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Ghous M, Masood Q, Nawaz Malik A, Afridi A, Mehmood Q. Comparison of Nonimmersive Virtual Reality and Task-Oriented Circuit Training on Gait, Balance and Cognition Among Elderly Population: A Single-Blind Randomized Control Trial. Games Health J 2024. [PMID: 38512706 DOI: 10.1089/g4h.2022.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Purpose: The purpose of this study was to determine the effects of nonimmersive virtual reality (VR) and task-oriented circuit training on gait, balance, cognitive domains, and quality of life among the elderly population. Methods: This is a single-blind randomized control trial in which 28 elderly individuals between 60 and 75 years were selected. The participants were divided into two groups, task-oriented circuit training and the other receiving nonimmersive VR treatment, with 14 participants in each group. To analyze the effects of both training on balance and gait time up and go test (TUGT), dynamic gait index (DGI), measures were used and for cognitive domains Montreal cognitive assessment (MoCA) scale was used. Short form 12 (SF-12) (along with two domains, Physical Component Summary and Mental Component Summary) was used for the measurement of quality of life. The treatment duration was 8 weeks for both groups. Both the pre-test and post-test readings were analyzed and compared. Results: The mean age of participants was 66.91 ± 3.79 years. Within-group comparison between the pre-test and post-test indicated that significant differences (P < 0.05) existed in all the outcome measures (TUGT, DGI, MoCA, and SF-12) in both groups. However, between-group comparison, significant differences were only found in TUGT and DGI in nonimmersive VR group. Conclusion: This study concluded that both interventions nonimmersive VR and task-oriented circuit training were beneficial for improving balance, gait, quality of life, and cognitive domains like memory, attention spans, executive functions, and so on in elderly population. However nonimmersive virtual reality training is a more effective, feasible, and safe alternative and can be proposed as a form of fall prevention exercise for the older adults. ClinicalTrials.gov Identifier: NCT05021432.
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Affiliation(s)
- Misbah Ghous
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Islamabad, Islamabad, Pakistan
| | - Qudsia Masood
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Islamabad, Islamabad, Pakistan
| | - Arshad Nawaz Malik
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Islamabad, Islamabad, Pakistan
| | - Ayesha Afridi
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Islamabad, Islamabad, Pakistan
| | - Qamar Mehmood
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Islamabad, Islamabad, Pakistan
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Marques LM, Uchida PM, Barbosa SP. The impact of Exergames on emotional experience: a systematic review. Front Public Health 2023; 11:1209520. [PMID: 37744509 PMCID: PMC10512833 DOI: 10.3389/fpubh.2023.1209520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Gamification has proven to be a significant tool for health promotion, with a particular focus on physical activities such as Exergames, which improve not only physical, but also cognitive health. However, it is still not clear what effect the practice of Exergames has on changing the emotional experience. Purpose The objective of this systematic review is to evaluate the impact of Exergames training on emotional experience. Methods A systematic search was conducted in the PUBMED and SCOPUS databases. The relevant articles were screened independently by three researchers. Data concerning emotional measures and Exergame practice were extracted for analysis. Results The search yielded 38 articles, of which 16 were included. Exergames were found to significantly impact happiness, anxiety, depressive symptoms, mental health-related quality of life, self-worth, self-esteem, self-efficacy, perceived behavioral control, vigor, vitality, intrinsic motivation, perceived energy, and relaxation. Conclusion Our review supports the evidence that the practice of physical activity through Exergames, on the emotional experience generally generates an increase in positive emotions. In this sense, the results found support both the use of Exergames as a leisure activity that promotes wellbeing and emotional regulation, as well as for health promotion, public health, and clinical practice purposes. Our review strongly supports the notion that engaging in physical activity through Exergames generally leads to an increase in positive emotions. As a result, these findings endorse the utilization of Exergames as a leisure activity to promote well-being and emotional regulation. Moreover, Exergames hold potential for health promotion, public health, and clinical practice purposes.
