in community but also those living in nursing homes; the relationship between age of participants or amount of time of gameplay and effect size is weak and the direction of the relationship is not definitive.

Interactive balance training integrating sensor-based visual feedback of movement performance: a pilot study in older adults

Background

Wearable sensor technology can accurately measure body motion and provide incentive feedback during exercising. The aim of this pilot study was to evaluate the effectiveness and user experience of a balance training program in older adults integrating data from wearable sensors into a human-computer interface designed for interactive training.

Methods

Senior living community residents (mean age 84.6) with confirmed fall risk were randomized to an intervention (IG, n = 17) or control group (CG, n = 16). The IG underwent 4 weeks (twice a week) of balance training including weight shifting and virtual obstacle crossing tasks with visual/auditory real-time joint movement feedback using wearable sensors. The CG received no intervention. Outcome measures included changes in center of mass (CoM) sway, ankle and hip joint sway measured during eyes open (EO) and eyes closed (EC) balance test at baseline and post-intervention. Ankle-hip postural coordination was quantified by a reciprocal compensatory index (RCI). Physical performance was quantified by the Alternate-Step-Test (AST), Timed-up-and-go (TUG), and gait assessment. User experience was measured by a standardized questionnaire.

Results

After the intervention sway of CoM, hip, and ankle were reduced in the IG compared to the CG during both EO and EC condition (p = .007-.042). Improvement was obtained for AST (p = .037), TUG (p = .024), fast gait speed (p = . 010), but not normal gait speed (p = .264). Effect sizes were moderate for all outcomes. RCI did not change significantly. Users expressed a positive training experience including fun, safety, and helpfulness of sensor-feedback.

Conclusions

Results of this proof-of-concept study suggest that older adults at risk of falling can benefit from the balance training program. Study findings may help to inform future exercise interventions integrating wearable sensors for guided game-based training in home- and community environments. Future studies should evaluate the added value of the proposed sensor-based training paradigm compared to traditional balance training programs and commercial exergames.

Trial registration

http://www.clinicaltrials.govNCT02043834.

Electronic supplementary material

The online version of this article (doi:10.1186/1743-0003-11-164) contains supplementary material, which is available to authorized users.

Immersive technology and the elderly: a mini-review

Technologies that provide immersive experiences continue to become more ubiquitous across all age groups. This paper presents a review of the literature to provide a snapshot of the current state of research involving the use of immersive technologies and the elderly. A narrative literature review was conducted using the ScienceDirect, EBSCOhost, Springerlink and ERIC databases to summarize primary studies from which conclusions were drawn into a holistic interpretation. The majority of the studies examined the effect of immersive technologies on elder peoples' age-related declines, including sensory and motor changes (vision, hearing, motor skills), cognitive changes and social changes. Various immersive technologies have been described and tested to address these age-related changes, and have been categorized as 'games and simulations', 'robotics' and 'social technologies'. In most cases, promising results were found for immersive technologies to challenge age-related declines, especially through the increase of morale.

Interventions to promote health: crossing networks of intellectual and developmental disabilities and aging

BACKGROUND

People with intellectual and developmental disabilities experience lower levels of healthy behaviors as do older persons, making health promotion a key priority for these populations.

OBJECTIVE

The aim of this paper is to review the two fields of developmental disability and aging health promotion research in order to understand strategies used by both and to identify emerging and innovative practices that disability researchers can learn from each other.

METHODS

We conducted scoping reviews of health promotion intervention peer reviewed articles in English from 1991 to 2011 for intellectual and developmental disabilities and from 2007 to 2011 for the more extensive gerontological literature. Two reviewers extracted data.

RESULTS

The disability review identified 34 studies and three main types of interventions: exercise, multi-component, and health screens. The aging review identified 176 articles which had a wider variety of intervention topics and techniques, with more articles including innovative approaches to bringing interventions to community settings across a wider variety of populations.

CONCLUSIONS

As people with intellectual and developmental disabilities are living longer, disability health promotion can look to the aging literature for ideas to incorporate in future interventions for people with intellectual and developmental disabilities, while the gerontological research can learn from the research in intellectual and developmental disabilities on ways to adapt health promotion interventions to people with cognitive and physical limitations. Use of universal design principles could enable greater inclusion of people with disabilities in health promotion interventions for the general aging population.

The effect of interactive cognitive-motor training in reducing fall risk in older people: a systematic review

Background

It is well-known physical exercise programs can reduce falls in older people. Recently, several studies have evaluated interactive cognitive-motor training that combines cognitive and gross motor physical exercise components. The aim of this systematic review was to determine the effects of these interactive cognitive-motor interventions on fall risk in older people.

Methods

Studies were identified with searches of the PubMed, EMBASE, and Cochrane CENTRAL databases from their inception up to 31 December 2013. Criteria for inclusion were a) at least one treatment arm that contained an interactive cognitive-motor intervention component; b) a minimum age of 60 or a mean age of 65 years; c) reported falls or at least one physical, psychological or cognitive fall risk factor as an outcome measure; d) published in Dutch, English or German. Single case studies and robot-assisted training interventions were excluded. Due to the diversity of populations included, outcome measures and heterogeneity in study designs, no meta-analyses were conducted.

Results

Thirty-seven studies fulfilled the inclusion criteria. Reporting and methodological quality were often poor and sample sizes were mostly small. One pilot study found balance board training reduced falls and most studies reported training improved physical (e.g. balance and strength) and cognitive (e.g. attention, executive function) measures. Inconsistent results were found for psychological measures related to falls-efficacy. Very few between-group differences were evident when interactive cognitive-motor interventions were compared to traditional training programs.

Conclusions

The review findings provide preliminary evidence that interactive cognitive-motor interventions can improve physical and cognitive fall risk factors in older people, but that the effect of such interventions on falls has not been definitively demonstrated. Interactive cognitive-motor interventions appear to be of equivalent efficacy in ameliorating fall risk as traditional training programs. However, as most studies have methodological limitations, larger, high-quality trials are needed.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2318-14-107) contains supplementary material, which is available to authorized users.