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Chan WLS, Chan CWL, Chan HHW, Chan KCK, Chan JSK, Chan OLW. A randomised controlled pilot study of a Nintendo Ring Fit Adventure™ balance and strengthening exercise program in community-dwelling older adults with a history of falls. Australas J Ageing 2024. [PMID: 38404233 DOI: 10.1111/ajag.13297] [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: 10/11/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES This pilot study examined the feasibility, acceptability, and effects of a Nintendo Ring Fit Adventure™-based balance and muscle strengthening exercise program in community-dwelling older adults with a history of falls. METHODS Older adults who have had at least one fall in the past year were randomly assigned to an experimental (n = 21) or control group (n = 21). The experimental group performed 16 exercise sessions in total, lasting 60 min each, twice a week for 8 weeks, whereas the control group received usual care. Feasibility was evaluated based on the scores of participants in the exercises. Acceptance was evaluated using a customised questionnaire examining participants' self-perceived enjoyment, feasibility and improvements. Clinical outcomes including balance (Mini-BESTest), lower limb muscle strength (Five-Time Sit-to-Stand test), mobility (Timed-Up and Go test), dual-task ability (Timed-Up and Go test-Dual Task), fear of falling (Icon-FES) and executive function (Color Trails Test) were evaluated at baseline and 8 weeks. RESULTS Thirty-one participants (74%) finished the 8-week assessment. The experimental group significantly improved their scores in six out of eight exercises (all p < .031). The mean scores of the self-perceived enjoyment, feasibility and improvement domains of the acceptability questionnaire were 3.46 ± .53, 3.08 ± .59, and 3.47 ± .57 respectively. A significant improvement in the anticipatory subscore of the Mini-BESTest was found in the experimental group compared to the control group (p = .02; Partial eta squared = .14). CONCLUSIONS The Nintendo Ring Fit Adventure™-based exercise program was feasible, acceptable, and potentially effective in community-dwelling older adults with a history of falls.
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Affiliation(s)
- Wayne Lap Sun Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Cody Wing Lam Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Howard Ho Wing Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kelvin Chi Kin Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jerry Sai Kit Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Oscar Lok Wang Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Guimarães V, Sousa I, de Bruin ED, Pais J, Correia MV. Using shoe-mounted inertial sensors and stepping exergames to assess the motor-cognitive status of older adults: A correlational study. Digit Health 2023; 9:20552076231167001. [PMID: 37009304 PMCID: PMC10061638 DOI: 10.1177/20552076231167001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Objective Stepping exergames designed to stimulate physical and cognitive skills can provide important information concerning individuals’ performance. In this study, we investigated the potential of stepping and gameplay metrics to assess the motor-cognitive status of older adults. Methods Stepping and gameplay metrics were recorded in a longitudinal study involving 13 older adults with mobility limitations. Game parameters included games’ scores and reaction times. Stepping parameters included length, height, speed, and duration, measured by inertial sensors placed on the shoes while interacting with the exergames. Parameters measured on the first gameplay were correlated against standard cognitive and mobility assessments, including the Montreal Cognitive Assessment (MoCA), gait speed, and the Short Physical Performance Battery. Based on MoCA scores, patients were then stratified into two groups: cognitively impaired and healthy controls. The differences between the two groups were visually inspected, considering their within-game progression over the training period. Results Stepping and gameplay metrics had moderate-to-strong correlations with cognitive and mobility performance indicators: faster, longer, and higher steps were associated with better mobility scores; better cognitive games’ scores and reaction times, and longer and faster steps were associated with better cognitive performance. The preliminary visual analysis revealed that the group with cognitive impairment required more time to advance to the next difficulty level, also presenting slower reaction times and stepping speeds when compared to the healthy control group. Conclusion Stepping exergames may be useful for assessing the cognitive and motor status of older adults, potentially allowing assessments to be more frequent, affordable, and enjoyable. Further research is required to confirm results in the long term using a larger and more diverse sample.
