Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: a randomized controlled trial

Effectiveness of a multicomponent exercise intervention in community-dwelling older Chinese people with cognitive frailty: protocol for a mixed-methods research

Aims

To evaluate the effectiveness of a multicomponent exercise intervention and to clarify the underlying mechanisms of the program in community-dwelling older adults with cognitive frailty. Additionally, the perception of participants in the program will be explored.

Design

A mixed-methods design, including a randomized controlled trial and an exploratory qualitative study, was used.

Methods

Each group consists of 41 participants. The experimental group will undergo a 12-week multicomponent exercise intervention, including warm-up, exergaming aerobic exercise, elastic-band resistance exercise, and cool-down. This intervention was developed based on the Health Belief Model (HBM) and Self-Efficacy Model (SEM). The control group will not receive any intervention. Physical frailty and cognitive function will be considered as primary outcomes. Data will be collected both at baseline and at the end of the intervention period. Fisher's exact test, analysis of covariance, and generalized linear models will be conducted to compare mean changes between the two groups. Additionally, the mediation models will be used to examine whether any intervention effects are mediated through exercise self-efficacy.

Discussion

The findings of this study are anticipated to provide valuable insights for healthcare providers, enabling them to learn about effective strategies to enhance exercise adherence and promote improved functionality, independence, and quality of life for older adults with cognitive frailty.Clinical trial registration: [https://clinicaltrials.gov/], identifier [ChiCTR2200058850].

Effects of Exergames and Conventional Physical Therapy on Functional Physical Performance in Older Adults: A Randomized Controlled Trial

Objective: To evaluate the effects of exergames added to a conventional physical therapy (CPT) program on functional fitness and dynamometric muscle performance for the sit-to-stand (STS) maneuver in older adults and to compare their results concerning a CPT-only intervention. Materials and Methods: Fifty independent older adults were randomly assigned to CPT and exergames (CPT+ExG group; n = 25; age = 71.8 ± 6.8 years) or CPT alone (CPT group; n = 25; age = 71.3 ± 7.4 years). CPT was performed twice a week (60 min/session) for 8 weeks. The CPT+ExG group added exergames for 30 minutes in each session. The Senior Fitness Test was applied, considering the 30-second chair stand test as the primary outcome. Additionally, dynamometric muscle performance during the STS maneuver was assessed. Results: The CPT+ExG group improved the 30-second chair stand (lower body strength), back scratch (upper body flexibility), and 8-foot up-and-go (agility/dynamic balance) tests (all P < 0.05). Both groups improved the kinetic dynamometric variables peak force, peak power, and total work (all P < 0.05). Also, both groups improved the 30-second arm curl test (upper body strength) (P < 0.05), although the increase was higher in the CPT+ExG group compared with the CPT group (time × group; P < 0.05). Conclusion: Adding exergames to a CPT program only significantly increases upper limb strength compared with CPT alone. The findings of this study have implications for the design of future exergame interventions focused on improving STS maneuver performance in older adults.

Feasibility, effectiveness and acceptability of two perturbation-based treadmill training protocols to improve reactive balance in fall-prone older adults (FEATURE): protocol for a pilot randomised controlled trial

INTRODUCTION

Perturbation-based balance training (PBT) targets the mechanism of falls (eg, slipping, tripping) to specifically train the recovery actions needed to avoid a fall. This task-specific training has shown great promise as an effective and efficient intervention for fall prevention in older adults. However, knowledge about the dose-response relationship of PBT, as well as its feasibility and acceptability in older adults with increased risk of falling is still limited. Thus, the aim of this study is to compare the effectiveness of two different treadmill PBT protocols for improving reactive balance control in fall-prone older adults, and to evaluate the feasibility and acceptability of these protocols.