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Affiliation(s)
- Lucas Murrins Marques
- Faculdade de Medicina, Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sara Pinto Barbosa
- Faculdade de Medicina, Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
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Guimarães V, Sousa I, de Bruin ED, Pais J, Correia MV. Using shoe-mounted inertial sensors and stepping exergames to assess the motor-cognitive status of older adults: A correlational study. Digit Health 2023; 9:20552076231167001. [PMID: 37009304 PMCID: PMC10061638 DOI: 10.1177/20552076231167001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Objective Stepping exergames designed to stimulate physical and cognitive skills can provide important information concerning individuals’ performance. In this study, we investigated the potential of stepping and gameplay metrics to assess the motor-cognitive status of older adults. Methods Stepping and gameplay metrics were recorded in a longitudinal study involving 13 older adults with mobility limitations. Game parameters included games’ scores and reaction times. Stepping parameters included length, height, speed, and duration, measured by inertial sensors placed on the shoes while interacting with the exergames. Parameters measured on the first gameplay were correlated against standard cognitive and mobility assessments, including the Montreal Cognitive Assessment (MoCA), gait speed, and the Short Physical Performance Battery. Based on MoCA scores, patients were then stratified into two groups: cognitively impaired and healthy controls. The differences between the two groups were visually inspected, considering their within-game progression over the training period. Results Stepping and gameplay metrics had moderate-to-strong correlations with cognitive and mobility performance indicators: faster, longer, and higher steps were associated with better mobility scores; better cognitive games’ scores and reaction times, and longer and faster steps were associated with better cognitive performance. The preliminary visual analysis revealed that the group with cognitive impairment required more time to advance to the next difficulty level, also presenting slower reaction times and stepping speeds when compared to the healthy control group. Conclusion Stepping exergames may be useful for assessing the cognitive and motor status of older adults, potentially allowing assessments to be more frequent, affordable, and enjoyable. Further research is required to confirm results in the long term using a larger and more diverse sample.
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Affiliation(s)
- Vânia Guimarães
- Fraunhofer Portugal AICOS, Porto, Portugal
- Faculty of Engineering, University of Porto, Porto, Portugal
- Vânia Guimarães, Fraunhofer Portugal AICOS, 4200-135 Porto, Portugal.
| | - Inês Sousa
- Fraunhofer Portugal AICOS, Porto, Portugal
| | - Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Joana Pais
- Neuroinova, Lda., Vila Nova de Gaia, Portugal
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Miguel Velhote Correia
- Faculty of Engineering, University of Porto, Porto, Portugal
- INESC TEC (Institute for Systems and Computer Engineering, Technology and Science), Porto, Portugal
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Litz E, Werner C, Bauer JM, Hauer K. Effects and Feasibility of a Memory Exergame Training in Older Adults: A Randomized Controlled Trial. Games Health J 2021; 10:383-390. [PMID: 34860129 DOI: 10.1089/g4h.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The aim of the study is to assess the feasibility, sustainability, and effectiveness of task-specific memory exergame training on motor-cognitive performance in older adults. Materials and Methods: Fifty older adults (age: 78.8 ± 7.0 years) participated in a randomized controlled trial with a 10-week intervention and 3-month follow-up period. Both the intervention group (IG: n = 29) and control group (CG: n = 21) underwent a once-weekly exercise program, including strength and balance exercises, while the IG performed an additional exergame training, combining dynamic balance with visuospatial memory tasks. Outcome measures were completion time for distinct levels of memory exergame tasks without (condition 1) and with procedural support (condition 2) and (sub)-total game scores documented by a game-specific assessment strategy. Results: Significant improvements in the IG compared with the CG over the intervention period were found for completion times in most of the analyzed levels of condition 1 (P < 0.001-0.047; ηp2 = 0.238-0.335) and one level of condition 2 (P < 0.001, ηp2 = 0.267), for the subtotal game score of condition 1 (P = 0.002; ηp2 = 0.186), and for the total game score (P = 0.005; ηp2 = 0.162). Improvements were partially sustained 3 months after training cessation (P = 0.008-0.039, ηp2 = 0.095-0.174). Completion rates for initial levels were 86%-98%. No clinical events or safety issues were observed during the training. Conclusion: The study demonstrates that additional memory exergame training effectively, and sustainably, improves performance in complex motor-cognitive tasks involving dynamic balance and visuospatial memory in older adults.
