Are exergames promoting mobility an attractive alternative to conventional self-regulated exercises for elderly people in a rehabilitation setting? Study protocol of a randomized controlled trial

The influence of multiple cognitive workload levels of an exergame on dorsal attention network connectivity at the source level

This study investigates how adding a cognitive task on a balance board (exergame) affects connectivity in the dorsal attention network (DAN) during an exergame task. Healthy young adults performed a soccer ball-moving task by tilting a balance board with their feet while their brain activity was measured using electroencephalography (EEG). In this exergame, the speed of obstacles in front of the goal manipulated the cognitive workload. Higher speed means a higher cognitive workload. The study found significant changes in functional connectivity within DAN regions, specifically in the alpha band. During the shift from easy to medium cognitive task, we observed a significant increase in connectivity (p= 0.0436) between the right inferior temporal (ITG R) and the Left middle temporal (MTG L). During the transition from easy to hard cognitive tasks, strengthened interactions (p= 0.0324) between inferior temporal (ITG) and parsopercularis (pOPPER) were found. This suggests that the proposed balanceboard-based exergame enhances the functionality of specific brain regions, such as ITG and MTG regions, and improves connectivity in the frontal cortex. We also found a correlation between brain activity and performance data, highlighting that increased cognitive workload resulted in decreased performance and heightened frontal alpha activity. These findings align with research suggesting that adding cognitive games to physical activity-based tasks in rehabilitation programs can boost brain activity, resulting in improved decision-making and visual processing skills. This information can help clinicians tailor rehabilitation methods that target specific brain regions.

Effects of kinect-based virtual reality training on bone mineral density and fracture risk in postmenopausal women with osteopenia: a randomized controlled trial

Osteopenia is a condition characterized by low bone mineral density (BMD) that increases fracture risk, particularly among postmenopausal women (PMW). This study aimed to determine the effects of Kinect-based VRT on BMD and fracture risk in PMW with osteopenia. The study was a prospective, two-arm, parallel-design, randomized controlled trial. The study enrolled 52 participants, 26 randomly assigned to each group. In the experimental group, Kinect-based VRT was provided thrice weekly for 24 weeks for 45 min/session. Both groups were instructed to engage in a daily 30-min walk outdoors. The fracture risk assessment tool (FRAX) was used to calculate fracture risk, and dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. Both variables were assessed at baseline and 24 weeks afterwards. After 24 weeks of Kinect-based VRT, the experimental group showed significant BMD increases in the right and left femoral necks and lumbar spine (p value < 0.001). In the control group, the BMD at the right and left femoral necks showed fewer significant changes (p value < 0.022 and 0.004, respectively). In the control group, lumbar spine BMD did not change (p = 0.57). The experimental group showed significantly lower FRAX scores for hip fracture prediction (HFP) and hip prediction of major osteoporotic (HPMO) at both femoral necks (p value < 0.001) than the control group (p = 0.05 and p = 0.01, respectively), but no significant change at the left femoral neck for HFP (p = 0.66) or HPMO (p = 0.26). These findings indicate that a Kinect-based VRT intervention resulted in significantly increased BMD and a reduced fracture risk, as predicted by HFP and HPMO measurements. These improvements were more pronounced in the experimental group than in the control group. Thus, Kinect-based VRT may be utilized as an effective intervention to improve BMD and reduce fracture risk in postmenopausal women with osteopenia.

Immersive Virtual Reality Fitness Games to Improve Recovery After Colorectal Surgery: A Randomized Single Blind Controlled Pilot Trial