METHODS AND ANALYSIS

The study is designed as a pilot randomised controlled trial with a 6-week intervention and 6-week follow-up period. Thirty-six community-dwelling, fall-prone (Timed Up and Go >12 s, habitual gait speed <1.0 m/s and/or fall history) older adults will be randomised (1:1) to receive six (weeks 1-6) or two treadmill PBT sessions (weeks 1+6) plus four conventional treadmill training sessions (weeks 2-5). Training sessions are conducted 1×/week for 30 min. Each PBT will include 40 perturbations in anterior-posterior and mediolateral directions. Reactive balance after perturbations in standing (Stepping Threshold Test (STT)) and walking (Dynamic Stepping Threshold Test (DSTT)) will be assessed as the primary outcome for effectiveness. Secondary outcomes are spatiotemporal and kinematic parameters collected during STT, DSTT and PBT, maximum perturbation magnitude for each PBT session, static and dynamic balance, physical capacity, physical activity, concerns with falling and executive functions. Feasibility will be assessed via training adherence, drop-out rate, perturbations actually performed and adverse events; and acceptability via self-designed questionnaire and focus groups.

ETHICS AND DISSEMINATION

The study has been approved by the Ethics Committee of the Medical Faculty Heidelberg (S-602/2022). Findings will be disseminated through publications in peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

DRKS00030805.

Using shoe-mounted inertial sensors and stepping exergames to assess the motor-cognitive status of older adults: A correlational study

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.

Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention

BACKGROUND

Side-stepping is a potential exercise program to reduce fall risk in community-dwelling adults in their seventies, but it has never been tested in nursing home residents. This was a pilot quasi-experimental study to examine the feasibility and potential mobility and balance benefits of an intervention based on voluntary non-targeted side-stepping exercises in nursing home residents who fall recurrently.

METHODS

Twenty-two participants were recruited and non-randomly assigned to an intervention group ([Formula: see text]11, side-stepping exercises, STEP) participating in an 8-week protocol and to a control group ([Formula: see text]11, usual physiotherapy care, CTRL). They were clinically assessed at 4-time points: baseline, after 4 and 8 weeks, and after a 4-week follow-up period (usual physiotherapy care). Statistical differences between time points were assessed with a Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA.

RESULTS

Compared to baseline, significant benefits were observed in the STEP group at 8 weeks for the Timed Up and Go ([Formula: see text]0.020) and 6-minute walking test ([Formula: see text]0.001) as well as for the Berg Balance Scale ([Formula: see text]0.041) and Mini motor test ([Formula: see text]0.026). At follow-up, the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale significantly worsened in the STEP group ([Formula: see text]0.009 and [Formula: see text]0.001, respectively). No significant differences were found between the groups at the same time points.

CONCLUSIONS

Our intervention was feasible and improved mobility and balance after almost 8 weeks. Studies with larger samples and randomized control trials are needed to consolidate our preliminary observations and confirm the deterioration of some tests when side-stepping exercises are discontinued.

TRIAL REGISTRATION

Identifier: ISRCTN13584053. Retrospectively registered 01/09/2022.

A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults

BACKGROUND

Balance impairment causes frequent falls in older adults, and preventing falls remains challenging. Dual-task (DT) training reduces falls by improving balance, but the precise theory is not fully understood. This review aims to explore the theories underlying the effectiveness of DT in improving balance and reducing falls in older adults.

METHODS

Eleven electronic databases were searched from database inception to June 2022. Two reviewers independently performed study screening and data extraction. The risk of bias (RoB) in the included studies was assessed using the Cochrane Collaboration RoB 2 tool.

RESULTS

The searches yielded 1478 citations, of which 30 studies met the inclusion criteria and were included in the review. Twenty-two of the 30 included studies utilized the motor-cognitive type of DT for training, while six used motor-motor and two utilized cognitive-cognitive DT. The included studies reported 20 different theories to explain the effectiveness of DT for improving balance and reducing falls in older adults. The predominant theory identified in the included studies was attention theory (n = 14). Overall, 26 studies reported improved balance and five studies found a reduction in fall incidence following DT training. Balance and falls improved significantly in 15 motor-cognitive DT intervention studies.

CONCLUSION

Attention shifting between two tasks is reported to occur following DT training. Motor-cognitive DT training improves balance and reduces fall incidence in older adults by shifting attention based on the difficulty and priority of a task from the motor to the cognitive task.

