Effect of Wii Fit Exercise With Balance and Lower Limb Muscle Strength in Older Adults: A Meta-Analysis

Wii Fit Exercise's Effects on Muscle Strength and Fear of Falling in Older Adults With Alzheimer Disease: A Randomized Controlled Trial

PURPOSE

This study aimed to investigate how Wii Fit exercises affect muscle strength and fear of falling in older adults with Alzheimer's disease.

METHOD

The study included a total of 32 volunteers with Alzheimer's disease, aged 65-80 years. These participants were divided into two groups: the exercise group and the control group. The exercise group received a 30-min (one session) twice-weekly exercise program for 6 weeks with games selected from different categories, such as balance and aerobic exercises, with the Nintendo Wii virtual reality device. During this period, the control group did not receive any treatment, and routine medical treatments continued. At baseline and 6 weeks later, Mini-Mental State Examination, knee extension muscle strength, Timed Up and Go Test, and Tinetti Fall Efficacy Scale results were recorded in the exercise and control groups.

RESULTS

In intragroup comparison, a statistically significant difference was found in all tests (muscle strength, Timed Up and Go Test, and Tinetti Fall Efficacy Scale) in the exercise group after the exercise program (p < .05), while no significant difference was found in the control group (p > .05). According to the interaction of group and time in the intergroup comparison, there was no difference between the groups (exercise and control group) in muscle strength and Timed Up and Go Test (p > .05), but there was a difference in Tinetti Fall Efficacy Scale (p < .05).

CONCLUSIONS

This randomized controlled trial supports the claim that Wii Fit exercises can reduce the fear of falling in older adults with Alzheimer's disease.

Using the Nintendo™ Wii to Improve Physical Function and Reduce the Risk of Falls in Older Adults: A Randomized Controlled Clinical Trial

(1) Background: Numerous exercise programs that improve physical capacity and the risk of falls in older adults have been proposed with varying degrees of success. A novel approach may be to use a video game system that uses real-time force feedback to train older adults. The aim of this study was to evaluate the effects of a Nintendo™ Wii-based exercise program on physical function and risk of falls in older people. (2) Methods: This 12-week randomized controlled clinical trial involved 73 participants: 36 individuals participating in a control group (CG) and 37 in an experimental group (EG) participating in a combined program. Balance was measured using the Tinetti scale, flexibility was assessed with the back scratch test and the sit-and-reach test, and lower body strength was assessed with the 30 s chair stand-up test. (3) Results: The results of this study show significant improvements in balance, gait, flexibility, and strength of the lower limbs compared to a control group. (4) Conclusions: A Nintendo™ Wii-based exercise program for seniors produces improvements in the physical health of older adults. These improvements highlight the importance of integrating physical exercise through video games as an effective strategy to improve the general health and quality of life of older adults.

Effectiveness of Nintendo Wii Fit© for Physical Therapy in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Multiple sclerosis (MS) is a chronic, inflammatory, and autoimmune disease that mainly affects the central nervous system and currently has no cure. Exergaming is considered a non-immersive approach to improving functional and motor skills in the treatment of MS. The aim of this systematic review was to evaluate the effectiveness of the Nintendo Wii Fit© (NWF) on physical outcomes compared with control regimes in patients with MS. The search was performed in seven databases including articles published up to June 2024. The PICOS model was used to establish the study eligibility criteria. The Cochrane Collaboration tool and the PEDro scale were used to assess the risk of bias and evaluate the methodological quality of the studies, respectively. A meta-analysis using the standardized mean difference (SMD) and confidence interval (95% CI) was developed using the Review Manager 5.4 software. Seven articles were included in the systematic review. The statistical analysis showed favorable overall results for the NWF on functional mobility (SMD = 0.25; 95% CI = 0.09, 0.41) and fatigue (SMD = 0.41; 95% CI = 0.00, 0.82). In conclusion, this systematic review suggests that the NWF has shown favorable effects compared to control regimes on functional mobility and fatigue outcomes in patients with MS.

Balance Board or Motion Capture? A Meta-Analysis Exploring the Effectiveness of Commercially Available Virtual Reality Exergaming in Enhancing Balance and Functional Mobility Among the Elderly

Force platforms and motion capture are commonly used as feedback mechanisms in exergaming; nevertheless, their therapeutic effectiveness may vary. Therefore, the primary objective of this study was to evaluate the effectiveness of commercially available virtual reality (VR) exergaming systems on balance and functional mobility, with a supplementary analysis considering the administered dose of exergaming. The search was conducted in five databases. Commercially available exergaming platforms were classified into two categories: VR exergaming with a balance board (including Wii Balance Board) and motion capture (including Xbox Kinect). Two categories of control interventions (treatment as usual [TAU] and no treatment [NT]) were extracted. The meta-analysis was performed separately for static, dynamic, and proactive balance outcomes and for the aggregated results of all included outcomes with subgroup analysis of lower, moderate, and higher doses. In total, 28 studies with 1457 participants were included. Both exergaming systems were particularly effective in improving the single leg stance outcome. VR exergaming with motion capture was found to be more effective than TAU with a standardized mean difference (SMD) of 0.48 (P = 0.006) and NT (SMD = 0.86; P = 0.02). In conclusion, commercially available VR exergaming with a motion capture feedback mechanism has demonstrated effectiveness as an intervention for balance training when compared with NT. Specifically, high doses (above 134 minutes per week) appear to be more beneficial for healthy older adults. Moreover, the findings provide some weak evidence supporting the effectiveness of VR exergaming with a balance board for improving functional mobility, particularly when compared with NT.

