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Mao Q, Zhang J, Yu L, Zhao Y, Luximon Y, Wang H. Effectiveness of sensor-based interventions in improving gait and balance performance in older adults: systematic review and meta-analysis of randomized controlled trials. J Neuroeng Rehabil 2024; 21:85. [PMID: 38807117 PMCID: PMC11131332 DOI: 10.1186/s12984-024-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/10/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Sensor-based interventions (SI) have been suggested as an alternative rehabilitation treatment to improve older adults' functional performance. However, the effectiveness of different sensor technologies in improving gait and balance remains unclear and requires further investigation. METHODS Ten databases (Academic Search Premier; Cumulative Index to Nursing and Allied Health Literature, Complete; Cochrane Central Register of Controlled Trials; MEDLINE; PubMed; Web of Science; OpenDissertations; Open grey; ProQuest; and Grey literature report) were searched for relevant articles published up to December 20, 2022. Conventional functional assessments, including the Timed Up and Go (TUG) test, normal gait speed, Berg Balance Scale (BBS), 6-Minute Walk Test (6MWT), and Falling Efficacy Scale-International (FES-I), were used as the evaluation outcomes reflecting gait and balance performance. We first meta-analyzed the effectiveness of SI, which included optical sensors (OPTS), perception sensors (PCPS), and wearable sensors (WS), compared with control groups, which included non-treatment intervention (NTI) and traditional physical exercise intervention (TPEI). We further conducted sub-group analysis to compare the effectiveness of SI (OPTS, PCPS, and WS) with TPEI groups and compared each SI subtype with control (NTI and TPEI) and TPEI groups. RESULTS We scanned 6255 articles and performed meta-analyses of 58 selected trials (sample size = 2713). The results showed that SI groups were significantly more effective than control or TPEI groups (p < 0.000) in improving gait and balance performance. The subgroup meta-analyses between OPTS groups and TPEI groups revealed clear statistically significant differences in effectiveness for TUG test (mean difference (MD) = - 0.681 s; p < 0.000), normal gait speed (MD = 4.244 cm/s; p < 0.000), BBS (MD = 2.325; p = 0.001), 6MWT (MD = 25.166 m; p < 0.000), and FES-I scores (MD = - 2.036; p = 0.036). PCPS groups also presented statistically significant differences with TPEI groups in gait and balance assessments for normal gait speed (MD = 4.382 cm/s; p = 0.034), BBS (MD = 1.874; p < 0.000), 6MWT (MD = 21.904 m; p < 0.000), and FES-I scores (MD = - 1.161; p < 0.000), except for the TUG test (MD = - 0.226 s; p = 0.106). There were no statistically significant differences in TUG test (MD = - 1.255 s; p = 0.101) or normal gait speed (MD = 6.682 cm/s; p = 0.109) between WS groups and control groups. CONCLUSIONS SI with biofeedback has a positive effect on gait and balance improvement among a mixed population of older adults. Specifically, OPTS and PCPS groups were statistically better than TPEI groups at improving gait and balance performance, whereas only the group comparison in BBS and 6MWT can reach the minimal clinically important difference. Moreover, WS groups showed no statistically or clinically significant positive effect on gait and balance improvement compared with control groups. More studies are recommended to verify the effectiveness of specific SI. Research registration PROSPERO platform: CRD42022362817. Registered on 7/10/2022.
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Affiliation(s)
- Qian Mao
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiaxin Zhang
- School of System Design and Intelligent Manufacturing, Southern University of Science and Technology, Shenzhen, China
| | - Lisha Yu
- School of Data Science, Lingnan University, Hong Kong, China
| | - Yang Zhao
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Yan Luximon
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hailiang Wang
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China.
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Akdağ MA, Menekşeoğlu AK, Seğmen H, Gözek B, Korkmaz MD, Güçlü B. Measuring tactile sensitivity and mixed-reality-assisted exercise for carpal tunnel syndrome by ultrasound mid-air haptics. Front Neurosci 2024; 18:1319965. [PMID: 38312930 PMCID: PMC10835795 DOI: 10.3389/fnins.2024.1319965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy, which causes numbness and pain in the thumb, the index and middle fingers and the radial side of the ring finger. Regular hand exercises may improve the symptoms and prevent carpal tunnel surgery. This study applied a novel ultrasonic stimulation method to test tactile sensitivity in CTS and also a mixed-reality-assisted (MR-assisted) exercise program which measured hand movements and provided haptic feedback for rehabilitation. Methods Twenty patients with mild unilateral CTS took part in the experiments. A mid-air haptics device (Ultrahaptics STRATOS Explore) was used to apply amplitude-modulated ultrasound waves (carrier frequency: 40 kHz) onto the skin to create tactile stimulation mechanically. Participants performed a two-alternative forced-choice task for measuring tactile thresholds at 250-Hz modulation frequency. They were tested at the index fingers and the thenar eminences of both hands. Additionally, 15 CTS patients used an MR-assisted program to do hand exercises with haptic feedback. Exercise performance was assessed by calculating errors between target and actual hand configurations. System Usability Scale (SUS) was adopted to verify the practical usability of the program. Results Thresholds at the thenar eminences of the affected and healthy hands were not significantly different. While the thresholds at the healthy index fingers could be measured, those of the affected fingers were all higher than the stimulation level produced by the maximum output from the ultrasound device. In the exercise program, a significant positive correlation (ρ = 0.89, p < 0.001) was found between the performance scores and the SUS scores, which were above the criterion value established in the literature. Discussion The results show that thenar tactile sensitivity is not affected in mild CTS as expected from the palmar cutaneous branch of the median nerve (PCBm), but index finger threshold is likely to be higher. Overall, this study suggests that mid-air haptics, with certain improvements, may be used as a preliminary test in the clinical setting. Moreover, the device is promising to develop gamified rehabilitation programs and for the treatment follow-up of CTS.
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Affiliation(s)
- Mehmet Akif Akdağ
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, Türkiye
| | - Ahmet Kıvanç Menekşeoğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
| | - Hatice Seğmen
- Department of Neurology, University of Health Sciences, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
| | - Berk Gözek
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, Türkiye
| | - Merve Damla Korkmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
| | - Burak Güçlü
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, Türkiye
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Park JH, Jeon HS, Kim JH, Kim YJ, Moon GA. Effectiveness of non-immersive virtual reality exercises for balance and gait improvement in older adults: A meta-analysis. Technol Health Care 2024; 32:1223-1238. [PMID: 37781824 DOI: 10.3233/thc-230156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Virtual reality (VR)-based physical exercise is an innovative and effective intervention strategy for healthcare in older adults. OBJECTIVE This meta-analysis aimed to clarify the effects of VR-based balance exercise programs on various balancing abilities of older adults. In addition, the effect size of each variable was computed by total exercise time, sensor type, avatar presence, and feedback type to determine influencing factors that lead to the success of VR-based rehabilitation programs. METHODS The databases searched were PubMed/Medline, CINAHL, NDSL, and Google Scholar. Inclusion criteria were: (1) independent older adults; (2) non-immersive VR exercise; (3) randomized controlled design; (4) both balance and gait data; and (5) written in English and Korean. The studies without information to compute effect sizes were excluded. Standardized mean difference was used to analyze the effect size (d). RESULTS Twenty-five studies were finally included in this study. The main findings of this meta-analysis were as follows: (1) Non-immersive VR-based balance exercises are moderately and largely effective for improving overall balance function, (2) VR balance exercise was more effective for static balance than for gait, (3) VR exercise is more effective when avatars are presented and KP is provided as feedback. CONCLUSION Total exercise time and mode of feedback are influencing factors that affect the effectiveness of VR-based balance exercises.
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Affiliation(s)
- Joo-Hee Park
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Kangwon-do, Korea
| | - Hye-Seon Jeon
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Kangwon-do, Korea
| | - Ji-Hyun Kim
- Department of Physical Therapy, The Graduate School, Yonsei University, Kangwon-do, Korea
| | - Ye Jin Kim
- Department of Physical Therapy, The Graduate School, Yonsei University, Kangwon-do, Korea
| | - Gyeong Ah Moon
- Department of Physical Therapy, The Graduate School, Yonsei University, Kangwon-do, Korea
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Chirico A, Avellone M, Palombi T, Alivernini F, Alessandri G, Filosa L, Pistella J, Baiocco R, Lucidi F. Exploring the Psychological Nexus of Virtual and Augmented Reality on Physical Activity in Older Adults: A Rapid Review. Behav Sci (Basel) 2023; 14:31. [PMID: 38247683 PMCID: PMC10813312 DOI: 10.3390/bs14010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
With the global population of older adults projected to double to 2.1 billion by 2050, it becomes crucial to promote healthy aging to alleviate the associated disease burden. In this context, technology, particularly virtual reality (VR) and augmented reality (AR), has garnered attention for its potential to augment physical activity in older adults. These immersive technologies offer interactive and enjoyable exercise experiences, making physical activity more appealing. However, the effectiveness of these interventions is not solely attributed to technology itself but is deeply intertwined with psychological processes. This rapid review examines the effectiveness of VR and AR interventions in enhancing physical exercise among healthy older adults while exploring the role of psychological variables, including mood, self-efficacy, and motivation. The results of the study show that technology-enhanced physical activity interventions hold great promise but call attention to the need for a comprehensive understanding of psychological dynamics that will pave the way for more tailored and effective interventions. Future research endeavors should aim to bridge these gaps in knowledge to optimize the impact of technology on healthy aging.
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Affiliation(s)
- Andrea Chirico
- Department of Psychology Development and Socialization Processes, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (M.A.); (F.A.); (J.P.); (R.B.); (F.L.)
| | - Marco Avellone
- Department of Psychology Development and Socialization Processes, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (M.A.); (F.A.); (J.P.); (R.B.); (F.L.)
| | - Tommaso Palombi
- Department of Psychology Development and Socialization Processes, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (M.A.); (F.A.); (J.P.); (R.B.); (F.L.)
| | - Fabio Alivernini
- Department of Psychology Development and Socialization Processes, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (M.A.); (F.A.); (J.P.); (R.B.); (F.L.)
| | - Guido Alessandri
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (G.A.); (L.F.)
| | - Lorenzo Filosa
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (G.A.); (L.F.)
| | - Jessica Pistella
- Department of Psychology Development and Socialization Processes, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (M.A.); (F.A.); (J.P.); (R.B.); (F.L.)
| | - Roberto Baiocco
- Department of Psychology Development and Socialization Processes, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (M.A.); (F.A.); (J.P.); (R.B.); (F.L.)
| | - Fabio Lucidi
- Department of Psychology Development and Socialization Processes, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (M.A.); (F.A.); (J.P.); (R.B.); (F.L.)