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Affiliation(s)
- Elena Litz
- AGAPLESION Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany
| | - Christian Werner
- AGAPLESION Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany.,Centre of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Juergen M Bauer
- AGAPLESION Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany.,Centre of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany
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Hauer K, Litz E, Günther-Lange M, Ball C, de Bruin ED, Werner C. Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: a randomized controlled trial. Eur Rev Aging Phys Act 2020; 17:17. [PMID: 33005256 PMCID: PMC7525984 DOI: 10.1186/s11556-020-00248-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Training effects reported for stepping exergames on stepping performances in older adults often based on not comprehensively validated outcomes measures, and follow-up data on their sustainability are lacking. The aim of this study is to evaluate the effectiveness and sustainability of a motor-cognitive stepping exergame training on the stepping performance in older adults. Methods Fifty-eight older adults (78.3 ± 6.5 years) participated in the randomized controlled trial with a 10-week intervention and 10-week follow-up period. The intervention group (IG: n = 29) took part in a once-weekly exercise program including strength and balance exercises supplemented with an additional stepping exergame training. The control group (CG: n = 29) only performed the strength and balance exercises. Outcome measures included stepping reaction times (SRTs) and games scores for individual stepping exergame levels and for the overall exergame performance, as measured by an assessment strategy previously validated in older adults. Results SRTs and/or games scores for 7 out of 10 levels and the overall exergame performance significantly improved in the IG compared to the CG during the intervention (p ≤ 0.001–0.039, ηp2 = 0.090–0.445). Training gains were sustained for 2 levels and for the overall exergame performance (p = 0.017–0.033, ηp2 = 0.127–0.193). Conclusion The study demonstrates that the additional stepping exergame training effectively and sustainably improves the performance in complex motor-cognitive stepping exergame tasks in older adults, which can be relevant for preventing falls. Future research is needed to evaluate the effectiveness of such training on reducing the number of falls. Trial registration ISRCTN registry, ISRCTN14855620, 06/06/2019 (retrospectively registered).
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Affiliation(s)
- Klaus Hauer
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany
| | - Elena Litz
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany
| | - Michaela Günther-Lange
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany
| | - Caroline Ball
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, HCP H 25.1, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Christian Werner
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany.,Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
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Bakker J, Donath L, Rein R. Balance training monitoring and individual response during unstable vs. stable balance Exergaming in elderly adults: Findings from a randomized controlled trial. Exp Gerontol 2020; 139:111037. [PMID: 32730797 DOI: 10.1016/j.exger.2020.111037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Exercise-based fall prevention programs mainly refer to multimodal and challenging balance exercises. Individual load monitoring and interpretations are crucial to enable adequate adaptation responses on the individual level. Thus, assessing internal responses to external stimuli throughout an intervention period need to be adequately addressed. The aim of this secondary analysis of a 3-armed randomized controlled trial was to analyze internal and external loads of unstable vs. stable balance Exergame training in healthy seniors. We intended to elucidate whether differences of external and internal load criteria occur over the intervention period. METHODS A total of 51 healthy seniors (females: n = 34; males: n = 17; age: 69 ± 6 years; BMI: 27 ± 5) were allocated to either volitional stepping (VOL), volitional stepping under unstable conditions (VOL + US) or an inactive control group (CON). VOL and VOL + US completed 8 weeks of Exergame based step training (three weekly sessions, 45 min each) using the Dividat Senso device. Twelve different balance Exergames were used, consisting of virtual reality like video games. The original nonswinging, stable platform was employed for VOL, whereas VOL + US used an adapted Senso mounted on a swinging Posturomed Rack. The instability level was increased for VOL + US only every second week. External (game scores) and internal (perceived efforts, using the rated perceived exertion scale (RPE)) load measures were individually recorded for every session. Statistical analysis was carried out using linear mixed-effects modelling. RESULTS Although VOL + US completed similar games at identical training volumes under unstable conditions, the achieved game scores did not significantly differ between both training groups (p = 0.71). Both intervention groups notably improved their game scores over the 8 training weeks (p < 0.01). A significant time x group interaction effect was observed for perceived effort (p < 0.01), serving as an internal load measure. Subsequent post-hoc testing revealed significant greater perceived exertion values in each of the first 7 weeks (p < 0.05) in VOL + US compared to VOL. No between-group differences were found for RPE in week 8. Whereas RPE values in VOL + US decreased over time (week 1: 4.6 ± 1.9; week 8: 3.1 ± 1.6), VOL indicated similar RPE values for all weeks (week 1: 3.1 ± 1.3; week 8: 2.9 ± 1.4). A detailed analysis of all twelve games revealed that differences in perceived exertion depend on the game content: in 75% of the involved games the RPE level was significantly higher in VOL + US compared to VOL (p < 0.05). CONCLUSION Monitoring internal and external loads on individual level are paramount for gaining adequate training adaptations. Our results indicate that between-group differences in perceived efforts a) can funnel over time, b) depend on game content and c) do not necessarily affect overall scoring. Future studies should individually employ and monitor measures of perceived efforts to guarantee an adequate challenge to the balance system within exercise-based fall prevention programs.
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Affiliation(s)
- Julia Bakker
- Institute of Exercise Training and Sport Informatics, German Sport University, Cologne, Germany
| | - Lars Donath
- Institute of Exercise Training and Sport Informatics, German Sport University, Cologne, Germany
| | - Robert Rein
- Institute of Exercise Training and Sport Informatics, German Sport University, Cologne, Germany.
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