Effects of active exergames on physical performance in older people: an overview of systematic reviews and meta-analysis

This overview assessed the available body of published peer-reviewed systematic reviews and meta-analyses related to the effects of active exergames compared with active/passive control on physical performance outcomes in older people. The methodological quality and certainty of evidence were assessed using PRISMA, AMSTAR 2, and GRADE. The protocol was registered in PROSPERO (code: CRD42023391694). The main outcomes indicate that 4,477 records, five systematic reviews, and 10 meta-analyses were included. The AMSTAR-2 reported six meta-analyses with high methodological quality, four moderate quality, two systematic reviews with low quality, and three very-low quality. Meta-analysis was performed on balance using the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG) tests, on cardiorespiratory fitness using the 6-min walk test, and on upper and lower limbs muscle strength using the handgrip strength, knee extension, and 30-s chair stand tests. Significant differences in favor of the active exergames groups concerning active/passive groups were reported in BBS (SMD = 0.85; 95% CI = 0.12-1.58; I2 = 96%; p = 0.02), TUG (SMD = 1.44; 95% CI = 0.71-2.16; I2 = 97%; p < 0.0001), and 30-s chair stand test (SMD = 0.79; 95% CI = 0.33-1.25; I2 = 88%; p = 0.0008). However, no significant differences were reported in favor of the active exergames groups in 6-min walk (SMD = 0.93; 95% CI = -0.64 to 2.50; I2 = 95%; p = 0.24), handgrip strength (SMD = 0.67; 95% CI = -0.04 to 1.38; I2 = 84%; p = 0.06), and knee extension tests (SMD = 0.20; 95% CI = -0.05 to 0.44; I2 = 95%; p = 0.12) compared to active/passive control. However, it was impossible to perform a meta-analysis for the variables of walking speed as a fall risk due to the diversity of instruments and the small number of systematic reviews with meta-analysis. In conclusion, interventions utilizing active exergames have shown significant improvements in the static and dynamic balance and lower limb muscle strength of apparently healthy older people, compared to control groups of active/inactive participants, as measured by BBS, TUG, and 30-s chair stand tests. However, no significant differences were found in the 6-min walk, HGS, and knee extension tests.

Systematic review registration

PROSPERO, CRD42023391694.

Effects of community-based fall prevention interventions for older adults using information and communication technology: A systematic review and meta-analysis

Objectives: This systematic review and meta-analysis aimed to investigate the effect of fall prevention interventions using information and communication technology (ICT). Methods: A comprehensive search across four databases was performed. The inclusion criteria were fall prevention interventions including telehealth, computerized balance training, exergaming, mobile application education, virtual reality exercise, and cognitive-behavioral training for community-dwelling adults aged ≥60 years. Results: Thirty-four studies were selected. Telehealth, smart home systems, and exergames reduced the risk of falls (RR = 0.63, 95% CI [0.54, 0.75]). Telehealth and exergame improved balance (MD = 3.30, 95% CI [1.91, 4.68]; MD = 4.40, 95% CI [3.09, 5.71]). Telehealth improved physical function (SMD = 0.69, 95% CI [0.23, 1.16]). Overall, ICT fall interventions improved fall efficacy but not cognitive function. For quality of life (QOL), mixed results were found depending on the assessment tools. Conclusion: Future investigations on telehealth, smart home systems, or exergames are needed to motivate older adults to exercise and prevent falls.

Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews

BACKGROUND

It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place.

OBJECTIVE

This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest.

METHODS

The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database.

RESULTS

A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps.

CONCLUSIONS

Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa.

Effectiveness of two different exergaming systems in addition to conventional treatment for physical therapy in patients with multiple sclerosis: A study protocol for a multicenter, assessor-blind, 24-week, randomized controlled trial

Objectives

The main aim is to evaluate and compare the effectiveness of two specific exergaming systems in addition to conventional treatment on improving physical functional capacity, balance, muscle strength, spasticity in lower limbs, and quality of life in patients with multiple sclerosis. The secondary aim is to compare the effectiveness of each exergaming system to isolated conventional treatment.

Design

A multicenter, assessor-blind, 24-week, randomized controlled trial.

Methods

39 patients diagnosed with multiple sclerosis will be allocated to three groups. A control group will perform a conventional treatment based on daily routine activities and/or combined training, whereas the experimental groups will be randomly divided to develop an active videogame-based exercise program through Nintendo Ring Fit Adventure© or Nintendo Wii Fit©, in addition to the conventional treatment. Study outcomes will be assessed at baseline and at 12 and 24 weeks. One-way ANOVA or Kruskal-Wallis tests will be used to analyze differences between groups at baseline and mixed ANOVA for differences between-within groups over time.