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Yoon KI, Jeong TS, Kim SC, Lim SC. Anonymizing at-home fitness: enhancing privacy and motivation with virtual reality and try-on. Front Public Health 2023; 11:1333776. [PMID: 38192556 PMCID: PMC10773911 DOI: 10.3389/fpubh.2023.1333776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction This study aimed to address privacy concerns associated with video conferencing tools used in home-based exercise training. To that end, a method that could anonymize participants' appearances and exercise environments during at-home fitness sessions was proposed. Methods This method combines virtual reality for 3-D human-model rendering using key-points tracking with a virtual try-on system enhanced by UV mapping and instance segmentation. To validate the proposed method, we conducted a user study by recruiting participants to assess effectiveness of virtual reality and virtual try-on in terms of privacy protection, self-confidence, and coaching satisfaction. Results Experimental results demonstrated the effectiveness and improved user experience of using virtual reality or virtual try-on in remote fitness, particularly in enhancing privacy protection and self-confidence with statistical significance. However, no significant differences were noted in coaching satisfaction. Discussion These findings confirmed the efficacy of our proposed approach. We believe that the proposed approach can significantly contribute to the future of remote fitness training, offering a more secure and engaging environment for users, thereby potentially increasing adherence to fitness regimens and overall physical wellbeing.
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Affiliation(s)
- Kang-Il Yoon
- Department of Mechanical, Robotics, and Energy Engineering, Dongguk University, Seoul, Republic of Korea
| | - Tae-Soo Jeong
- Department of Mechanical, Robotics, and Energy Engineering, Dongguk University, Seoul, Republic of Korea
| | - Seung-Chan Kim
- Machine Learning Systems Lab, College of Sports Science, Sungkyunkwan University, Suwon, Republic of Korea
| | - Soo-Chul Lim
- Department of Mechanical, Robotics, and Energy Engineering, Dongguk University, Seoul, Republic of Korea
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Mahmud MR, Cordova A, Quarles J. Visual Cues for a Steadier You: Visual Feedback Methods Improved Standing Balance in Virtual Reality for People with Balance Impairments. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2023; 29:4666-4675. [PMID: 37788203 DOI: 10.1109/tvcg.2023.3320244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Users of head-mounted displays (HMDs) for virtual reality (VR) sometimes have balance issues since HMDs impede their view of the outside world. This has a greater impact on people with balance impairments since many rely more heavily on their visual cues to keep their balance. This is a significant obstacle to the universal usability and accessibility of VR. Although previous studies have verified the imbalance issue, not much work has been done to diminish it. In this study, we investigated how to increase VR balance by utilizing additional visual cues. To examine how different visual approaches (static, rhythmic, spatial, and center of pressure (CoP) based feedback) affect balance in VR, we recruited 100 people (50 with balance impairments due to multiple sclerosis and 50 without balance impairments) across two different geographic locations (United States and Bangladesh). All people completed both standing visual exploration as well as standing reach and grasp tasks. Results demonstrated that static, rhythmic, and CoP visual feedback approaches enhanced balance significantly ( ) in VR for people with balance impairments. The methods described in this study could be applied to design more accessible virtual environments for people with balance impairments.
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Raipure A, Kasatwar P. The Effects of Nintendo Wii Fit on Postural Balance Control Training in the Geriatric Population: A Review. Cureus 2022; 14:e31420. [DOI: 10.7759/cureus.31420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022] Open
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Baragash RS, Aldowah H, Ghazal S. Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions. Digit Health 2022; 8:20552076221132099. [PMCID: PMC9629585 DOI: 10.1177/20552076221132099] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies. Methods To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being. Results The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions. Conclusion This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.
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Affiliation(s)
- Reem Sulaiman Baragash
- Centre for Instructional Technology and Multimedia, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia,Reem Sulaiman Baragash, Centre for Instructional Technology and Multimedia, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia.
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| | - Hanan Aldowah
- Centre for Instructional Technology and Multimedia, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| | - Samar Ghazal
- Centre for Instructional Technology and Multimedia, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
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Benefits of Virtual Reality Program and Motor Imagery Training on Balance and Fall Efficacy in Isolated Older Adults: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111545. [PMID: 36363502 PMCID: PMC9692723 DOI: 10.3390/medicina58111545] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
Background and Objectives: for isolated older adults, alternative training indoors to maintain balance is essential; however, related studies are lacking. To improve the balance of isolated older adults and reduce their fear of falling, we aimed to examine the balance−keeping effect of a virtual reality (VR) program and motor imagery training (MIT) and propose training that could improve physical activity among older adults. Methods: a total of 34 older adults admitted to a convalescent hospital were assessed. VR (n = 12) and MIT (n = 10) groups completed their assigned intervention in six weeks, whereas the control group (CG) (n = 12) did not. The follow−up was performed after two weeks. Results: in group × time interactions, body center movement area, open and closed eyes balance scores, and fall efficacy were significantly different (p < 0.05). In contrast with the VR group, the MIT group did not show a significant difference in the open or closed eyes balance scores depending on the period. However, there was a significant difference between the MIT group and CG in the open eyes balance score post-test (d = 1.13, 95% confidence interval, 0.40−12.33). Conclusions: we propose VR and MIT as training methods to prevent physical weakness in isolated older adults.
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Buyle M, Jung Y, Pavlou M, Gonzalez SC, Bamiou DE. The role of motivation factors in exergame interventions for fall prevention in older adults: A systematic review and meta-analysis. Front Neurol 2022; 13:903673. [PMID: 35989930 PMCID: PMC9388774 DOI: 10.3389/fneur.2022.903673] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022] Open
Abstract
Balance disorders and falls are common in the elderly population. Regular balance exercises are an evidence-based physical intervention to prevent falls in older adults, while patient motivation and adherence are important factors for intervention outcome. Exergames are a relatively new, alternative intervention for physical rehabilitation as they improve balance and strength in older adults. The aims of this systematic review and meta-analysis were to assess the (1) effect of motivation factors as per the Capability, Opportunity and Motivation model of Behavior change (COM-B) on the effectiveness of exergame interventions in healthy older adults, (2) effectiveness of exergames to improve balance in older healthy adults and, (3) impact of exergames on cognitive outcomes. Results show that motivation and capability components influence the general outcome of the exergame training. Motivational factors should thus be considered when setting-up an exergame intervention. Furthermore, exergame intervention appears to be a promising training method in comparison to traditional exercise training. However, exergame training in itself might not be sufficient to improve fall risk and cognitive performance.
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Affiliation(s)
- Margot Buyle
- Psychological Sciences Research Institute and Institute of NeuroScience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- *Correspondence: Margot Buyle
| | - Yujin Jung
- Audiology Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Marousa Pavlou
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Sergi Costafreda Gonzalez
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Doris-Eva Bamiou
- University College London Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
- Biomedical Research Centre, National Institute for Health Research, London, United Kingdom
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Teraz K, Šlosar L, Paravlić AH, de Bruin ED, Marusic U. Impact of Motor-Cognitive Interventions on Selected Gait and Balance Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychol 2022; 13:837710. [PMID: 35783735 PMCID: PMC9245546 DOI: 10.3389/fpsyg.2022.837710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Efficient performance of most daily activities requires intact and simultaneous execution of motor and cognitive tasks. To mitigate age-related functional decline, various combinations of motor and cognitive training have shown promising results. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy of different types of motor-cognitive training interventions (e.g., sequential and simultaneous) on selected functional outcomes in healthy older adults. Methods Six online academic databases were used to retrieve eligible RCTs up to April 2021, following PRISMA guidelines and PICO criteria. A random-effects model was used for all meta-analyses conducted on selected functional outcomes: single- and dual-task gait speed, the Timed Up and Go Test (TUG), and Berg Balance Scale (BBS) score. Effect size (ES) was calculated as Hedges' g and interpreted as: trivial: <0.20, small: 0.20–0.60, moderate: 0.61–1.20, large: 1.21–2.00, very large: 2.01–4.00 or extremely large >4.00. Results From 2,546 retrieved records, 91 RCTs were included for meta-analysis (n = 3,745 participants; 64.7–86.9 years). The motor-cognitive interventions included differed according to the type of training (e.g., sequential, simultaneous with additional cognitive task or exergame training. The results showed that motor-cognitive interventions can improve gait speed under single-task conditions (small ES = 0.34, P = 0.003). The effect of the intervention was moderated by the type of control group (Q = 6.203, P = 0.013): passive (moderate ES = 0.941, P = 0.001) vs. active controls (trivial ES = 0.153, P = 0.180). No significant effect was found for dual-task walking outcomes (P = 0.063). Motor-cognitive intervention had a positive effect on TUG (small ES = 0.42, P < 0.001), where the effect of intervention was moderated by control group [passive (moderate ES = 0.73, P = 0.001) vs. active (small ES = 0.20, P = 0.020)], but not by the type of training (P = 0.064). Finally, BBS scores were positively affected by motor-cognitive interventions (small ES = 0.59, P < 0.001) with however no significant differences between type of control group (P = 0.529) or intervention modality (P = 0.585). Conclusions This study provides evidence for the effectiveness of various types of motor-cognitive interventions on performance-based measures of functional mobility in healthy older adults. With respect to significant effects, gait speed under single-task condition was improved by motor-cognitive interventions, but the evidence shows that this type of intervention is not necessarily more beneficial than motor training alone. On the other hand, motor-cognitive interventions are better at improving multicomponent tasks of dynamic balance and mobility function, as measured by the TUG. Because of substantial heterogeneity and the current limited availability of different types of interventions, the conclusions should be interpreted with caution.