Introduction: Early mobilization after surgery is crucial for reducing postoperative complications and restoring patients' fitness and ability to care for themselves. Immersive, activity-promoting fitness games in virtual reality (VR) can be used as a low-cost motivational adjunct to standard physiotherapy to promote recovery after surgery. In addition, they have potentially positive effects on mood and well-being, which are often compromised after colorectal surgery. The purpose of this pilot study was to evaluate the feasibility and clinical outcomes of a VR-based intervention that provides additional mobilization. Methods: Patients undergoing curative surgery for colorectal cancer were randomly assigned to an intervention group or a control group. Participants in the intervention group (VR group) received daily bedside fitness exercises using immersive, activity-promoting, virtual reality fitness games in addition to standard care during their postoperative hospital stay. Results: A total of 62 patients were randomized. The feasibility outcomes were in line with the predefined goals. In the VR group, an improvement in overall mood (+0.76 points; 95% confidence interval [CI] 0.39 to 1.12; P < 0.001) and a shift toward positive feelings were observed. The median length of hospital stay was 7.0 days in the VR group compared with 9.0 days in the control group, but the difference (2.0 days) did not reach statistical significance (95% CI -0.0001 to 3.00; P = 0.076). Surgical outcomes, health status, and measures of distress did not differ between groups. Conclusions: The study demonstrated the feasibility of a VR intervention that improved overall mood and showed a desirable effect on feelings and length of hospital stay after colorectal surgery. The results should stimulate further research investigating the potential of VR as an adjunct to physiotherapy to enhance mobilization after surgery.

Physical and Affective Physical Literacy Domains Improved After a Six-Week Exergame Exercise Program in Older Adults: A Randomized Controlled Clinical Trial

Introduction: We investigated the effects of an exergames-based exercise program for older adults, and its benefits on their physical literacy (PL) domains, such as physical (mobility skills), affective (motivation and confidence), cognitive (knowledge about physical activity [PA]), and behavioral (daily exertion) when compared with a conventional exercise program and no training (NT) (control). Material and Methods: Forty older adults (mean age 72 years) volunteered and were randomized within three groups-exergame training (ET; n = 15), conventional training (CT; n = 14), and NT (n = 11). ET group performed training sessions based on a commercially available exergame console, while the CT group enrolled in a convention exercise program (aerobic, strength, balance, and flexibility exercises). The training program was conducted three times a week for 6 weeks. The Timed Up and Go Test (TUG), Exercise Confidence Survey (ECS), Motives for Physical Activity Measure-Revised (MPAM-R), Knowledge and Understanding Questionnaire (K&UQ), and total PA tracking (using wearable technology) were used as the study's outcomes. Outcome variables were measured at preintervention (week 0), postintervention (week 6), and at the time of final follow-up (week 9). Results: We observed a reduction in the ET TUG time at postintervention and follow-up. Also, a significant main effect for group and moment of measurement was observed for the Fitness-Health subscore, derived from MPAM-R. The values demonstrated by ET and CT were statistically different (P = 0.01) and a within-group comparison revealed significant differences in the ET from preintervention to both postintervention and follow-up (both, P = 0.01). We did not observe any other significant difference. Conclusion: Our results suggest that a 6-week exergame-based training program may have the potential in improving the physical and affective domains of PL in community-dwelling older adults. The topics related to fitness and health seem to be of interest in this population and programs can make use of them to improve the PL domains.

The effect of virtual reality technology on anti-fall ability and bone mineral density of the elderly with osteoporosis in an elderly care institution

OBJECTIVE

To explore the impact of virtual reality (VR) training on anti-fall ability and bone mineral density (BMD) among elderly patients admitted to a healthcare institution.

METHODS

People (aged 50) with osteoporosis in an elderly care institution in Anhui Province June 2020 to October 2021 were selected and randomly divided into VR group (n = 25) and control group (n = 25). In VR group, the virtual reality rehabilitation training system was used for training, while control group was treated with traditional fall prevention exercise intervention. The changes of Berg Balance Scale (BBS), timed up and go test (TUGT), functional gait assessment (FGA), bone mineral density (BMD) and falls during 12 months of training were compared between the two groups.