Evaluation of a Novel Step Training Mobile App Intervention in Cardiopulmonary Rehabilitation: A Single-Arm Prospective Cohort Study

Objective: To establish the usability, acceptability, safety, and exercise adherence of a step training mobile app. Design: A single-arm prospective cohort study. Setting: Royal Brisbane and Women's Hospital, Australia. Subjects: Twenty-six cardiopulmonary rehabilitation participants. Intervention: Twelve weeks of step training using the mobile app Clock Yourself. Participants used Clock Yourself at home and during cardiopulmonary rehabilitation sessions, prescribed for a total of 15-20 minutes three times a week. Main Measures: The primary outcomes of interest were usability and acceptability and were measured using the System Usability Scale (SUS) and Attitudes to Falls-Related Interventions Scale (AFRIS) questionnaire, respectively. Safety and adherence were measured by self-report and participant diary, respectively. Secondary outcomes measuring changes in stepping, gait, balance, and physical performance included Manual test of Choice Stepping Reaction Time (CSRT-M), Short Physical Performance Battery (SPPB), Gait speed with and without a cognitive dual task (DT) and Timed Up and Go with and without a cognitive DT (TUG and TUGcog). Results: Twenty-one participants completed the study. Clock Yourself was considered highly useable (SUS [median] = 82.5/100; interquartile range [IQR, 67.5-95], equating to an "A" rating [A-F scale]) and acceptable (AFRIS [median] = 38/42 [IQR, 31-41]). Participants practiced Clock Yourself for a median of 18.29 minutes per week and no adverse events were reported. At 12 weeks, mean change in CSRT-M, SPPB, gait speed, DT gait speed, TUG, and TUGcog were all statistically significant (P < 0.01). Conclusion: Twelve weeks of mobile app-based step training was safe and considered usable and acceptable by participants. On average, participants did not meet the prescribed practice dosage. Statistically significant changes were observed in all physical measures; however, results are confounded by participation in cardiopulmonary rehabilitation and lack of control group.

Effects and Feasibility of a Memory Exergame Training in Older Adults: A Randomized Controlled Trial

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; η_p² = 0.238-0.335) and one level of condition 2 (P < 0.001, η_p² = 0.267), for the subtotal game score of condition 1 (P = 0.002; η_p² = 0.186), and for the total game score (P = 0.005; η_p² = 0.162). Improvements were partially sustained 3 months after training cessation (P = 0.008-0.039, η_p² = 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.

The Effects of a Home-Based Combined Motor Control and Ergonomic Program on Functional Ability and Fear of Falling: A Randomized Controlled Trial

Objectives

Physical exercise is a key intervention for improving functional ability and preventing falls in older people. However, the implemented interventions targeted balance, gait, and muscle strength, while little is known regarding motor control exercises in this population. Therefore, this study aimed to investigate the effects of a 12-week home-based motor control exercise program combined with an ergonomic home modification (the McHeELP program).

Patients and methods

Fifty-two older people (aged ≥65 years), who had experienced at least one fall incident in the past 12 months, were randomly assigned into two groups; the McHeELP group (McHeELP-G) (n=26) that received the McHeELP program and the control group (CG) (n=26). Physical performance measures (PPMs) and patient-reported outcomes (PROs) were used to evaluate participants. At baseline, 3rd month (post-intervention), and again at 6th month (follow up), balance control was assessed using the Tandem stance test (Tandem) and the Functional Reach Test (FRT). Functionality was assessed by the 4 meters walking test (4MWT), Timed Up and Go (TUG) test, 30 seconds-Sit to stand test and the Greek version of Lower Extremity Functional Scale (LEFS-Greek). The Greek version of the Falls Self-efficacy International scale (FES-I_GREEK) was used for the evaluation of "fear-of-falling" (FOF). The home falls and accidents screening tool (HOMEFAST) is used to identify home hazards. Two-way mixed ANOVA model, independent samples t-test, One-factor Repeated Measures ANOVA model and ANCOVA model were used for the statistical analysis of the data.