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Affiliation(s)
- Kaja Teraz
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Šlosar
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Armin H. Paravlić
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - 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
- *Correspondence: Eling D. de Bruin
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea – ECM, Maribor, Slovenia
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Liu M, Zhou K, Chen Y, Zhou L, Bao D, Zhou J. Is Virtual Reality Training More Effective Than Traditional Physical Training on Balance and Functional Mobility in Healthy Older Adults? A Systematic Review and Meta-Analysis. Front Hum Neurosci 2022; 16:843481. [PMID: 35399351 PMCID: PMC8984187 DOI: 10.3389/fnhum.2022.843481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/23/2022] [Indexed: 12/04/2022] Open
Abstract
Objective The studies showed the benefits of virtual reality training (VRT) for functional mobility and balance in older adults. However, a large variance in the study design and results is presented. We, thus, completed a systematic review and meta-analysis to quantitatively examine the effects of VRT on functional mobility and balance in healthy older adults. Methods We systematically reviewed the publications in five databases. Studies that examine the effects of VRT on the measures of functional mobility and balance in healthy older adults were screened and included if eligible. Subgroup analyses were completed to explore the effects of different metrics of the intervention design (e.g., session time) on those outcomes related to functional mobility and balance. Results Fifteen studies of 704 participants were included. The quality of these studies was good. Compared to traditional physical therapy (TPT), VRT induced greater improvement in TUG (MD = −0.31 s, 95% CI = −0.57 to −0.05, p = 0.02, I2 = 6.34%) and one-leg stance with open eyes (OLS-O) (MD = 7.28 s, 95% CI = 4.36 to 10.20, p = 0.00, I2 = 36.22%). Subgroup analyses revealed that immersive VRT with more than 800 min of total intervention time over 8 weeks and at least 120 min per week and/or designed by the two motor-learning principles was optimal for functional mobility and balance. Conclusion Virtual reality training can significantly improve functional mobility and balance in healthy older adults compared to TPT, and the findings provided critical knowledge of the optimized design of VRT that can inform future studies with more rigorous designs. Systematic Review Registration [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021297085].
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Affiliation(s)
- Meng Liu
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Kaixiang Zhou
- Sports Coaching College, Beijing Sport University, Beijing, China
- College of Sports, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yan Chen
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Limingfei Zhou
- School of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
- *Correspondence: Dapeng Bao,
| | - Junhong Zhou
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
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Altorfer P, Adcock M, de Bruin ED, Graf F, Giannouli E. Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study. Front Aging Neurosci 2021; 13:739948. [PMID: 34912206 PMCID: PMC8667343 DOI: 10.3389/fnagi.2021.739948] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: The aim of this pilot randomized clinical trial was to test the feasibility and efficacy of an exergame-based cognitive-motor training program in geriatric inpatients. Methods: The study participants were randomly allocated to either the exergame intervention group or the control group. The control group received the standard rehabilitation treatment offered in the clinic. In addition to the standard rehabilitation program, the intervention group conducted supervised exergame training on 5 days per week using the Dividat Senso, an exergame system specifically designed for older adults. The primary outcome was feasibility, as measured by e.g., adherence rate, attrition rate, occurrence of adverse events, System Usability Scale (SUS) and NASA-TLX score. Secondary outcomes included measures of physical and cognitive functioning such as comfortable walking speed, maximal walking speed, dual task walking speed, Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Color-Word Interference test (D-KEFS), Trail Making test A and B (TMT), Go/No-Go test and Step Reaction Time test (SRTT). All secondary outcome measures were assessed pre- and post-intervention. Results: Thirty-nine persons were included in the study. Average adherence rate was 99%, there were no intervention-related dropouts and no adverse events. The mean System Usability Scale (SUS) score was 83.6 and the mean NASA-TLX score 45.5. Significant time-group interaction effects were found for the dual task walking speed, the Go/No-Go test and Step Reaction Time test (SRTT). Conclusion: Exergaming is a feasible, safe and effective cognitive-motor training approach in inpatient rehabilitation of geriatric patients. Incorporating exergaming in the rehabilitation program of geriatric patients offers potential to reduce fall risk factors and to increase patients' exercise motivation and rehabilitation success.
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Affiliation(s)
- Patrizia Altorfer
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland
| | - Manuela Adcock
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, 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
| | - Florian Graf
- VAMED Rehaklinik Dussnang, Clinic for Geriatric and Orthopedic Rehabilitation, Dussnang, Switzerland
| | - Eleftheria Giannouli
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, University of Basel, Basel, Switzerland
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14
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Chen Y, Zhang Y, Guo Z, Bao D, Zhou J. Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis. J Neuroeng Rehabil 2021; 18:164. [PMID: 34819097 PMCID: PMC8611920 DOI: 10.1186/s12984-021-00917-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Physical training (PT, e.g., Tai Chi and strength training) has been demonstrated to improve balance control and prevent falls. Recently, exergame intervention (EI) has emerged to prevent falls by enhancing both physical and cognitive functions in older adults. Therefore, we aim to quantitatively assess and compare the effects of PT and EI on the performance of balance control and fall prevention in healthy older adults via meta-analysis. METHODS A search strategy based on the PICOS principle was used to find the publication in the databases of PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE. The quality and risk of bias in the studies were independently assessed by two researchers. RESULTS Twenty studies consisting of 845 participants were included. Results suggested that as compared to PT, EI induced greater improvement in postural control (sway path length, SMD = - 0.66, 95% CI - 0.91 to - 0.41, P < 0.001, I2 = 0%; sway speed, SMD = - 0.49, 95% CI - 0.71 to - 0.27, P < 0.001, I2 = 42%) and dynamic balance (SMD = - 0.19, 95% CI - 0.35 to - 0.03, P = 0.02, I2 = 0%) in healthy older adults. The EI with 90-119 min/week for more than 8-week significantly reduced falls. Subgroup analyses revealed that exergames, which were designed by the two principles of repeatedly performing diversified tasks and gradually increase the difficulty of the task, induced significant effects in improving balance control and falls prevention respectively (P = 0.03, P = 0.009). In addition, intervention that combines EI and PT induced significant improvement in postural control (P = 0.003). CONCLUSION The exergame intervention, especially the combination of EI and PT, is a promising strategy to improve balance control and reduce falls in healthy older adults. Future studies with rigorous design, larger sample size, and follow-up assessments are needed to further assess the effectiveness of diverse exergame interventions in fall prevention and to quantify the "dose-effect" relationship, as well as the carry-over effect of such intervention, which will ultimately help optimize the rehabilitative strategies to improve balance control and prevent falls.
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Affiliation(s)
- Yan Chen
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Yuan Zhang
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Zhenxiang Guo
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China.
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, USA
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Kamnardsiri T, Phirom K, Boripuntakul S, Sungkarat S. An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study. JMIR Serious Games 2021; 9:e27848. [PMID: 34704953 PMCID: PMC8581754 DOI: 10.2196/27848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Declines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. OBJECTIVE The aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. METHODS In the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants' characteristics and PACES scores. RESULTS The results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. CONCLUSIONS These findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined.
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Affiliation(s)
- Teerawat Kamnardsiri
- Research Group of Modern Management and Information Technology, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
- Department of Digital Game, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Kochaphan Phirom
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinun Boripuntakul
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Bourrelier J, Fautrelle L, Haratyk E, Manckoundia P, Mérienne F, Mourey F, Kubicki A. Enhancement of Anticipatory Postural Adjustments by Virtual Reality in Older Adults with Cognitive and Motor Deficits: A Randomised Trial. Geriatrics (Basel) 2021; 6:geriatrics6030072. [PMID: 34449605 PMCID: PMC8395892 DOI: 10.3390/geriatrics6030072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. METHODS Frail older adults (n = 37) were included in this study who were randomized and divided into a VR exercises group (VR group) or a control group using the Nintendo Wii system (CTRL group). Finally, 22 patients were included in the data treatment. APA were studied through muscular activation timings measured with electromyographic activities. The functional reach test, the gait speed, and the time up and go were also evaluated before and after a 3-week training phase. RESULTS AND DISCUSSION As the main results, the training phase with VR improved the APA and the functional reach test score along the antero-posterior axis. Together, these results highlight the ability of a VR training phase to induce neuromuscular adaptations during the APA period in frail older adults. Then, it underlines the effective transfer from learning carried out during the VR training movements to control balance abilities in a more daily life context.
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Affiliation(s)
- Julien Bourrelier
- Laboratoire INSERM U1093 CAPS, Université de Bourgogne Franche-Comté, 21078 Dijon, France; (J.B.); (P.M.); (F.M.)
| | - Lilian Fautrelle
- Laboratoire ToNIC, Toulouse NeuroImaging Center, UMR1214, Inserm, UPS, 31000 Toulouse, France;
- Equipe de Recherche Interdisciplinaire en Activités Physiques, Institut National Universitaire Champollion, STAPS, Campus de Rodez, 12000 Rodez, France
| | - Etienne Haratyk
- UFR Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Bourgogne Franche-Comté, 21000 Dijon, France;
| | - Patrick Manckoundia
- Laboratoire INSERM U1093 CAPS, Université de Bourgogne Franche-Comté, 21078 Dijon, France; (J.B.); (P.M.); (F.M.)
- Centre Hospitalier Universitaire, Pôle Personnes Âgées, 21000 Dijon, France
| | - Frédéric Mérienne
- LE2I FRE 2005, Arts et Métiers, CNRS, UBFC, HeSam, 71100 Chalon-sur-Saône, France;
| | - France Mourey
- Laboratoire INSERM U1093 CAPS, Université de Bourgogne Franche-Comté, 21078 Dijon, France; (J.B.); (P.M.); (F.M.)
- UFR Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Bourgogne Franche-Comté, 21000 Dijon, France;
| | - Alexandre Kubicki
- Laboratoire INSERM U1093 CAPS, Université de Bourgogne Franche-Comté, 21078 Dijon, France; (J.B.); (P.M.); (F.M.)
- IFMS NFC, Hôpital Nord Franche-Comté, 25200 Montbéliard, France
- Correspondence: ; Tel.: +33-643887789
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17
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Yazici O, Ceylan E, Demir Yazici S, Tas Gulen S. Evaluation of balance in patients with chronic obstructive pulmonary disease with practical tests. Int J Clin Pract 2021; 75:e13901. [PMID: 33283390 DOI: 10.1111/ijcp.13901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) have impaired balance and hence fall more frequently. Easy application of balance evaluation tests can prevent the loss of time in the outpatient clinic for patients with COPD. In this study, we aimed to compare the efficacy of Berg Balance Scale (BBS), a time-consuming but a widely used test, with other easy-to-perform tests such as the Single Leg Stance (SLS), Five Repetition Sit to Stand (5STS), Four Step Square (FSST), and Timed Up and Go (TUG) tests. METHODS A total of 71 patients with COPD and 70 control subjects with matching demographic characteristics were included in the study. All patients undertook pulmonary function tests and their scores of 6-min walk-test (6MWT), modified Medical Research Council (mMRC) dyspnoea scale, COPD assessment questionnaire (CAT) and body mass index (B) were recorded. In addition, the severity of airway obstruction (O), the dyspnoea severity (D) and exercise capacity (E) (BODE) index scores were measured. All patients with COPD were classified into four groups, A to D, based on the GOLD 2017 criteria. All subjects undertook the BBS, SLS, 5STS, FSST and TUG tests. RESULTS Balance tests revealed increased balance impairment in patients with COPD in comparison with the control subjects (P < .05). The BBS, SLS, FSST and TUG examinations suggested that balance impairment was frequent in Groups C and D patients with COPD (P < .05). FSST and TUG had the highest correlation with BBS (r = -.812 and -.842 and P < .001 and <.001, respectively). The results of FSST and TUG were the closest to those of BBS test. CONCLUSIONS FSST and TUG tests can be applied for the assessment of bodily balance status among patients with COPD in outpatient clinics.