RESULTS

BBS and FGA were positively correlated with BMD of the lumbar vertebrae and femoral neck, and TUGT was negatively correlated with BMD of the lumbar vertebrae and femoral neck. After 12 months of training, the BBS score, TUGT evaluation and FGA evaluation of the two groups were significantly improved compared with those prior to training (P < 0.05). However, there was no significant difference in the lumbar spine and femoral neck BMD between the two groups 6 months after the intervention. The femoral neck and lumbar spine BMD of the VR group improved, and it was significantly higher than that of the control group 12 months after the intervention. Nevertheless, there was no significant difference in terms of the incidence of adverse events between the two groups.

CONCLUSION

VR training can improve anti-fall ability and increase femoral neck and lumbar spine BMD and can effectively prevent and reduce the risk of injury among elderly people with osteoporosis.

Immersive virtual reality fitness games for enhancement of recovery after colorectal surgery: study protocol for a randomised pilot trial

BACKGROUND

Physical inactivity after surgery is an important risk factor for postoperative complications. Compared to conventional physiotherapy, activity-promoting video games are often more motivating and engaging for patients with physical impairments. This effect could be enhanced by immersive virtual reality (VR) applications that visually, aurally and haptically simulate a virtual environment and provide a more interactive experience. The use of VR-based fitness games in the early postoperative phase could contribute to improved mobilisation and have beneficial psychological effects. Currently, there is no data on the use of VR-based fitness games in the early postoperative period after colorectal surgery.

METHODS

This pilot trial features a single-centre, randomised, two-arm study design with a 1:1 allocation. Patients undergoing elective abdominal surgery for colorectal cancer or liver metastases of colorectal cancer will be recruited. Participants will be randomly assigned to an intervention group or a control group. Patients randomised to the intervention group will perform immersive virtual reality-based fitness exercises during their postoperative hospital stay. Feasibility and clinical outcomes will be assessed.

DISCUSSION

Early mobilisation after surgery is crucial for reducing many postoperative complications. VR-based interventions are easy to use and often inexpensive, especially compared to interventions that require more medical staff and equipment. VR-based interventions could serve as an alternative or complement to regular physiotherapy and enhance mobilisation after surgery. The proposed pilot study will be the first step to evaluate the feasibility of VR-based interventions in the perioperative period, with the aim of improving the postoperative rehabilitation of cancer patients.

TRIAL REGISTRATION

The trial has been registered in the German Clinical Trials Register (DRKS) Nr. DRKS00024888 , on April 13, 2021, WHO Universal Trial Number (UTN) U1111-1261-5968.

Motor Performance and Skill Acquisition in Oral Motor Training With Exergames: A Pilot Study

Objective

To investigate the effects of oral-motor training with exergames on motor performance and motor skill acquisition in two different age groups.

Methods

Thirty-two healthy participants were recruited in the current pilot study and divided equally into two groups (Gen Z and Baby Boomers) according to their age. A pair of electromyographic (EMG) electrodes were placed on the participants’ masseter muscles. The EMG device communicated via Bluetooth with a mobile video game in response to the electromyographic activity of the masseter muscles during clenching. During the experimental session, participants were asked to play a video game in five blocks of 5 min each, with a 3-min break between each time block. The goal of the game was to collect as many coins (game points) as possible and to dodge/avoid upcoming obstacles (game life). Motor performance was assessed by performance scores and the number of game lives. Skill acquisition was measured by task efficiency (ratio of performance scores and number of game lives) across time blocks.

Results

The results of the study showed significantly lower performance scores (p < 0.001), a higher number of game lives (p < 0.001), and lower task efficiency in the Baby Boomer group compared to the Gen Z group. Specifically, the results showed that there was a significant difference in task efficiency between the first and second, third and fourth, fourth- and fifth-time blocks in the Gen Z group (p < 0.002). However, there was only a significant difference between first- and second-time blocks in the Baby Boomer group (p = 1.012), suggesting that skill acquisition in the Baby Boomer group did not change significantly over the course of the time blocks.

Conclusion

The study showed higher motor performance and superior motor skill acquisition with novel exergame training in the Gen Z group compared to the Baby Boomer group. The results of the study indicate that there is an improvement in oral motor skills with short-term training, yet the differences in oral motor skills between the two groups are still evident. The Baby Boomer group, unlike the Gen Z group, did not show robust improvement in task efficiency over the course of the series.

