Effects of Video Game Training on the Musculoskeletal Function of Older Adults: A Systematic Review and Meta-analysis

Intervention Characteristics Associated With a Reduction in Fear of Falling Among Community-Dwelling Older People: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND AND OBJECTIVES

Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people.

RESEARCH DESIGN AND METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed.

RESULTS

Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: -1.047, 95% confidence interval [CI]: -1.598; -0.496) and delivery in a community setting (SMD: -0.528, 95% CI: -0.894; -0.161) were-compared to interventions without these characteristics-associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: -0.823, 95% CI: -1.255; -0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011).

DISCUSSION AND IMPLICATIONS

Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.

Does Physical Dance Training with Virtual Games Change Muscle Quality of Community-Dwelling Older Women?

Objective: The aim of the study is to analyze the effects of physical dance training with a virtual game on muscle quality (MQ) of community-dwelling older women. Materials and Methods: In total, 46 older women participated in the study and were assigned to either a control group (CG, n = 25, 71 ± 5 years) or training group (TG, n = 21, 69 ± 4 years). The following assessments were performed at baseline and after 12 weeks: quadriceps, ankle plantar flexor, and dorsiflexor isokinetic peak torque (PT) (Biodex System 4 Dynamometer); quadriceps cross-sectional area (CSA) measured using magnetic resonance imaging; intramuscular noncontractile tissue (IMNCT) (Image-Pro Plus 4.5.0.29 for Windows); and MQ (ratio of quadriceps PT to CSA). Each week for 12 weeks, the TG undertook three 40-minute sessions of physical training with the "Dance Central" game for Xbox 360^® with Kinect, while the CG was instructed to maintain usual activities of daily living. Results: The TG increased quadriceps eccentric PT at 60°/s (P = 0.04) and ankle plantar flexor concentric PT at 60°/s (P = 0.02) when compared with the CG. No significant difference in quadriceps CSA, IMNCT, and MQ was observed. Conclusion: Physical dance training with virtual games can increase quadriceps and ankle plantar flexor strength without changing IMNCT and MQ of community-dwelling older women. Trial number: RBR-8xkwyp (ensaiosclinicos.gov.br-Brazilian Clinical Trials Registry).

Effects of exergames and cognitive-motor dual-task training on cognitive, physical and dual-task functions in cognitively healthy older adults: An overview

This overview aims to summarize the effectiveness of cognitive-motor dual-task and exergame interventions on cognitive, physical and dual-task functions in healthy older adults, as well as the feasibility, safety, adherence, transfer and retention of benefits of these interventions. We searched for systematic reviews or meta-analyses assessing the effects of cognitive-motor dual-task and exergame interventions on cognitive, physical and dual-task functions in cognitively healthy older adults through eight databases (CDSR (Cochrane), MEDLINE (PubMed), Scopus, EMBASE, CINAHL, PsycINFO, ProQuest and SportDiscus). Two reviewers performed the selection, data extraction and risk of bias evaluation independently (PROSPERO ID: CRD42019143185). Eighteen reviews were included in this overview. Overall, positive effects of cognitive-motor dual-task interventions on cognitive, physical and dual-task functions, as well as exergames on cognitive functions only, were observed in cognitively healthy older adults. In contrast, the effects of exergames on physical functions are more controversial, and their effects on dual-task functions have not been studied. The feasibility, safety, adherence, transfer and retention of benefits for both intervention types are still unclear. Future studies should follow more rigorous methodological standards in order to improve the quality of evidence and provide guidelines for the use of cognitive-motor dual-task and exergame interventions in older adults.

Effects of A "Modified" Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model

Strength and balance exercises form part of multifactorial programs to reduce the risk of falling and promote active ageing. The aim of this study was to evaluate the effect of a strength and balance exercise program, adapted from the traditional Otago Exercise Program (OTAGO) into a technological system. A non-randomized experimental study enrolled 34 participants (83.24 ± 6.89 years) from a daycare center in Portugal, who were distributed into an intervention group (IG; 18 participants) and a control group (CG; 16 participants). The IG underwent a "modified" OTAGO incorporated in a technological system using pressure and inertial sensors, feedback, and Exergames for 8 weeks, 3 times a week. The CG continued their regular activities. Outcome measures were evaluated at baseline and after 8 weeks of intervention. After the program, differences were observed between the groups in handgrip strength (p = 0.03), step test (p = 0.03), 4stage balance test "modified" (p < 0.001) and activities and participation profile related to mobility (PAPM) (p < 0.001). The IG showed positive results in the self-efficacy for exercise (p = 0.03), PAPM (p = 0.00) and all functional tests, except for timed up and go (p = 0.35). No significant changes were observed in the CG. The results support this intervention program as a good exercise solution to improve functional abilities, social participation, and self-efficacy, reducing the risk of falling.

Effects of physical training with the Nintendo Wii Fit Plus® and protein supplementation on musculoskeletal function and the risk of falls in pre-frail older women: Protocol for a randomized controlled clinical trial (the WiiProtein study)

BACKGROUND

Frailty is one of the key geriatric syndromes and is related to the loss of functional independence. However, the practice of physical training (PT) combined with protein supplementation (PS) may improve musculoskeletal function (MF).

OBJECTIVE

To verify the effect of PT using 'exergames' with or without PS on MF, nutritional status, and risk of falls in pre-frail older women.

METHOD

The protocol is for a randomized controlled clinical trial with a sample of pre-frail older women, divided into 5 groups: control group; PT using exergames; PS; PT using exergames combined with PS; PT using exergames combined with isoenergetic supplementation. The primary outcomes will be: the strength and power of the lower limbs, assessed by isokinetic dynamometer and the sit-and-stand test carried out 5 times; muscle architecture, assessed by ultrasound; body composition, assessed by anthropometric measurements, bioelectrical impedance and dual energy X-ray absorptiometry; and functional mobility and risk of falls, assessed using the Timed-Up and Go test. The secondary outcomes will be: centre of pressure (CoP), assessed using a force plate; and fear of falling, assessed using the Falls Efficacy Scale - International, Brazil. PT using exergames with a gradual increase in the mass weighted vest will be carried out twice a week for 50 min over 3 months. The supplements will be ingested 5 days a week for 3 months. All outcomes will be assessed before and after 3 months.

DISCUSSION

The WiiProtein study will be the first clinical trial to examine the effects of PT using exergames with progressive resistance, which may or may not be combined with PS, on MF, nutritional status, and risk of falls in pre-frail older women.

Exergame technology and interactive interventions for elderly fall prevention: A systematic literature review

Training balance and promoting physical activities in the elderly can contribute to fall-prevention. Due to the low adherence of conventional physical therapy, fall interventions through exergame technologies are emerging. The purpose of this review study is to synthesize the available research reported on exergame technology and interactive interventions for fall prevention in the older population. Twenty-five relevant papers retrieved from five major databases were critically reviewed and analyzed. Results showed that the most common exergaming device for fall intervention was Nintendo Wii, followed by Xbox Kinect. Even though the exergame intervention protocols and outcome measures for assessing intervention effectiveness varied, the accumulated evidences revealed that exergame interventions improved physical or cognitive functions in the elderly. However, it remains inconclusive whether or not the exergame-based intervention for the elderly fall prevention is superior to conventional physical therapy and the effect mechanism of the exergaming on elderly's balance ability is still unclear.