Results

Homogeneity was found between McHeELP-G and CG regarding the demographic and clinical characteristics, and no statistically significant difference was found at baseline measurements of PROs and PPMs, except HOMEFAST (p=0.031). Post-intervention (3rd month), the comparison of the absolute values between groups revealed that the McHeELP-G achieved statistically significant better balance control (longer Tandem stance test and higher values of FRT), better functionality [faster gait speed (4MWT), shorter TUG performance time, and a higher number of repetitions at 30 seconds-Sit to stand] (all p-values <0.05), while no difference was found for LEFS-Greek score (p=0.095), compared to CG. In addition, McHeELP-G reported lesser FOF than CG [lower FES-I_GREEK score (p=0.041)], and fewer home-hazards [lower HOMEFAST score (p=0.041)]. At follow up measurement (6th month), all PPMs scores of McHeELP-G, regarding balance control and functionality, were remained statistically significant (all p-values <0.005), and the FES-I_GREEK score (p=0.034), while no difference was found between groups for LEFS-Greek score (p=0.146) and HOMEFAST score (p=0.185). Sensitivity analysis (from baseline to 3rd and 6th month) revealed similar findings to the "comparison of the absolute values between groups" analysis. The within-group changes from baseline to 3rd month of McHeELP-G were statistically significant improved for all PPMs and PROs (all p-values <0.05), while in CG, statistical significant difference was found for TUG, FRT-right, and HOMEFAST (p<0.05). Those within-group changes were also preserved until 6th month.

Conclusions

The study's findings provide encouraging evidence that McHeELP program may increase functional ability and decrease FOF of older people. However, further research is required for a thorough understanding of the effect of McHeELP program. 

PUP® (Patient Is Up) Smart Sock Technology Prevents Falls Among Hospital Patients With High Fall Risk in a Clinical Trial and Observational Study

Hospital inpatient falls, especially of older adult patients, can result in injury and death and generate high costs. A new technology, PUP^® (Patient Is Up) Smart Socks, combines sensors and geolocation in socks with a wireless platform. To determine whether these socks prevent falls of patients with high fall risk, we performed a clinical trial at one hospital, and an observational study at two other hospitals. In the clinical trial, patients spent 1,694 patient-days wearing the socks, reducing falls from 4 to 0 per 1,000 patient-days (p < 0.01). In the observational study, patients spent 2,286 patient-days wearing the socks, reducing falls from 4 to 1.3 per 1,000 patient-days (p < 0.05). The new technology resulted in a significant reduction in fall rates among patients with high fall risk and may greatly reduce inpatient fall-related injury and death and their associated costs. [Journal of Gerontological Nursing, 47(10), 37-43.].

Combining Stochastic Resonance Vibration With Exergaming for Motor-Cognitive Training in Long-Term Care; A Sham-Control Randomized Controlled Pilot Trial

Purpose: Physical and mental functions allow classifying older adults as “Go-Go” (independent functioning); “Slow-Go” (in need of care with a slight handicap); and “No-Go” (in need of care with severe functional limitation). The latter group exhibits reduced exercise tolerance. More recently technology-based motor-cognitive types of training services emerged as a possible training service. This study examined the use of technology including stochastic resonance whole-body vibration and Exergame-dance training for motor-cognitive training in care home dwelling adults.

Methods: Seventeen older adults (10 women, 7 men, age range: 79–98) were randomly assigned to the intervention (IG, n = 9) or the sham group (SG, n = 8). IG performed five sets of 1-min whole-body vibration with 1-min rest in between, three times a week for the first 4 weeks of the training period with varying frequency. From weeks five to eight the Exergame-dance training was conducted after the vibration sessions. SG performed a stochastic resonance whole-body vibration training with the same terms applied, however, with a fixed frequency of 1 Hz, Noise 1. From weeks five to eight a passive trampoline-programme of 5 min was applied following the vibration sessions. Primary outcome was the Short Physical Performance Battery (SPPB). Secondary outcomes were the Trail Making Test A and B (TMT A & B) and the Falls Efficacy Scale–International (FES-I). Outcomes were measured at baseline, after 4 and 8 weeks of intervention and at follow-up (4 weeks after the intervention). The non-parametric Puri and Sen rank-order test was applied, followed by an ANOVA for repeated measures to analyse main and interaction effects. Mann–Whitney U-Test was used to determine differences between the groups.

Results: The post-hoc analysis showed significant effects on the SPPB total score with large effect sizes from baseline to 8 weeks (+72%, p = 0.005, η² = 0.423). The TMT part B displayed significant improvements with large effect sizes from baseline to 8 weeks (+17.5%, p = 0.002, η² = 0.779) and to follow-up (+21%, p = 0.001, η² = 0.827).

Conclusion: The technology based 8-week training programme consisting of a combination of stochastic resonance whole-body vibration and Exergame-dance training showed beneficial effects on both physical and cognitive performance in older care home dwelling adults.