Effectiveness of virtual reality technology on functional mobility of older adults: systematic review and meta-analysis

BACKGROUND

The accessibility, versatility and motivation provided by virtual reality technology (VRT) have fostered its rapid expansion as a rehabilitation technique to improve functional mobility. The aim of this study was to investigate the effectiveness of rehabilitation programmes using VRT, specific virtual reality technology (VRT-S) and non-specific virtual reality technology (VRT-NS), to improve functional mobility in individuals aged >60 years versus conventional treatment (CT) or no intervention.

METHODS

Nine databases (Cochrane Library, Scopus, PEDro, Medline, CSIC, Web of Science, OT Seeker, NGCH and CINAHL) were searched to identify randomised trials up to December 2019. Results of clinical trials that used VRT-S and VRT-NS in rehabilitation were combined, using a random effects model with inverse variance weighting of the studies. GRADE was used to assess the quality of evidence. The protocol was registered in PROSPERO: CRD42019131630. Overall, there was moderate quality of evidence for the functional mobility results, which means that the estimate of effect is likely to change.

RESULTS

Sixteen of the 18 studies selected (n = 568) provided data for the subgroup meta-analysis. VRT-NS was more effective in improving functional mobility than no intervention [standardised mean difference (SMD) = -1.02; 95% confidence interval (CI) -1,91 to -0,14). VRT-NS was also more effective than CT in improving resistance in ambulation (SMD = -1.20; 95% CI -1.93 to 0.46). No significant differences were found between VRT-S and CT or no intervention. Programmes in which >18 sessions were applied were more beneficial (SMD = -0.89; 95% CI -1.71 to -0.08; <0.001) than programmes with ≤18 sessions (SMD = 0.04; 95% CI -0.51 to 0.59) versus no intervention.

CONCLUSIONS

Our results suggest that VRT is an effective intervention for improving functional mobility in older persons compared with CT. VRT-NS proved to be more effective than VRT-S. However, these results are still not conclusive due to the low methodological quality of the studies. Thus, new studies and analyses are required.

Design and Evaluation of an Augmented Reality-Based Exergame System to Reduce Fall Risk in the Elderly

Falls are a major public health concern in today’s aging society. Virtual reality (VR) technology is a promising method for reducing fall risk. However, the absence of representations of the user’s body in a VR environment lessens the spatial sense of presence. In terms of user experience, augmented reality (AR) can provide a higher degree of presence and embodiment than VR. We developed an AR-based exergame system that is specifically designed for the elderly to reduce fall risk. Kinect2.0 was used to capture and generate 3D models of the elderly and immerse them in an interactive virtual environment. The software included three functional modules: fall risk assessment, cognitive–motor intervention (CMI) training, and training feedback. The User Experience Questionnaire (UEQ-S) was used to evaluate user experience. Twenty-five elders were enrolled in the study. It was shown that the average scores for each aspect were: pragmatic quality score (1.652 ± 0.868); hedonic quality score (1.880 ± 0.962); and overall score was 1.776 ± 0.819. The overall score was higher than 0.8, which means that the system exhibited a positive user experience. After comparing the average score in a dataset product of UEQ-S Data Analysis Tool, it was found that the pragmatic quality aspect was categorized as good, while the hedonic quality aspect was categorized as excellent. It revealed a positive evaluation from users.

Exergaming for Quality of Life in Persons Living with Chronic Diseases: A Systematic Review and Meta-analysis

OBJECTIVE

To evaluate the evidence of effectiveness of exergame-based rehabilitative interventions on health-related quality of life (HRQoL) in persons with chronic diseases. TYPE: Systematic review and meta-analysis.

LITERATURE SURVEY

Randomized and nonrandomized controlled trials of exergame rehabilitation interventions in populations with chronic diseases reporting HRQoL outcomes were identified by searching PubMed, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, using keywords and MeSH terms for papers published between January 2005 and March 2019.