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Affiliation(s)
- Onur Yazici
- Department of Chest Diseses, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - Emel Ceylan
- Department of Chest Diseses, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - Senay Demir Yazici
- Department of Physical Medicine and Rehabilitation, Atatürk State Hospital, Aydin, Turkey
| | - Sule Tas Gulen
- Department of Chest Diseses, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
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The Effects of Exergaming Training on Balance in Healthy Elderly Women-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041412. [PMID: 33546350 PMCID: PMC7913576 DOI: 10.3390/ijerph18041412] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/10/2023]
Abstract
Our aim was to observe, through objective testing using an assessment module incorporated in a new exergaming system, whether elderly people's static and functional balance is improved by a balance exergaming training program based on movements performed in everyday life. Thirteen healthy elderly women participated in 12 sessions of balance-based exergaming training (three times a week, 30 min per session). All objective outcomes, the quiet standing test, functional balance test (FBT), and limit of stability (LOS) test, were measured on three occasions: before intervention, after six training sessions, and after the completion of the four-week program. The results showed a significant improvement in LOS performance after the intervention. In FBT, participants exhibited a significant decrease (p < 0.01; Kendall's W = 0.5) in the average time to target hit after six trainings. The average center of pressure velocity increased after six and 12 sessions, however did not reach significance (p = 0.053); nevertheless the size of the effect was large (ηp2 = 0.22). The parameters of the quiet standing test were not significantly affected by the training. The results support the need for more definite and objective studies assessing exergaming for balance in elderly.
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McLaughlin EC, El-Kotob R, Chaput JP, Janssen I, Kho ME, Poitras VJ, Ross R, Ross-White A, Saunders TJ, Sherrington C, Giangregorio LM. Balance and functional training and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab 2020; 45:S180-S196. [DOI: 10.1139/apnm-2020-0279] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This overview of systematic reviews examined the effect of balance and functional strength training on health outcomes in adults aged 18 years or older, to inform the Canadian 24-hour Movement Guidelines. Four electronic databases were searched for systematic reviews published between January 2009 and May 2019. Eligibility criteria were determined a priori for population (community-dwelling adults), intervention (balance and functional training), comparator (no intervention or different types/doses), and outcomes (critical: falls and fall-related injuries; adverse events; important: physical functioning and disability; health-related quality of life; physical activity; and sedentary behaviour). Two reviewers independently screened studies for eligibility and performed AMSTAR 2 assessment. One review was selected per outcome. Of 3288 records and 355 full-text articles, 5 systematic reviews were included, encompassing data from 15 890 participants in 23 countries. In adults 65 years and older, balance and functional training and Tai Chi reduced the rate of falls and the number of people who fell, and improved aspects of physical functioning and physical activity. The effect on health-related quality of life and falls requiring hospitalization was uncertain. While inconsistently monitored, only 1 serious adverse event was reported. No evidence was available in adults under age 65 years. Included systematic reviews and primary evidence reported by review authors ranged in quality. Overall, participation in balance and functional training reduced falls and improved health outcomes in adults 65 years of age and older. PROSPERO registration no.: CRD42019134865. Novelty This overview informs updated guidelines for balance training in adults. Balance and functional training reduced falls and improved health outcomes.
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Affiliation(s)
| | - Rasha El-Kotob
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Michelle E. Kho
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada
| | | | - Robert Ross
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Amanda Ross-White
- Queen’s University Library, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Travis J. Saunders
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lora M. Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, ON N2J 0E2, Canada
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20
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Leon-Llamas JL, Villafaina S, Murillo-Garcia A, Dominguez-Muñoz FJ, Gusi N. Effects of 24-Week Exergame Intervention on the Gray Matter Volume of Different Brain Structures in Women with Fibromyalgia: A Single-Blind, Randomized Controlled Trial. J Clin Med 2020; 9:E2436. [PMID: 32751515 PMCID: PMC7463870 DOI: 10.3390/jcm9082436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Exergame-induced changes in the volume of brain gray matter have not been studied in fibromyalgia (FM). This study evaluates the effects of a 24-week exergame-based intervention on the gray matter volume of different brain structures in patients with FM through magnetic resonance imaging (MRI). METHODS A total of 25 FM patients completed 24 weeks of intervention program, and another 25 FM patients did not receive any intervention. T1-weighted MRI was used to assess brain volume, and FreeSurfer software was used to segment the brain regions. RESULTS No significant effects on gray matter volume of different structures and total gray matter were found. CONCLUSIONS FM patients did not show significant changes in gray matter brain volume between the control and experimental groups after 24 weeks. FM patients showed significant relationships between peak oxygen consumption (pVO2) and the left and right regions of the hippocampus and the left and right regions of the amygdala.
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Affiliation(s)
| | | | - Alvaro Murillo-Garcia
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain; (J.L.L.-L.); (S.V.); (F.J.D.-M.); (N.G.)
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21
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Yang CM, Chen Hsieh J(S, Chen YC, Yang SY, Lin HCK. Effects of Kinect exergames on balance training among community older adults: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e21228. [PMID: 32664177 PMCID: PMC7360267 DOI: 10.1097/md.0000000000021228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recent years have witnessed wide applications of exergames to balance training among the older adults. However, research concerning balance training with the use of Kinect for Xbox has remained scarce. While previous studies have shown the positive effects of exergames on improving balance and preventing falling among the older adults, there has been a paucity of empirical evidence supporting the superiority of Kinect exercise to conventional exercise over balance training among the older adults. Therefore, this study aimed to compare the feasibility, safety, and effectiveness of Kinect exercise against conventional exercise over balance training among the community older adults. METHOD A total of 20 participants were randomly assigned to the Kinect Exercise Group (N = 10) or the Conventional Exercise Group (N = 10) for a 5-week balance training (45 minutes a time, 2 times a week). Assessor blinding was employed to assess the participants' performance before and after the treatment, including 30-Second Chair Stand Test (30-sec CST), Timed Up and Go (TUG), Functional Reach Test (FRT), and One-Leg Stance Test (OLST) respectively with eyes open and closed. Subjective feeling of the intensity of pain and side effects were recorded throughout the investigation period. Nonparametric statistics was used for data analysis. RESULTS Within-group comparison between the pre-test and post-test indicated that significant differences existed in all of the 5 tests (30-sec CST, TUG, FRT, OLST with eyes open, and OLST with eyes closed) in the Kinect exercise group. To the Conventional exercise group, however, significant differences were only observed in 30-sec CST, FRT and OLST with eyes open. With regard to between-group comparison, significant differences were only found in FRT. CONCLUSION Such results indicated that both treatments were helpful in improving the participants' balance performance, that Kinect exercise was more effective in terms of overall balance ability, and that Kinect exercise was particularly beneficial to functional reach enhancement in comparison with traditional exercise. Kinect exercise could be a feasible, safe, and effective alternative for dynamic balance training among older adults.
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Affiliation(s)
- Chi-Min Yang
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center
- Department of Information and Learning Technology, National University of Tainan, Tainan
| | | | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, ROC
| | - Shu-Yu Yang
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center
| | - Hao-Chiang Koong Lin
- Department of Information and Learning Technology, National University of Tainan, Tainan
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Davies AF, Hill P, Fay D, Dee A, Locher C. Body Reprogramming: Reframing the Fibromyalgia narrative and providing an integrative therapeutic model. Health Psychol Open 2020; 7:2055102920971494. [PMID: 35186312 PMCID: PMC8851147 DOI: 10.1177/2055102920971494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We propose a theory known as the Hyland model to help conceptualise
Fibromyalgia within a complex adaptive control system. A fundamental
assumption is that symptom generating mechanisms are causally
connected, forming a network that has emergent properties. An illness
narrative has been developed which has a ‘goodness of fit’ with the
lived experience of those with Fibromyalgia. The theory guides
management within the clinical setting and incorporates current
evidence-based therapeutic strategies, within a multi-modal
intervention described as ‘Body Reprogramming’. This intervention
focuses on non-pharmacological and lifestyle-based considerations. The
theoretical framework also helps explain why modest therapeutic
effects are gained from current pharmacological options.
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Affiliation(s)
| | - Patrick Hill
- Sandwell and West Birmingham Hospitals NHS Trust, UK
| | | | - Annily Dee
- University Hospitals Plymouth NHS Trust, UK
| | - Cosima Locher
- Harvard Medical School, USA.,University of Plymouth, UK.,University of Basel, Switzerland
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Villafaina S, Collado-Mateo D, Domínguez-Muñoz FJ, Gusi N, Fuentes-Garcia JP. Effects of exergames on heart rate variability of women with fibromyalgia: A randomized controlled trial. Sci Rep 2020; 10:5168. [PMID: 32198423 PMCID: PMC7083950 DOI: 10.1038/s41598-020-61617-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/24/2020] [Indexed: 12/27/2022] Open
Abstract
The objective of the present manuscript was to evaluate the effects of 24-weeks exergame intervention on the heart rate variability (HRV) of women with fibromyalgia. First, 56 women with fibromyalgia were assessed for eligibility. A total of 55 women fulfilled the inclusion criteria and participated in this single-blinded, randomized controlled trial. A 24-weeks of exergames were completed by the exercise group in the university facilities. It was focused on the mobility, postural control, upper and lower limbs coordination, aerobic fitness and strength. A total of 120 min per week, divided into two sessions of 60 min, was completed. A short-term 5 min record at rest was used to assess the HRV. Time (SDNN and RMSSD) and non-linear indexes (Higuchi´s Fractal Dimension, SD1, SD2, ln stress score, and SD1/SD2) of HRV were extracted. Fifty participants (achieving an 89.28% of adherence), recruited from the local fibromyalgia association completed the study. They were randomly divided into an exercise (age = 54.04[8.45]) and a control group (52.72[9.98]). Significant interaction (group*time) effects in SDNN, ln stress score, SD2, and SD1/SD2 ratio were found. The EG showed an increase of SDNN and a decreased ln stress score and SD2. The CG showed an increased ln stress score, SD1/SD2. In conclusion, 24-weeks of exergame intervention based on the tool VirtualEx-FM improved the autonomic control in patients with fibromyalgia. However, significant effects on Higuchi´s fractal dimension were not found. This is the first study using exergame as a therapy in women with fibromyalgia which has led to an improvement the autonomic balance in these patients.