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Affiliation(s)
- Vânia Guimarães
- Fraunhofer Portugal AICOS, Porto, Portugal
- Faculty of Engineering, University of Porto, Porto, Portugal
- Vânia Guimarães, Fraunhofer Portugal AICOS, 4200-135 Porto, Portugal.
| | - Inês Sousa
- Fraunhofer Portugal AICOS, Porto, Portugal
| | - 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
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Joana Pais
- Neuroinova, Lda., Vila Nova de Gaia, Portugal
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Miguel Velhote Correia
- Faculty of Engineering, University of Porto, Porto, Portugal
- INESC TEC (Institute for Systems and Computer Engineering, Technology and Science), Porto, Portugal
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Müller H, Baumeister J, Bardal EM, Vereijken B, Skjæret-Maroni N. Exergaming in older adults: the effects of game characteristics on brain activity and physical activity. Front Aging Neurosci 2023; 15:1143859. [PMID: 37213536 PMCID: PMC10196070 DOI: 10.3389/fnagi.2023.1143859] [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: 01/13/2023] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Exergames are increasingly used in rehabilitation settings for older adults to train physical and cognitive abilities. To meet the potential that exergames hold, they need to be adapted to the individual abilities of the player and their training objectives. Therefore, it is important to know whether and how game characteristics affect their playing. The aim of this study is to investigate the effect of two different kinds of exergame (step game and balance game) played at two difficulty levels on brain activity and physical activity. Methods Twenty-eight older independently living adults played two different exergames at two difficulty levels each. In addition, the same movements as during gaming (leaning sideways with feet in place and stepping sideways) were performed as reference movements. Brain activity was recorded using a 64-channel EEG system to assess brain activity, while physical activity was recorded using an accelerometer at the lower back and a heart rate sensor. Source-space analysis was applied to analyze the power spectral density in theta (4 Hz-7 Hz) and alpha-2 (10 Hz-12 Hz) frequency bands. Vector magnitude was applied to the acceleration data. Results Friedman ANOVA revealed significantly higher theta power for the exergaming conditions compared to the reference movement for both games. Alpha-2 power showed a more diverse pattern which might be attributed to task-specific conditions. Acceleration decreased significantly from the reference movement to the easy condition to the hard condition for both games. Discussion The results indicate that exergaming increases frontal theta activity irrespective of type of game or difficulty level, while physical activity decreases with increasing difficulty level. Heart rate was found to be an inappropriate measure in this population older adults. These findings contribute to understanding of how game characteristics affect physical and cognitive activity and consequently need to be taken into account when choosing appropriate games and game settings for exergame interventions.
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Affiliation(s)
- Helen Müller
- Exercise Science and Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- *Correspondence: Helen Müller,
| | - Jochen Baumeister
- Exercise Science and Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Ellen Marie Bardal
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nina Skjæret-Maroni
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Dierick F, Bouché AF, Guérin S, Steinmetz JP, Federspiel C, Barvaux V, Buisseret F. Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention. BMC Geriatr 2022; 22:1006. [PMID: 36585630 PMCID: PMC9804952 DOI: 10.1186/s12877-022-03696-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Side-stepping is a potential exercise program to reduce fall risk in community-dwelling adults in their seventies, but it has never been tested in nursing home residents. This was a pilot quasi-experimental study to examine the feasibility and potential mobility and balance benefits of an intervention based on voluntary non-targeted side-stepping exercises in nursing home residents who fall recurrently. METHODS Twenty-two participants were recruited and non-randomly assigned to an intervention group ([Formula: see text]11, side-stepping exercises, STEP) participating in an 8-week protocol and to a control group ([Formula: see text]11, usual physiotherapy care, CTRL). They were clinically assessed at 4-time points: baseline, after 4 and 8 weeks, and after a 4-week follow-up period (usual physiotherapy care). Statistical differences between time points were assessed with a Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA. RESULTS Compared to baseline, significant benefits were observed in the STEP group at 8 weeks for the Timed Up and Go ([Formula: see text]0.020) and 6-minute walking test ([Formula: see text]0.001) as well as for the Berg Balance Scale ([Formula: see text]0.041) and Mini motor test ([Formula: see text]0.026). At follow-up, the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale significantly worsened in the STEP group ([Formula: see text]0.009 and [Formula: see text]0.001, respectively). No significant differences were found between the groups at the same time points. CONCLUSIONS Our intervention was feasible and improved mobility and balance after almost 8 weeks. Studies with larger samples and randomized control trials are needed to consolidate our preliminary observations and confirm the deterioration of some tests when side-stepping exercises are discontinued. TRIAL REGISTRATION Identifier: ISRCTN13584053. Retrospectively registered 01/09/2022.