METHODOLOGY

Risk of bias was assessed by using the PEDro scale. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to score the quality of evidence. Pooled effects were reported as standardized mean differences (SMDs) or weighted mean difference (MDs) and 95% confidence intervals (CIs), using a random-effects model. Heterogeneity was weighted by inconsistency I² tests.

SYNTHESIS

Thirty-four trials were identified (1594 participants). Overall, the evidence was low quality. Exergames significantly improved HRQoL in populations with chronic diseases, with a small effect size (32 studies; 1544 participants; SMD 0.24; 95% CI 0.1 to 0.4; I²  = 27%) and specifically in people with neurological disorders (20 studies, 956 participants, SMD 0.22; 95% CI 0.2 to 0.4; I²  = 49%), rheumatologic diseases (four studies, 210 participants, SMD 0.39; 95% CI 0.1 to 0.7; I²  = 4%), and cardiorespiratory and chronic metabolic conditions (five studies, 309 participants, SMD 0.23; 95% CI 0.0 to 0.5; I²  = 0%). Exergaming interventions in health care settings demonstrated similarly small but positive effects (22 studies, 905 participants, SMD 0.30; 95% CI 0.1 to 0.5; I²  = 41%), whereas those carried out in home-based contexts did not.

CONCLUSIONS

Exergame-based rehabilitative interventions performed in health care settings led to small but statistically significant improvements in HRQoL in persons with chronic diseases.

Interactive video game-based approaches improve mobility and mood in older adults: A nonrandomized, controlled tri̇al

BACKGROUND AND PURPOSE

Recently, technology-based approaches have become more frequently used in the field of rehabilitation. The aim of this study was to evaluate the effectiveness of interactive video games on mobility, general mood, and quality of life and compare them with physical activity approaches in older adults.

METHODS

Ninety-one residents of a nursing home were assessed and 58 volunteers who met the criteria were included in the study. Participants in Group I (n = 16) participated in a 30-min exercise program using the "Nintendo Wii Fit Plus" twice a week for 8 weeks. Group II (n = 14) participated in a physical activity program consisting of a bicycle ergometer and treadmill for the same duration. Participants were assessed pre- and post-intervention for functional mobility, general depression, and quality of life. The "Wilcoxon Signed-Rank" test was used to compare the pre- and post-treatment outcomes. The Kruskal-Wallis analysis of variance (post hoc Tukey's HSD test) was used to evaluate differences between the groups.

RESULTS

and Discussion: Post-intervention, the scores in the Berg Balance Scale increased significantly for GI and GII compared to the control group (p = 0.001, p = 0.002) Timed Up and Go Test improved for GI (p = 0.001) and 10-Meter Walk Test improved for GI (p = 0.003). Although there was a significant change in Hamilton depression score for GI and GII (p < 0.005), between-group differences were not significant.

CONCLUSIONS

Both programs demonstrated significant improvement in in all parameters. However, video-based program was more effective than physical activity, especially in mobility and balance parameters.

Study Protocol: Does an Acute Intervention of High-Intensity Physical Exercise Followed by a Brain Training Video Game Have Immediate Effects on Brain Activity of Older People During Stroop Task in fMRI?-A Randomized Controlled Trial With Crossover Design

Background: Elderly people are affected by processes leading to decline in various aspects of daily living that impair their quality of life. Regarding neurological aspects, executive functions have been shown to be valuable for daily life and to slow decline during aging. Most intervention studies intended to improve cognitive functions during aging specifically address long-term destructive processes and countermeasures. However, to an increasing degree, studies also investigate the acute benefits that prove to be useful for daily life, such as physical exercise or video games in the form of exercise video gaming (“exergaming”). Because little is known about the change in cognitive ability following acute intervention of a combination of physical exercise and video gaming, especially for older people, this work is designed as an attempt to address this matter.