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Affiliation(s)
- Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV). Faculty of Sport Science, University of Extremadura, Extremadura, Spain
| | - Daniel Collado-Mateo
- Centre for Sport Studies, Rey Juan Carlos University, 28943, Fuenlabrada, Madrid, Spain.
| | - Francisco J Domínguez-Muñoz
- Physical Activity and Quality of Life Research Group (AFYCAV). Faculty of Sport Science, University of Extremadura, Extremadura, Spain
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV). Faculty of Sport Science, University of Extremadura, Extremadura, Spain
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Balance and Dizziness Disorders in the Elderly: a Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041258. [PMID: 32075307 PMCID: PMC7068357 DOI: 10.3390/ijerph17041258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Abstract
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.
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Fang Q, Ghanouni P, Anderson SE, Touchett H, Shirley R, Fang F, Fang C. Effects of Exergaming on Balance of Healthy Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Games Health J 2020; 9:11-23. [PMID: 31800322 DOI: 10.1089/g4h.2019.0016] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Balance is critical for older adults to perform daily activities. However, age-related declines in balance increase the risk of falls and severe injuries, such as bone fractures and head injuries. Exergames have been widely applied to improve health-related outcomes in older adults. This meta-analysis aims to quantify the effects of exergaming interventions on balance performance in healthy older adults. A literature search was performed using PubMed, ScienceDirect, SPORTDiscus, COCHRANE, EBSCO, and EMBASE. A total of 16 experimental studies met inclusion criteria for a full-text review. Data synthesis examined balance functions, including static, dynamic, proactive, and perceived balance abilities when performing daily activities. Intervention protocols of the reviewed studies included an average of two to three 40-minute exergaming sessions per week for 8 weeks. A random effects model identified significant effects in favor of the exergaming group, with moderate effect size in dynamic balance (Hedges' g = 0.36, 95% CI = 0.26-1.30, P < 0.001), and perceived balance (Hedges' g = 0.31, 95% CI = 0.04-0.58, P = 0.02); and considerable effect size in Chair Stand Test (Hedges' g = 0.78, 95% CI = 0.26-1.30, P = 0.003), and balance test batteries (Hedges' g = 0.72, 95% CI = 0.42-1.02, P < 0.001). No significant effect was found in the static balance (Hedges' g = 0.22, 95% CI = -0.31 to 0.76, P = 0.42), or proactive balance (Hedges' g = 0.54, 95% CI = -0.12 to 1.20, P = 0.11). Meta-analysis identified exergaming-associated benefits in older adults' balance function and confidence. This finding supports the feasibility of exergaming as a supplementary approach to improve balance for healthy older adults. Health professionals may optimize treatment effect by integrating exergaming sessions into a traditional balance exercise program.
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Affiliation(s)
- Qun Fang
- Department of Kinesiology, Mississippi State University, Mississippi State, Mississippi
| | - Parisa Ghanouni
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia
| | - Sarah E Anderson
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Hilary Touchett
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rebekah Shirley
- Department of Kinesiology, Mississippi State University, Mississippi State, Mississippi
| | - Fang Fang
- Rehabilitation Center, Qing Dao Fu Wai Hospital, Qingdao, China
| | - Chao Fang
- Department of Pharmacology, the Fourth Military Medical University, Xi'an, China
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Mohamed AA, Jan YK. Effect of Adding Proprioceptive Exercise to Balance Training in Older Adults with Diabetes: A Systematic Review. Curr Diabetes Rev 2020; 16:327-339. [PMID: 31526352 DOI: 10.2174/1573399815666190712200147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Accidental fall is a serious problem in older adults. The incidence of accidental fall increases by any dysfunction in the proprioceptive system. The function of the proprioceptive system usually is much affected in people with Diabetes Mellitus (DM), particularly in older ages. However, proprioceptive exercise significantly improves the balance control in older adults, no systematic review demonstrated its effectiveness in improving the balance control in older adults with DM. Thus, this systematic review was conducted to examine the effectiveness of adding proprioceptive exercise to any balance training in older adults with DM. METHODS A systematic search was performed in five major databases. The inclusion criteria of this search included older adults with DM, peripheral neuropathy, randomized control trial, and proprioceptive dysfunction. The exclusion criterion of this search included any study where participants had a history of a disease that might affect the balance control such as ataxia, stroke, and Parkinsonism. The outcome of interest was the importance of including proprioceptive exercise in increasing the effectiveness of balance training in older adults with DM. RESULTS Nine RCTs met the inclusion criteria for this systematic review. Seven studies of these nine studies included randomization details. Only two studies included the blindness, and only one of them included double blindness. The description of the withdrawal of participants was shown in eight studies. All the included studies used a control group and accomplished the homogeny between subjects in the both groups. CONCLUSION This systematic review showed that proprioceptive exercise is a vital component that should be included in any balance training to gain short-term improvement in the balance control in older adults with DM.
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Affiliation(s)
- Ayman A Mohamed
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey
| | - Yih-Kuen Jan
- Department Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, United States
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Ng YL, Ma F, Ho FK, Ip P, Fu KW. Effectiveness of virtual and augmented reality-enhanced exercise on physical activity, psychological outcomes, and physical performance: A systematic review and meta-analysis of randomized controlled trials. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2019.05.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Effects of Exergames on Brain Dynamics in Women with Fibromyalgia: A Randomized Controlled Trial. J Clin Med 2019; 8:jcm8071015. [PMID: 31336706 PMCID: PMC6679308 DOI: 10.3390/jcm8071015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Exergames are non-immersive versions of virtual reality that involve physical exercise and have shown several benefits on physical fitness and quality of life in women with fibromyalgia. However, the effects on brain dynamics are still unknown. Aim: the aim was to evaluate the effects of a 24-week exergame intervention on resting brain dynamics in women with fibromyalgia in a single-blinded, randomized controlled trial. Methods: Fifty-six women with fibromyalgia were assessed for eligibility; 55 fulfilled the inclusion criteria. The exercise group completed a 24-week exergame-based intervention that focused on mobility, postural control, upper and lower limb coordination, aerobic fitness, and strength. This group received two 60-min sessions per week. We measured electroencephalographic (EEG) signals from 19 channels. Participants were also divided into two subgroups according to the duration of their symptoms. The intervention was more effective in the group with a shorter duration of symptoms, showing between-group differences in F8, T5 and T4. Conclusion: Exergames may lead to changes in brain dynamics that could be related to increased cerebral blood flow.
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Villafaina S, Collado-Mateo D, Domínguez-Muñoz FJ, Fuentes-García JP, Gusi N. Benefits of 24-Week Exergame Intervention on Health-Related Quality of Life and Pain in Women with Fibromyalgia: A Single-Blind, Randomized Controlled Trial. Games Health J 2019; 8:380-386. [PMID: 31259617 DOI: 10.1089/g4h.2019.0023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: To evaluate the effects of 24-week exergame-based intervention on health-related quality of life (HRQoL) and pain in patients with fibromyalgia as well as to analyze the effectiveness of the intervention in subgroups of patients with different pain intensity levels. Design: Single-blinded, randomized controlled trial. Setting: University facilities Participants: Fifty-five women with fibromyalgia participated in the study. Intervention: The exercise group (EG) completed 24 weeks of exergames focused on mobility, postural control, upper and lower limbs coordination, aerobic fitness, and strength. A total of 120 minutes per week, divided into two sessions of 60 minutes, was completed. Main outcome measures: The Euroqol-5 Dimensions-5 Levels (EQ-5D-5L) was used to assess the HRQoL. In addition, pain intensity was measured using a visual analog scale (VAS). Results: Twenty-five out of 28 women allocated to the EG completed the intervention, which means an 89.29% of adherence. They were randomly divided into an exercise (age = 54.04 [8.45]) and a control group (52.72 [9.98]). Significant effects on the perceived health status and pain intensity (P < 0.05) were found. K-means clustering procedure revealed two groups with different response to the intervention. The respond group obtained significant effects of the exergame intervention in EQ-5D-5L, pain VAS, and VAS-EQ, compared with those who did not respond. Conclusions: Exergames could be a useful tool to improve perceived health status and pain intensity level in women with fibromyalgia with a reduced health-related quality of life.
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Affiliation(s)
| | - Daniel Collado-Mateo
- Faculty of Sport Science, University of Cáceres, Cáceres, Spain.,Facultad de Educación, Universidad Autónoma de Chile, Talca, Chile
| | | | | | - Narcis Gusi
- Faculty of Sport Science, University of Cáceres, Cáceres, Spain
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31
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Osoba MY, Rao AK, Agrawal SK, Lalwani AK. Balance and gait in the elderly: A contemporary review. Laryngoscope Investig Otolaryngol 2019; 4:143-153. [PMID: 30828632 PMCID: PMC6383322 DOI: 10.1002/lio2.252] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/12/2018] [Accepted: 12/15/2018] [Indexed: 11/09/2022] Open
Abstract
Background The prevalence of balance and gait deficits increases with age and is associated with the increased incidence of falls seen in the elderly population; these falls are associated with significant morbidity and mortality. Objectives To review changes in gait and balance associated with aging and the effect of visual perturbations on gait and balance in the elderly to provide a basis for future research. Methods PubMed and Cochrane Library were searched for articles from 1980 to present pertaining to gait and balance in older adults (>60) and younger adults (<60). Search terms included balance, posture, gait, locomotion, gait variability, gait disorders, gait disturbance, elderly, aging, falls, vision, visual, vestibular, and virtual reality. The references section of queried articles was also used to find relevant studies. Studies were excluded if subjects had a diagnosed gait or balance disorder. Results Elderly adults show age-related decline in sensory systems and reduced ability to adapt to changes in their environment to maintain balance. Elderly adults are particularly dependent on vision to maintain postural stability. Distinct changes in spatiotemporal gait parameters are associated with aging, such as slower gait and increased gait variability, which are amplified with exposure to visual perturbations. Increased gait variability, specifically with mediolateral perturbations, poses a particular challenge for elderly adults and is linked to increased falls risk. Virtual reality training has shown promising effects on balance and gait. Conclusion Elderly adults show age-related decline in balance and gait with increased gait variability and an associated increased risk of falls. Level of Evidence 5.