Discussion

The findings from this evidence-based trial, which includes both Nintendo© active videogames, could potentially establish exergame training as a valuable and reliable therapeutic tool for neurorehabilitation. It is essential to consider the customization, specifically in our case, on each multiple sclerosis condition, and ensure patients' adherence to the treatment.

Effectiveness of telerehabilitation and home-based falls prevention programs for community-dwelling older adults: a systematic review and meta-analysis protocol

INTRODUCTION

Falls among older adults are associated with adverse sequelae including fractures, chronic pain and disability, which can lead to loss of independence and increased risks of nursing home admissions. The COVID-19 pandemic has significantly increased the uptake of telehealth, but the effectiveness of virtual, home-based fall prevention programmes is not clearly known. We aim to synthesise the trials on telerehabilitation and home-based falls prevention programmes to determine their effectiveness in reducing falls and adverse outcomes, as well as to describe the safety risks associated with telerehabilitation.

METHODS AND ANALYSIS

This protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Database searches from inception to August 2022 will be conducted without language restrictions of MEDLINE, EMBASE, Ovid HealthSTAR, CINAHL, SPORTDiscus, Physiotherapy EvidenceDatabase (PEDro) and the Cochrane Library. Grey literature including major geriatrics conference proceedings will be reviewed. Using Covidence software, two independent reviewers will in duplicate determine the eligibility of randomised controlled trials (RCTs). Eligible RCTs will compare telerehabilitation and home-based fall prevention programmes to usual care among community-dwelling older adults and will report at least one efficacy outcome: falls, fractures, hospitalisations, mortality or quality of life; or at least one safety outcome: pain, myalgias, dyspnoea, syncope or fatigue. Secondary outcomes include functional performance in activities of daily living, balance and endurance. Risk of bias will be assessed using the Cochrane Collaboration tool. DerSimonian-Laird random effects models will be used for the meta-analysis. Heterogeneity will be assessed using the I² statistic and Cochran's Q statistic. We will assess publication bias using the Egger's test. Prespecified subgroup analyses and univariate meta-regression will be used.

ETHICS AND DISSEMINATION

Ethics approval is not required. The results will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42022356759.

Leg Muscle Activity and Joint Motion during Balance Exercise Using a Newly Developed Weight-Shifting-Based Robot Control System

A novel and fun exercise robot (LOCOBOT) was developed to improve balance ability. This system can control a spherical robot on a floor by changing the center of pressure (COP) based on weight-shifting on a board. The present study evaluated leg muscle activity and joint motion during LOCOBOT exercise and compared the muscle activity with walking and sit-to-stand movement. This study included 10 healthy male adults (age: 23.0 ± 0.9 years) and examined basic LOCOBOT exercises (front-back, left-right, 8-turn, and bowling). Electromyography during each exercise recorded 13 right leg muscle activities. Muscle activity was represented as the percentage maximal voluntary isometric contraction (%MVIC). Additionally, the joint motion was simultaneously measured using an optical motion capture system. The mean %MVIC differed among LOCOBOT exercises, especially in ankle joint muscles. The ankle joint was primarily used for robot control. The mean %MVIC of the 8-turn exercise was equivalent to that of walking in the tibialis anterior, and the ankle plantar flexors were significantly higher than those in the sit-to-stand motion. Participants control the robot by ankle strategy. This robot exercise can efficiently train the ankle joint muscles, which would improve ankle joint stability.

Effectiveness of feedback-based technology on physical and cognitive abilities in the elderly

Aging raises a social and health challenge because the passing of time causes changes in cognitive and physical functions that impair functionality and quality of life. In addition, advancements in technology and information technology have led to the development of new techniques for retraining based on the feedback technology provides. To solve the negative consequences of aging, a randomized clinical trial was carried out to assess the effectiveness of a protocol using feedback-based technology to improve physical and cognitive functions in older adults. For the purpose of this study, 200 patients were selected from a Social and Community Services Center in the province of Seville and only 46 of them became participants of the study (after applying the inclusion criteria). These patients were divided into two groups: control and experimental. Physical and cognitive abilities were assessed using the Miniexamen cognoscitivo Test (an adaptation of the MiniMental examination test), Yesevage's Depression Scale, Oddball Test, Attention Network Test, Berg Scale, Tinetti Scale, and Timed Up and Go Test. The intervention applied to the experimental group consisted of a supervised protocol using the Nintendo® Wii video game console and the Wii-Fit© video game during 16 sessions, 2 times a week with a duration of 30 min per session. The control group did not receive any treatment. The experimental group showed statistically significant improvements in all the physical variables (balance, gait, autonomy, and fall risk), as other authors had proven, and in memory and reaction times; there were no improvements in attention networks. The control group (placebo) even showed a decrease in their functions, with worse results on the Timed up and Go test Scale. The intervention using feedback-based technology has been proven effective in improving physical and cognitive abilities and in preventing and promoting healthy aging.