Methods: This study is a randomized crossover controlled trial to test the response to an acute bout of high-intensity physical exercise followed by a short session with a brain training (Brain Age) video game in physically active and cognitively healthy older adults (60–70 years). The response is measured using Stroop task performance (cognitive task for executive function) and related brain activity assessed with functional magnetic resonance imaging (fMRI). The control conditions are low-intensity physical exercise and Tetris for video gaming.

Discussion: This study is intended to provide insight into the alteration of executive function and its related brain activity from an acute intervention with a combination of physical exercise and video gaming in older people. The protocol might not be implementable in daily life to improve cognitive abilities. However, the results can support future studies that investigate cognition and the combination of physical exercise and video gaming. Moreover, it can provide real-life implications.

Trial registration: This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (UMIN000033054). Registered 19 July 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000037687.

Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis

BACKGROUND

The range of benefits associated with regular physical activity participation is irrefutable. Despite the well-known benefits, physical inactivity remains one of the major contributing factors to ill-health throughout industrialized countries. Traditional lifestyle interventions such as group education or telephone counseling are effective at increasing physical activity participation; however, physical activity levels tend to decline over time. Consumer-based wearable activity trackers that allow users to objectively monitor activity levels are now widely available and may offer an alternative method for assisting individuals to remain physically active.

OBJECTIVE

This review aimed to determine the effects of interventions utilizing consumer-based wearable activity trackers on physical activity participation and sedentary behavior when compared with interventions that do not utilize activity tracker feedback.

METHODS

A systematic review was performed searching the following databases for studies that included the use of a consumer-based wearable activity tracker to improve physical activity participation: Cochrane Controlled Register of Trials, MEDLINE, PubMed, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, SPORTDiscus, and Health Technology Assessments. Controlled trials of adults comparing the use of a consumer-based wearable activity tracker with other nonactivity tracker-based interventions were included. The main outcome measures were physical activity participation and sedentary behavior. All studies were assessed for risk of bias, and the Grades of Recommendation, Assessment, Development, and Evaluation system was used to rank the quality of evidence. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. A random-effects meta-analysis was completed on the included outcome measures to estimate the treatment effect of interventions that included an activity tracker compared with a control group.

RESULTS

There was a significant increase in daily step count (standardized mean difference [SMD] 0.24; 95% CI 0.16 to 0.33; P<.001), moderate and vigorous physical activity (SMD 0.27; 95% CI 0.15 to 0.39; P<.001), and energy expenditure (SMD 0.28; 95% CI 0.03 to 0.54; P=.03) and a nonsignificant decrease in sedentary behavior (SMD -0.20; 95% CI -0.43 to 0.03; P=.08) following the intervention versus control comparator across all studies in the meta-analyses. In general, included studies were at low risk of bias, except for performance bias. Heterogeneity varied across the included meta-analyses ranging from low (I²=3%) for daily step count through to high (I²=67%) for sedentary behavior.

CONCLUSIONS

Utilizing a consumer-based wearable activity tracker as either the primary component of an intervention or as part of a broader physical activity intervention has the potential to increase physical activity participation. As the effects of physical activity interventions are often short term, the inclusion of a consumer-based wearable activity tracker may provide an effective tool to assist health professionals to provide ongoing monitoring and support.

Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis

BACKGROUND

The range of benefits associated with regular physical activity participation is irrefutable. Despite the well-known benefits, physical inactivity remains one of the major contributing factors to ill-health throughout industrialized countries. Traditional lifestyle interventions such as group education or telephone counseling are effective at increasing physical activity participation; however, physical activity levels tend to decline over time. Consumer-based wearable activity trackers that allow users to objectively monitor activity levels are now widely available and may offer an alternative method for assisting individuals to remain physically active.

OBJECTIVE

This review aimed to determine the effects of interventions utilizing consumer-based wearable activity trackers on physical activity participation and sedentary behavior when compared with interventions that do not utilize activity tracker feedback.