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Affiliation(s)
- Frédéric Dierick
- Centre National de Rééducation Fonctionnelle et de Réadaptation – Rehazenter, Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Rue André Vésale 1, 2674 Luxembourg, Luxembourg
| | - Anne-France Bouché
- “Le Richemont”, Physiotherapy Department, Korian Group, Rue de L’Enclos 13, 5537 Bioul-Anhée, Belgium
| | - Serge Guérin
- INSEEC Grande Ecole, Avenue Claude Vellefaux 27, 75010 Paris, France
| | | | | | - Vincent Barvaux
- grid.466351.30000 0004 4684 7362Haute Ecole Louvain en Hainaut, Rue de l’Hôpital 2, 6060 Gilly, Belgium
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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: 0] [Impact Index Per Article: 0] [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.
;
| | - 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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Ringgenberg N, Mildner S, Hapig M, Hermann S, Kruszewski K, Martin-Niedecken AL, Rogers K, Schättin A, Behrendt F, Böckler S, Schmidlin S, Jurt R, Niedecken S, Brenneis C, Bonati LH, Schuster-Amft C, Seebacher B. ExerG: adapting an exergame training solution to the needs of older adults using focus group and expert interviews. J Neuroeng Rehabil 2022; 19:89. [PMID: 35974409 PMCID: PMC9382774 DOI: 10.1186/s12984-022-01063-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exergames are playful technology-based exercise programs. They train physical and cognitive functions to preserve independence in older adults (OAs) with disabilities in daily activities and may reduce their risk of falling. This study gathered in-depth knowledge and understanding of three different user groups' experiences in and relevant needs, worries, preferences, and expectations of technology-based training, to develop an exergame training device for OAs. METHODS We conducted a qualitative study using semi-structured focus group interviews of primary (OAs in geriatric or neurological rehabilitation) and secondary (health professionals) end users, as well as expert interviews of tertiary end users (health insurance experts or similar), exploring user perspectives on adjusting an existing exergame to OAs' needs. Voice-recorded interviews were transcribed by researchers and analyzed using thematic analysis (TA) following an inductive, data-driven, iterative approach. RESULTS We interviewed 24 primary, 18 secondary, and 9 tertiary end users at two rehabilitation centers in Austria and Switzerland. Our TA approach identified five to six themes per user group. Themes in the primary end user group reflected aspects of safety, training goals, individuality, game environment, social interactions, and physical and technical overload. Themes in the secondary end user group comprised facets of meaningfulness, distraction through the game environment, safety, gamification elements, the availability and accessibility of the exergame. Tertiary end users' themes addressed aspects of financial reimbursement, suitable target populations, professional training for the handling of exergame devices, training goals, and concerns about the use of exergames in geriatric rehabilitation. CONCLUSIONS In conclusion, an exergame for OAs must be safe, motivating and fully adaptable to the target group while promoting the return to or preservation of autonomy and independence in daily life. Our findings contribute to developing hard- and software extensions for the ExerG training device. Further research is needed to expand the validity of our findings to larger populations.