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Affiliation(s)
- Muyinat Y Osoba
- Columbia University Vagelos College of Physicians and Surgeons New York New York
| | - Ashwini K Rao
- Department of Rehabilitation and Regenerative Medicine Columbia University Vagelos College of Physicians and Surgeons New York New York
| | - Sunil K Agrawal
- Department of Mechanical Engineering Columbia University New York New York
| | - Anil K Lalwani
- Department of Rehabilitation and Regenerative Medicine Columbia University Vagelos College of Physicians and Surgeons New York New York.,Department of Otolaryngology-Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York New York.,Department of Mechanical Engineering Columbia University New York New York
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Gomes GCV, Simões MDS, Lin SM, Bacha JMR, Viveiro LAP, Varise EM, Carvas Junior N, Lange B, Jacob Filho W, Pompeu JE. Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM for frail older adults: A randomized feasibility clinical trial. Maturitas 2018; 118:20-28. [DOI: 10.1016/j.maturitas.2018.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/17/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
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Effect of Acute Static Stretching on Lower Limb Movement Performance Using STABL Virtual Reality System. J Sport Rehabil 2018; 27:520-525. [PMID: 28714771 DOI: 10.1123/jsr.2017-0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT The effect of acute static stretching (ASS) on the lower limb reaction time (RT) has been recently questioned to decrease the risk of falling and injuries in situations requiring a rapid reaction, as in the cases of balance disturbance. OBJECTIVE The main purpose of this study was to detect the effect of ASS on the lower limb RT using a virtual reality device. DESIGN Two-group control group design. SETTING Research laboratory. PARTICIPANTS The control and experimental groups were formed randomly from 60 female university students. INTERVENTION Each participant in the experimental group was tested before and after ASS for the quadriceps, hamstrings, and planter flexor muscles, and compared with the control group with warming-up exercise alone. The stretching program involved warming up in the form of circular running inside the lab for 5 minutes followed by stretching of each muscle group three times, to the limit of discomfort of 45 seconds, with resting period of 15 seconds between stretches. MAIN OUTCOME MEASURES The measurements included the RT of the dominant lower-extremity using the dynamic stability program STABL Virtual Reality System (model no. DIZ 2709; Motekforce Link). RESULTS There was a statistically significant reduction (F = 162, P < .05) in posttest RT between the 2 groups and significant decrease in RT after stretching in the experimental group (7.5%; P < .05). CONCLUSION ASS of the lower limb muscles tends to decrease the lower limb RT and improve movement performance.
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Tahmosybayat R, Baker K, Godfrey A, Caplan N, Barry G. Movements of older adults during exergaming interventions that are associated with the Systems Framework for Postural Control: A systematic review. Maturitas 2018; 111:90-99. [PMID: 29673837 DOI: 10.1016/j.maturitas.2018.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
One in three older adults fall annually, in part due to impairments in the physiological systems that make up the postural control (PC) system. Exercise, particularly balance training, helps to prevent deterioration and even to improve outcomes in the PC system. Exergaming (exercise-gaming) is interactive computer gaming whereby an individual moves the body in response to onscreen cues in a playful format. Exergaming is an alternative method to standard practice for improving PC outcomes, which has been shown to reduce the risk of falling. Exergaming has received research attention, yet the intervention is still in its infancy. There could be benefit in exploring the movements trained with respect to a framework known for identifying underlying deficits in the PC system, the Systems Framework for Postural Control (SFPC). This may help target areas for improvement in balance training using exergames and shed light on the impact for fall prevention. A literature search was therefore conducted across six databases (CINAHL, EMBASE, PubMed, ISI, SPORTdiscus and Science Direct) using a range of search terms and combinations relating to exergaming, balance, exercise, falls and elderly. Quality assessment was conducted using the PEDro Scale and a custom-made quality assessment tool. Movements were rated by two reviewers based on the 9 operational definitions of the SFPC. Eighteen publications were included in the analysis, with a mean PEDro score of 5.6 (1.5). Overall, 4.99 (1.27) of the 9 operational definitions of the SFPC are trained in exergaming interventions. Exergaming does encourage individuals to stand up (3), lean while standing (4), move upper limbs and turn heads (6) and dual-task while standing (9), to some extent move the body forwards, backwards and sideways (1), and coordinate movements (2) but hardly at all to kick, hop, jump or walk (7), or to force a postural reaction from a physical force to the individual (5) and it does not mimic actual changes in sensory context (8). This is the first review, to our knowledge, that synthesises the literature on movements trained in exergaming interventions with respect to an established theoretical framework for PC. This review could provide useful information for designing exergames with PC outcomes in mind, which could help target specific exergames for multi-factorial training to overcome balance deficits. Some elements of PC are too unsafe to be trained using exergames, such as restricting sensory inputs or applying physical perturbations to an individual to elicit postural responses.
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Affiliation(s)
- Robin Tahmosybayat
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Alan Godfrey
- Department of Computing and Information Science, Faculty of Engineering and Environment, University of Northumbria, Newcastle Upon Tyne, UK
| | - Nick Caplan
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK.
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Estimation of Posturographic Trajectory Using k-Nearest Neighbors Classifier in Patients with Rheumatoid Arthritis and Osteoarthritis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1070:85-95. [PMID: 29445994 DOI: 10.1007/5584_2018_150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Rheumatoid arthritis (RA) and osteoarthritis (OA) are common rheumatic diseases and account for a significant percentage of disability. Posturography is a method that assesses postural stability and quantitatively evaluates postural sways. The objective of this study was to estimate posturographic trajectories applying pattern recognition algorithms. To this end, k-nearest neighbors (k-NN) classifier was used to differentiate between healthy subjects and patients with OA and RA. The following parameters of trajectories were computed: radius of sways, developed area, total length, and two directional components of sways: length of left-right and forward-backward motions. Posturographic tests were applied with eyes open and closed, and with biofeedback control. We found that in RA, the radius of sways, the trajectory area, and the biofeedback coordination were related to the patients' condition. The trajectory dynamics in OA patients were smaller compared to those in RA patients. The smallest misclassification errors were observed after feature selection in the biofeedback test compared with the eyes open and closed tests. We conclude that the estimation of posturographic trajectory with k-NN classifier could be helpful in monitoring the condition of RA patients.
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Choi SD, Guo L, Kang D, Xiong S. Exergame technology and interactive interventions for elderly fall prevention: A systematic literature review. APPLIED ERGONOMICS 2017; 65:570-581. [PMID: 27825723 DOI: 10.1016/j.apergo.2016.10.013] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/21/2016] [Accepted: 10/26/2016] [Indexed: 05/17/2023]
Abstract
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.
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Affiliation(s)
- Sang D Choi
- Department of Occupational & Environmental Safety & Health, University of Wisconsin - Whitewater, Whitewater, WI, USA
| | - Liangjie Guo
- Human Factors and Ergonomics Laboratory, Department of Industrial & Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Yuseong, South Korea; Department of Safety Engineering, China University of Geosciences, Wuhan, China
| | - Donghun Kang
- Department of Human & Systems Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
| | - Shuping Xiong
- Human Factors and Ergonomics Laboratory, Department of Industrial & Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Yuseong, South Korea.
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Gomes GCV, Bacha JMR, do Socorro Simões M, Lin SM, Viveiro LAP, Varise EM, Filho WJ, Pompeu JE. Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit Plus™ for frail elderly: study protocol for a feasibility trial. Pilot Feasibility Stud 2017; 3:41. [PMID: 29085661 PMCID: PMC5654058 DOI: 10.1186/s40814-017-0184-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/18/2017] [Indexed: 12/03/2022] Open
Abstract
Background Frailty can be defined as a medical syndrome with multiple causes and contributors, characterized by diminished strength and endurance and reduced physiological function that increases the vulnerability to develop functional dependency and/or death. Studies have shown that the most commonly studied exercise protocol for frail older adults is the multimodal training. Interactive video games (IVGs) involve tasks in virtual environments that combine physical and cognitive demands in an attractive and challenging way. The aim of this study will be to evaluate the feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM (NWFP) for frail older adults. Methods/design The study is a randomized controlled, parallel group, feasibility trial. Participants will be randomly assigned to the experimental group (EG) and control group (CG). The EG will participate in 14 training sessions, each lasting 50 min, twice a week. In each training session, the participants will play five games, with three attempts at each game. The first attempt will be performed with the assistance of a physical therapist to correct the movements and posture of the patients and subsequent attempts will be performed independently. Scores achieved in the games will be recorded. The participants will be evaluated by a blinded physical therapist at three moments: before and after intervention and 30 days after the end of the intervention (follow-up). We will assess the feasibility, acceptability, safety, and clinical outcomes (postural control, gait, cognition, quality of life, mood, and fear of falling). Discussion Due to the deficiencies in multiple systems, studies have shown that multimodal interventions including motor-cognitive stimulation can improve the mobility of frail elderly adults. IVGs, among them the NWFP, are considered as a multimodal motor-cognitive intervention that can potentially improve motor and cognitive functions in the frail elderly. However, there is still no evidence in the literature that proves the feasibility, safety, acceptability, and functional outcomes of this intervention in frail elderly individuals. Trial registration Brazilian Registry of Clinical Trials (RBR-823rst). World Health Organization Trial Registration Data Set (Additional file 1). Electronic supplementary material The online version of this article (10.1186/s40814-017-0184-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gisele Cristine Vieira Gomes
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, 51th Cipotânea Street, University City, Sao Paulo, 05360-000 Brazil
| | - Jéssica Maria Ribeiro Bacha
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, 51th Cipotânea Street, University City, Sao Paulo, 05360-000 Brazil
| | - Maria do Socorro Simões
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, 51th Cipotânea Street, University City, Sao Paulo, 05360-000 Brazil
| | - Sumika Mori Lin
- Department of Frail Syndrome, School of Medicine, University of Sao Paulo, 255, Doctor Olívio Pires Campos Street, Sao Paulo, 05403-000 Brazil
| | - Larissa Alamino Pereira Viveiro
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, 51th Cipotânea Street, University City, Sao Paulo, 05360-000 Brazil
| | - Eliana Maria Varise
- Department of Neuroscience and Behavior, University of Sao Paulo, 1721, Professor Mello de Morais Avenue, University City, Sao Paulo, 05508-030 Brazil
| | - Wilson Jacob Filho
- Department of Frail Syndrome, School of Medicine, University of Sao Paulo, 255, Doctor Olívio Pires Campos Street, Sao Paulo, 05403-000 Brazil
| | - José Eduardo Pompeu
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, 51th Cipotânea Street, University City, Sao Paulo, 05360-000 Brazil
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Donath L, Rössler R, Faude O. Effects of Virtual Reality Training (Exergaming) Compared to Alternative Exercise Training and Passive Control on Standing Balance and Functional Mobility in Healthy Community-Dwelling Seniors: A Meta-Analytical Review. Sports Med 2017; 46:1293-309. [PMID: 26886474 DOI: 10.1007/s40279-016-0485-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Balance training is considered an important means to decrease fall rates in seniors. Whether virtual reality training (VRT) might serve as an appropriate treatment strategy to improve neuromuscular fall risk parameters in comparison to alternative balance training programs (AT) is as yet unclear. OBJECTIVE To examine and classify the effects of VRT on fall-risk relevant balance performance and functional mobility compared to AT and an inactive control condition (CON) in healthy seniors. DATA SOURCES The literature search was conducted in five databases (CINAHL, EMBASE, ISI Web of Knowledge, PubMed, SPORTDiscus). The following search terms were used with Boolean conjunction: (exergam* OR exer-gam* OR videogam* OR video-gam* OR video-based OR computer-based OR Wii OR Nintendo OR X-box OR Kinect OR play-station OR playstation OR virtua* realit* OR dance dance revolution) AND (sport* OR train* OR exercis* OR intervent* OR balanc* OR strength OR coordina* OR motor control OR postur* OR power OR physical* OR activit* OR health* OR fall* risk OR prevent*) AND (old* OR elder* OR senior*). STUDY SELECTION Randomized and non-randomized controlled trials applying VRT as interventions focusing on improving standing balance performance (single and double leg stance with closed and open eyes, functional reach test) and functional mobility (Berg balance scale, Timed-up and go test, Tinetti test) in healthy community-dwelling seniors of at least 60 years of age were screened for eligibility. DATA EXTRACTION Eligibility and study quality (PEDro scale) were independently assessed by two researchers. Standardized mean differences (SMDs) served as main outcomes for the comparisons of VRT versus CON and VRT versus AT on balance performance and functional mobility indices. Statistical analyses were conducted using a random effects inverse-variance model. RESULTS Eighteen trials (mean PEDro score: 6 ± 2) with 619 healthy community dwellers were included. The mean age of participants was 76 ± 5 years. Meaningful effects in favor of VRT compared to CON were found for balance performance [p < 0.001, SMD: 0.77 (95 % CI 0.45-1.09)] and functional mobility [p = 0.004, SMD: 0.56 (95 % CI 0.25-0.78)]. Small overall effects in favor of AT compared to VRT were found for standing balance performance [p = 0.31, SMD: -0.35 (95 % CI -1.03 to 0.32)] and functional mobility [p = 0.05, SMD: -0.44 (95 % CI: -0.87 to 0.00)]. Sensitivity analyses between "weaker" (n = 9, PEDro ≤5) and "stronger" (n = 9, PEDro ≥6) studies indicated that weaker studies showed larger effects in favor of VRT compared to CON regarding balance performance (p < 0.001). CONCLUSIONS Although slightly less effective than AT, VRT-based balance training is an acceptable method for improving balance performance as well as functional mobility outcomes in healthy community dwellers. VRT might serve as an attractive complementary training approach for the elderly. However, more high-quality research is needed in order to derive valid VRT recommendations compared to both AT and CON.