METHODS

A systematic review was performed searching the following databases for studies that included the use of a consumer-based wearable activity tracker to improve physical activity participation: Cochrane Controlled Register of Trials, MEDLINE, PubMed, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, SPORTDiscus, and Health Technology Assessments. Controlled trials of adults comparing the use of a consumer-based wearable activity tracker with other nonactivity tracker-based interventions were included. The main outcome measures were physical activity participation and sedentary behavior. All studies were assessed for risk of bias, and the Grades of Recommendation, Assessment, Development, and Evaluation system was used to rank the quality of evidence. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. A random-effects meta-analysis was completed on the included outcome measures to estimate the treatment effect of interventions that included an activity tracker compared with a control group.

RESULTS

There was a significant increase in daily step count (standardized mean difference [SMD] 0.24; 95% CI 0.16 to 0.33; P<.001), moderate and vigorous physical activity (SMD 0.27; 95% CI 0.15 to 0.39; P<.001), and energy expenditure (SMD 0.28; 95% CI 0.03 to 0.54; P=.03) and a nonsignificant decrease in sedentary behavior (SMD -0.20; 95% CI -0.43 to 0.03; P=.08) following the intervention versus control comparator across all studies in the meta-analyses. In general, included studies were at low risk of bias, except for performance bias. Heterogeneity varied across the included meta-analyses ranging from low (I2=3%) for daily step count through to high (I2=67%) for sedentary behavior.

CONCLUSIONS

Utilizing a consumer-based wearable activity tracker as either the primary component of an intervention or as part of a broader physical activity intervention has the potential to increase physical activity participation. As the effects of physical activity interventions are often short term, the inclusion of a consumer-based wearable activity tracker may provide an effective tool to assist health professionals to provide ongoing monitoring and support.

Exergaming for Children and Adolescents: Strengths, Weaknesses, Opportunities and Threats

Exergaming, or active video gaming, has become an emerging trend in fitness, education and health sectors. It is defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). Since exergaming is becoming more popular, claims have been made on the usefulness of exergaming. It has, for example, been entitled as being "the future of fitness" by the American College of Sports Medicine, promoting PA and health in children and adolescents. However, research also suggests that long-term engagement in exergaming is difficult to achieve, and there is a noticeable reservation towards exergaming by parents, teachers and caregivers. To provide an overview and to outline the future directions of exergaming, the aim of this review was to critically illustrate the strengths, weaknesses, opportunities and threats of exergaming to promote PA and health in children and youth. The available evidence indicates that exergaming has the potential to improve health via an increase in PA. However, it seems that this potential is frequently underexploited, and further developments such as customized exergames are needed.

Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study

BACKGROUND

Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises.

OBJECTIVE

The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient's personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient's medical status.

METHODS

This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed.

RESULTS

The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that it would be a useful tool in their further rehabilitation, and expressed that they would like to use the game in the future. The therapists indicated that the exercise games highly meet the criteria of motor rehabilitation, and they intend to continue using the game as part of their rehabilitation treatment of patients. Comments from the patients and physiotherapists suggest that real-time corrective feedback when patients perform the exercises wrongly and a more personalized user interface with options for increasing or decreasing cognitive load are needed.

CONCLUSIONS

The results suggest that Fietsgame can be used as an alternative tool to traditional motor rehabilitation for patients with hip surgery. Lunges and squats are found to be more beneficial for patients who have relatively better balance skills. A follow-up randomized controlled study will be conducted to test the effectiveness of the Fietsgame to investigate how motivating it is over a longer period of time.

Exergames versus self-regulated exercises with instruction leaflets to improve adherence during geriatric rehabilitation: a randomized controlled trial

BACKGROUND

Improving mobility in elderly persons is a primary goal in geriatric rehabilitation. Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low. Exergames may improve adherence. This study therefore compared exergames with self-regulated exercise using instruction leaflets. The primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance during walking.

METHODS

Design: single center parallel group non-blinded randomized controlled trial with central stratified randomization.