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Affiliation(s)
- Lars Donath
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, 4052, Basel, Switzerland.
| | - Roland Rössler
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, 4052, Basel, Switzerland
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, 4052, Basel, Switzerland
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Effects of Exergames on Quality of Life, Pain, and Disease Effect in Women With Fibromyalgia: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:1725-1731. [PMID: 28322760 DOI: 10.1016/j.apmr.2017.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/15/2017] [Accepted: 02/22/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effects of an exergame-based intervention on a population sample of women with fibromyalgia. DESIGN Single-blinded, randomized controlled trial with 8-week intervention. SETTING Fibromyalgia center. PARTICIPANTS Participants (all women) (N=83) were divided into 2 groups: an exercise group (n=42; mean age ± SD, 52.52±9.73y) and a nonexercise group (n=41; mean age ± SD, 52.47±8.75y). INTERVENTIONS Women in the exercise group completed an 8-week exergame-based training program, which was focused on postural control and coordination of the upper and lower limbs, aerobic conditioning, strength, and mobility. Women (groups of 3) were encouraged to exercise for 120 minutes (over 2 sessions) per week. MAIN OUTCOME MEASURES Main outcome measures included pain and disease effect, which were assessed with the Fibromyalgia Impact Questionnaire (FIQ), a specific measure for fibromyalgia. Secondary outcome measure included quality of life, which was assessed with the EuroQoL-5 Dimensions-5 Levels (EQ-5D-5L) generic instrument. RESULTS The results showed that 97.62% of participants in the exercise group completed the 8-week intervention. The exercise group showed a significant improvement (P<.05) in the EQ-5D-5L utility index, and in 3 of 5 dimensions. For the FIQ, significant improvements were observed in the dimensions of pain, stiffness, anxiety, and feel good. The FIQ score was also reduced. The mean between-group improvement was 8.25 (95% confidence interval, 2.85-13.65). CONCLUSIONS The results and levels of compliance/adherence suggest this exergame-based training program is an effective intervention for reducing pain and increasing health-related quality of life in women with fibromyalgia.
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Szturm TJ, Sakhalkar VS, Kanitkar A, Nankar M. Computerized Dual-Task Testing of Gait and Visuospatial Cognitive Functions; Test-Retest Reliability and Validity. Front Hum Neurosci 2017; 11:105. [PMID: 28367119 PMCID: PMC5355418 DOI: 10.3389/fnhum.2017.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
The common occurrence of age decline in mobility and cognition does cause a decrease in the level of physical activity and an increased falls risk. Consequently, dual -task (DT) assessment that simultaneously addresses both mobility skills and cognitive functions are important because, continued difficulties and fall injuries will have a sizable impact in this population. The first objective of the present study was to assess test-retest reliability of a computerized DT treadmill walking protocol and concurrent outcome measures of gait and visuospatial executive function in a group of healthy older adults. Secondly, discriminative validity was evaluated by examining the effect of DT conditions (single task vs. dual-task) on; (a) spatiotemporal gait measures (average and coefficient of variation) and (b) visuomotor and visuospatial executive performance measures. Twenty-five community-dwelling individuals median age 65 (range 61-67) were recruited from a Fitness Facility. Participants performed a computerized visuomotor tracking task and a visuospatial executive game task in standing and while treadmill walking. Testing was conducted on two occasions, 1 week apart. Moderate to high test-retest reliability (ICC values of 0.65-0.88) were observed for spatiotemporal gait variables. No significant differences between the group means were observed between test periods in any gait variable. Moderate test-retest reliability (ICC values of 0.6-0.65) was observed for measures of visuomotor and visuospatial executive performance during treadmill walking. Significant DT effects were observed for both spatiotemporal gait variables and visuospatial executive performance measures. This study demonstrates the reliability and reproducibility of the computer-based assessment tool for dual task treadmill walking. The high to moderate ICC values and the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable data from community-dwelling older adults. The present computerized dual-task protocols broaden the types of standardized visuomotor and visuospatial executive activities for use with DT treadmill walking that has previously been reported.
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Affiliation(s)
- Tony J Szturm
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; Department of Physical Therapy, University of ManitobaWinnipeg, MB, Canada
| | - Vedant S Sakhalkar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; School of Medical Rehabilitation, University of ManitobaWinnipeg, MB, Canada
| | - Anuprita Kanitkar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; Applied Health Sciences, University of ManitobaWinnipeg, MB, Canada
| | - Mayur Nankar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of Manitoba Winnipeg, MB, Canada
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Tahmosybayat R, Baker K, Godfrey A, Caplan N, Barry G. A systematic review and meta-analysis of outcome measures to assess postural control in older adults who undertake exergaming. Maturitas 2017; 98:35-45. [PMID: 28274326 DOI: 10.1016/j.maturitas.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
Exergaming has been shown to be an effective tool to improve postural control (PC) in older community-dwelling individuals. The outcome measures (OMs) used to assess PC are varied and this could limit the estimation of the effectiveness of the intervention. This systematic review and meta-analysis aims to explore the OMs currently used to assess PC in exergaming interventions, for healthy elderly individuals aged over 60 years. The literature search was conducted across five databases (CINAHL, EMBASE, PubMed, ISI, SPORTdiscus and Science Direct) using a range of search terms and combinations relating to exergaming, balance, exercise, falls and elderly. Quality assessment was conducted using the PEDro Scale and a custom-made quality assessment tool. Eleven trials were included in the meta-analysis, with a mean (SD) PEDro score of 5.36 (1.57). Primary and secondary OMs showed small effects in favour of alternative training modes, although these effects were statistically insignificant for all primary OMs. Tertiary OMs could not be included in the meta-analysis due to varying output parameters from different instruments. Heterogeneity remained high across trials and no studies performed long-term follow-up. Exergaming is a potential alternative to PC training, although still in its infancy. Strong and well-designed RCTs are needed, targeting specific populations aged over 60 years. Variability in instrumented OMs prevents generalisation of results. Technological improvements may provide data not currently available from clinical and laboratory-based methods, and may allow PC to be assessed more realistically and specifically in relation to a population's activities of daily living, though this remains a new area of research.
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Affiliation(s)
- Robin Tahmosybayat
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK.
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Alan Godfrey
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - Nick Caplan
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, University of Northumbria, Newcastle Upon Tyne, UK; Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
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Alhasan H, Hood V, Mainwaring F. The effect of visual biofeedback on balance in elderly population: a systematic review. Clin Interv Aging 2017; 12:487-497. [PMID: 28293105 PMCID: PMC5345985 DOI: 10.2147/cia.s127023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Balance is commonly affected by multiple factors, especially among the elderly population. Visual biofeedback (VBF) is an intervention tool that can be used in balance rehabilitation. AIM This study aimed to systematically review randomized controlled trials that examine whether VBF training is effective in improving balance in an elderly population. DATA SOURCES Three databases were searched: CIAHL, EMBASE, and MEDLINE. The searches were limited to the period from 2010 to 2016. ELIGIBILITY CRITERIA Healthy adults, aged ≥65 years, with no specific disorders were included. Interventions were any VBF intervention with the aim of improving balance and were compared to no intervention, traditional exercises, placebo, or standard care. The outcome measures were balance as measured by any validated outcome measure. STUDIES APPRAISAL METHOD The Physiotherapy Evidence Database quality assessment tool and The Cochrane Collaboration tool for assessing risk of bias were used by two independent authors (HA and FM) in order to appraise the included studies. RESULTS The database search resulted in 879 articles, of which five papers were included. VBF was compared to no intervention, a placebo, and traditional exercise. The total number of participants in all the five included studies was 181, with a mean age of 74.3 years (standard deviation 6.7). Two studies were rated as high-quality studies, and three were rated as fair quality. CONCLUSION Engaging elderly people living in the community in VBF training was found to be effective and could improve their balance ability. However, the variation between studies in methodology, intervention protocol, and outcomes utilized made it difficult to inform a definitive statement regarding the potential application of VBF for balance training with the elderly. Furthermore, high-quality randomized control trials are required. The systematic review level of evidence is moderate, and the strength of recommendation is that VBF is likely to be beneficial.