SETTING

center for geriatric inpatient rehabilitation. Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise. Patients were assigned to self-regulated exercise using a) exergames on Windows Kinect® (exergame group EG) or b) instruction leaflets (conventional group CG). During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty minutes during ten working days. Patients reported adherence (primary outcome), enjoyment and motivation daily. Balance during walking was measured blind before and after the treatment phase with an accelerometer. Analysis was by intention to treat. Repeated measures mixed models and Cohen's d effect sizes (ES, moderate if >0.5, large if > 0.8) with 95% CIs were used to evaluate between-group effects over time. Alpha was set at 0.05.

RESULTS

From June 2014 to December 2015 217 patients were evaluated and 54 included, 26 in the EG and 28 in the CG. Adverse effects were observed in two patients in the EG who stopped because of pain during exercising. Adherence was comparable at day one (38 min. in the EG and 42 min. in the CG) and significantly higher in the CG at day 10 (54 min. in the CG while decreasing to 28 min. in the EG, p = 0.007, ES 0.94, 0.39-0.151). Benefits favoring the CG were also observed for enjoyment (p = 0.001, ES 0.88, 0.32 - 1.44) and motivation (p = 0.046, ES 0.59, 0.05-1.14)). There was no between-group effect in balance during walking.

CONCLUSIONS

Self-regulated exercise using instruction leaflets is superior to exergames regarding adherence, enjoyment and motivation in a geriatric inpatient rehabilitation setting. Effects were moderate to large. There was no between group difference in balance during walking.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02077049 , 6 February 2014.

Understanding older adults' perceptions of and attitudes towards exergames

Purpose

Maintaining physical activity is a key component of successful aging and has benefits for both physical and cognitive functioning in the older adult population. One promising method for engaging in physical activity is through exergames, which are video games designed to promote exercise. Exergames have the potential to be used by a wide range of people, including older adults, in a variety of settings, such as at home, in community living environments, or senior centers. However, exergames have not been designed for older adults (e.g., with respect to their attitudes, needs). Thus, older adults may not adopt these systems if they perceive them as not useful or relevant to them.

Method

Twenty older adults (aged 60-79) interacted with two exergames, and were then interviewed about their perceptions of the system's ease of use and usefulness, as well as their general attitudes towards the system.

Results

Participants identified the potential for exergames' usefulness for various goals, such as to increase their physical activity. However, they also reported negative attitudes concerning the system, including perceiving barriers to system use. Overall, participants said they would use the system in the future and recommend it to other people at their age for improving health, despite these use challenges.

Conclusion

The older adults were open to adopting exergames, which could provide opportunities to increase physical activity. Given the participants' overall positive perceptions of the usefulness of exergames, designers must address the perceived challenges of using these systems. Understanding barriers and facilitators for older adults' use of exergames can guide design, training, and adoption of these systems.

Person-generated Data in Self-quantification. A Health Informatics Research Program

OBJECTIVES

The availability of internet-connected mobile, wearable and ambient consumer technologies, direct-to-consumer e-services and peer-to-peer social media sites far outstrips evidence about the efficiency, effectiveness and efficacy of using them in healthcare applications. The aim of this paper is to describe one approach to build a program of health informatics research, so as to generate rich and robust evidence about health data and information processing in self-quantification and associated healthcare and health outcomes.

METHODS

The paper summarises relevant health informatics research approaches in the literature and presents an example of developing a program of research in the Health and Biomedical Informatics Centre (HaBIC) at the University of Melbourne. The paper describes this program in terms of research infrastructure, conceptual models, research design, research reporting and knowledge sharing.

RESULTS

The paper identifies key outcomes from integrative and multiple-angle approaches to investigating the management of information and data generated by use of this Centre's collection of wearable, mobiles and other devices in health self-monitoring experiments. These research results offer lessons for consumers, developers, clinical practitioners and biomedical and health informatics researchers.

CONCLUSIONS

Health informatics is increasingly called upon to make sense of emerging self-quantification and other digital health phenomena that are well beyond the conventions of healthcare in which the field of informatics originated and consolidated. To make a substantial contribution to optimise the aims, processes and outcomes of health self-quantification needs further work at scale in multi-centre collaborations for this Centre and for health informatics researchers generally.