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Affiliation(s)
- Hammad Alhasan
- Physiotherapy Department, Faculty of Applied Medical Science, Umm al-Qura University, Mecca, Kingdom of Saudi Arabia
| | - Victoria Hood
- School of Health Science, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Frederick Mainwaring
- School of Health Science, University of Nottingham, Nottingham, Nottinghamshire, UK
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Vojciechowski AS, Natal JZ, Gomes ARS, Rodrigues EV, Villegas ILP, Korelo RIG. Effects of exergame training on the health promotion of young adults. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.001.ao06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Training with exergames has been prescribed for health problems prevention, however, little is known about its influence on the self-perception of the physical condition and on the physical and motor skills (PMS). Objective: To investigate the effects of exergames (EXG) on the self-perception of the physical condition, level of physical activity and PMS in healthy young adults. Methods: Forty young adults, of both genders, were allocated by convenience into Control Group (CG, n = 20, 21.85 ± 0.62 years old), the individuals did not perform the physical training with exergames, and Intervention Group (IG, n = 20, 23.10 ± 0.61 years old), the subjects practiced exergames training (XBOX360 Kinect ®), in pairs, twice a week, for 12 weeks. Anthropometric measurements; self-perceived physical condition (International Fitness Scale-IFIS); International Physical Activity Questionnaire (IPAQ) and PMS (flexibility; abdominal endurance; upper limb strength and endurance, agility and velocity) were evaluated. Results: The IG presented better self-perception of the physical condition; increased physical activity level in the leisure domain and enhanced PMS after 12 weeks of intervention, compared to the CG. Conclusion: The EXG was efficient to improve skeletal muscle function, to contribute to physical exercise adherence and to promote physical health in active young adults.
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Lee MM, Shin DC, Song CH. Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: a randomized controlled pilot study. J Phys Ther Sci 2016; 28:2019-24. [PMID: 27512255 PMCID: PMC4968497 DOI: 10.1589/jpts.28.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was aimed at investigating the preliminary therapeutic efficacy and usefulness of canoe game-based virtual reality training for stroke patients. [Subjects and Methods] Ten stroke patients were randomly assigned to an experimental group (EG; n=5) or a control group (CG; n=5). Patients in both groups participated in a conventional rehabilitation program, but those in the EG additionally participated in a 30-min canoe game-based virtual reality training program 3 days a week for 4 weeks. Therapeutic efficacy was assessed based on trunk postural stability, balance, and upper limb motor function. In addition, the usefulness of canoe game-based virtual reality training was assessed in the EG and therapist group (TG; n=20), which consisted of physical and occupational therapists, by using the System Usability Scale (SUS). [Results] Improvements in trunk postural stability, balance, and upper limb motor function were observed in the EG and CG, but were greater in the EG. The mean SUS scores in the EG and TG were 71 ± 5.2 and 74.2 ± 4.8, respectively. [Conclusion] Canoe game-based virtual reality training is an acceptable and effective intervention for improving trunk postural stability, balance, and upper limb motor function in stroke patients.
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Affiliation(s)
- Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Republic of Korea
| | - Doo-Chul Shin
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Chang-Ho Song
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Chen CC. Improvement in the physiological function and standing stability based on kinect multimedia for older people. J Phys Ther Sci 2016; 28:1343-8. [PMID: 27190480 PMCID: PMC4868240 DOI: 10.1589/jpts.28.1343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/16/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The increase in the Taiwanese older population is associated with age-related inconveniences. Finding adequate and simple physical activities to help the older people maintaining their physiological function and preventing them from falls has become an urgent social issue. [Subjects and Methods] This study aimed to design a virtual exercise training game suitable for Taiwanese older people. This system will allow for the maintenance of the physiological function and standing stability through physical exercise, while using a virtual reality game. The participants can easily exercise in a carefree, interactive environment. This study will use Kinect for Windows for physical movement detection and Unity software for virtual world development. [Results] Group A and B subjects were involved in the exercise training method of Kinect interactive multimedia for 12 weeks. The results showed that the functional reach test and the unipedal stance test improved significantly. [Conclusion] The physiological function and standing stability of the group A subjects were examined at six weeks post training. The results showed that these parameters remained constant. This proved that the proposed system provide substantial support toward the preservation of the Taiwanese older people' physiological function and standing stability.
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Affiliation(s)
- Chih-Chen Chen
- Department of Management Information Systems, Hwa Hsia University of Technology, Taiwan
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Chen CC. Multimedia virtualized environment for shoulder pain rehabilitation. J Phys Ther Sci 2016; 28:1349-54. [PMID: 27190481 PMCID: PMC4868241 DOI: 10.1589/jpts.28.1349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/16/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Researchers imported games and virtual reality training to help participants
train their shoulders in a relaxed environment. [Subjects and Methods] This study included
the use of Kinect somatosensory device with Unity software to develop 3-dimensional
situational games. The data collected from this training process can be uploaded via the
Internet to a cloud or server for participants to perform self-inspection. The data can be
a reference for the medical staff to assess training effectiveness for those with
impairments and plan patient rehabilitation courses. [Results] In the training activities,
8 subjects with normal shoulder function demonstrated that the system has good stability
and reproducibility. Six subjects with impaired shoulder underwent 6 weeks of training.
During the third week of training, average performance stabilized. The t-test comparing
1–2 weeks to 3–4 weeks and 5–6 weeks showed significant differences. [Conclusion] Using
games as training methods improved patient concentration, interest in participation and
allowed patients to forget about their body discomfort. The equipment utilized in this
study is inexpensive, easy to obtain, and the system is easy to install. People can
perform simple self-training both at home or in the office.
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Affiliation(s)
- Chih-Chen Chen
- Department of Management Information Systems, Hwa Hsia University of Technology, Taiwan
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Kato N, Tanaka T, Sugihara S, Shimizu K, Kudo N. A study of the effect of visual depth information on upper limb movement by use of measurement of smoothness. J Phys Ther Sci 2016; 28:1134-41. [PMID: 27190441 PMCID: PMC4868201 DOI: 10.1589/jpts.28.1134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study verified that the smoothness of reaching movements is able to quantitatively evaluate the effects of two- and three-dimensional images on movement in healthy people. In addition, clinical data of cerebrovascular accident patients were also analyzed by the same method. [Subjects] Ten healthy adult volunteers and two male patients with previous cerebrovascular accidents participated. [Methods] The subjects were tasked with reaching for objects shown on a display. The target and virtual limb, rendered with computer graphics, were shown on the display. Movements of the virtual limb were synchronized with those of the subject. Healthy subjects reached for targets with their dominant arm, and cerebrovascular accident patients used their paretic arm. A polarized display and polarized glasses were used when the subjects were shown three-dimensional images. In the present study, jerk cost was used to quantify the smoothness of movement. [Results] Six of the 10 healthy subjects had significantly smoother reaching movements when viewing the three-dimensional images. The two cerebrovascular accident patients tended to have smoother movements in response to the three-dimensional images. [Conclusion] Analysis of the smoothness of movement was able to detect the influence of the depth cue in vision on movement quantitatively for the healthy subjects and cerebrovascular accident patients.
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Affiliation(s)
- Norio Kato
- Department of Physical Therapy, Faculty of Health Sciences,
Hokkaido University of Scienc,
Japan
- Graduate School of Information Science and Technology,
Hokkaido University, Japan
| | - Toshiaki Tanaka
- Department of Physical Therapy, Faculty of Health Sciences,
Hokkaido University of Scienc,
Japan
- Graduate School of Information Science and Technology,
Hokkaido University, Japan
| | - Syunichi Sugihara
- Institute of Gerontology, The University of Tokyo,
Japan
- Sapporo Syuyukai Hospital, Japan
| | - Koichi Shimizu
- Institute of Gerontology, The University of Tokyo,
Japan
| | - Nobuki Kudo
- Institute of Gerontology, The University of Tokyo,
Japan
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Harris DM, Rantalainen T, Muthalib M, Johnson L, Teo WP. Exergaming as a Viable Therapeutic Tool to Improve Static and Dynamic Balance among Older Adults and People with Idiopathic Parkinson's Disease: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2015; 7:167. [PMID: 26441634 PMCID: PMC4561514 DOI: 10.3389/fnagi.2015.00167] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/17/2015] [Indexed: 11/25/2022] Open
Abstract
The use of virtual reality games (known as “exergaming”) as a neurorehabilitation tool is gaining interest. Therefore, we aim to collate evidence for the effects of exergaming on the balance and postural control of older adults and people with idiopathic Parkinson’s disease (IPD). Six electronic databases were searched, from inception to April 2015, to identify relevant studies. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were used to calculate effect sizes between experimental and control groups. I2 statistics were used to determine levels of heterogeneity. 325 older adults and 56 people with IPD who were assessed across 11 studies. The results showed that exergaming improved static balance (SMD 1.069, 95% CI 0.563–1.576), postural control (SMD 0.826, 95% CI 0.481–1.170), and dynamic balance (SMD −0.808, 95% CI −1.192 to −0.424) in healthy older adults. Two IPD studies showed an improvement in static balance (SMD 0.124, 95% CI −0.581 to 0.828) and postural control (SMD 2.576, 95% CI 1.534–3.599). Our findings suggest that exergaming might be an appropriate therapeutic tool for improving balance and postural control in older adults, but more large-scale trials are needed to determine if the same is true for people with IPD.
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Affiliation(s)
- Dale M Harris
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
| | - Timo Rantalainen
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
| | - Makii Muthalib
- Movement to Health (M2H) Laboratory, Euromov, University of Montpellier , Montpellier , France
| | - Liam Johnson
- Clinical Exercise Science Research Program, Institute of Sport Exercise and Active Living (ISEAL), Victoria University , Melbourne, VIC , Australia ; The Florey Institute of Neuroscience and Mental Health, University of Melbourne , Melbourne, VIC , Australia
| | - Wei-Peng Teo
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
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