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Affiliation(s)
- Nathalie Ringgenberg
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Sarah Mildner
- Department of Health Sciences, IMC University of Applied Sciences Krems, Krems, Austria
| | - Marcia Hapig
- Research Center on Vascular Aging and Stroke, VASCage GmbH, Innsbruck, Austria
| | - Sarah Hermann
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
| | | | - Anna Lisa Martin-Niedecken
- Department of Design, Subject Area Game Design, Zurich University of the Arts, Zurich, Switzerland.,Sphery Ltd, Zurich, Switzerland
| | - Katja Rogers
- Stratford School of Interaction Design and Business, University of Waterloo, Waterloo, ON, Canada
| | | | - Frank Behrendt
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Sonja Böckler
- Department of Design, Subject Area Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - Stefan Schmidlin
- Department of Design, Subject Area Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - Roman Jurt
- Department of Design, Subject Area Game Design, Zurich University of the Arts, Zurich, Switzerland
| | | | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria.,Karl Landsteiner Institute of Interdisciplinary Rehabilitation Research, Münster, Austria
| | - Leo H Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Corina Schuster-Amft
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.,Institute of Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - Barbara Seebacher
- Karl Landsteiner Institute of Interdisciplinary Rehabilitation Research, Münster, Austria.,Department of Rehabilitation Research, Clinic for Rehabilitation Münster, Münster, Austria.,Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Janhunen M, Löppönen A, Walker S, Punsár T, Katajapuu N, Cheng S, Paloneva J, Pamilo K, Luimula M, Korpelainen R, Jämsä T, Heinonen A, Aartolahti E. Movement characteristics during customized exergames after total knee replacement in older adults. Front Sports Act Living 2022; 4:915210. [PMID: 35966111 PMCID: PMC9363837 DOI: 10.3389/fspor.2022.915210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction There is limited understanding of how older adults can reach kinematic goals in rehabilitation while performing exergames and conventional exercises, and how similar or different the kinematics during exergaming are when compared with conventional therapeutic exercise with similar movement. The aim of this study was to describe the movement characteristics performed during exercise in custom-designed exergames and conventional therapeutic exercises among patients who have undergone unilateral total knee replacement (TKR). In addition, the secondary aim was to assess the relation of these exercise methods, and to assess participants' perceived exertion and knee pain during exergaming and exercising. Materials and methods Patients up to 4 months after the TKR surgery were invited in a single-visit exercise laboratory session. A 2D motion analysis and force plates were employed to evaluate movement characteristics as the volume, range, and intensity of movement performed during custom-designed knee extension-flexion and weight shifting exergames and conventional therapeutic exercises post TKR. The perceived exertion and knee pain were assessed using the Borg Rating of Perceived Exertion and Visual Analog Scale, respectively. Results Evaluation of seven patients with TKR [age median (IQR), 65 (10) years] revealed that the volume and intensity of movement were mostly higher during exergames. Individual goniometer-measured knee range of motion were achieved either with exergames and conventional therapeutic exercises, especially in knee extension exercises. The perceived exertion and knee pain were similar after exergames and conventional therapeutic exercises. Conclusions During custom-designed exergaming the patients with TKR achieve the movement characteristics appropriate for post-TKR rehabilitation without increasing the stress and pain experienced even though the movement characteristics might be partly different from conventional therapeutic exercises by the volume and intensity of movement. Physical therapists could consider implementing such exergames in rehabilitation practice for patients with TKR once effectiveness have been approved and they are widely available.
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Affiliation(s)
- Maarit Janhunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Maarit Janhunen
| | - Antti Löppönen
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
- Department of Movement Sciences, Physical Activity, Sports and Health Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
- Antti Löppönen
| | - Simon Walker
- Faculty of Sport and Health Sciences, NeuroMuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Taavi Punsár
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Niina Katajapuu
- Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Sulin Cheng
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juha Paloneva
- Department of Orthopedics and Traumatology, Hospital Nova of Central Finland, Jyväskylä, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Konsta Pamilo
- Department of Orthopedics, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Mika Luimula
- Faculty of Business and Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva Aartolahti
- Institute of Rehabilitation, Jyväskylä University of Applied Sciences, Jyväskylä, Finland
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Torre MM, Temprado JJ. Effects of Exergames on Brain and Cognition in Older Adults: A Review Based on a New Categorization of Combined Training Intervention. Front Aging Neurosci 2022; 14:859715. [PMID: 35431905 PMCID: PMC9009337 DOI: 10.3389/fnagi.2022.859715] [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: 01/21/2022] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
The literature on exergames has reported inconsistent benefits on brain and cognitive functions. Moreover, it is still unknown whether they yield to equal or superior benefits as compared to other forms of physical exercise. However, until now, a review of exergaming literature was lacking, that would reverse the “product first” approach to replacing it with a “training first” approach that is, an analysis of the different studies based on a detailed description of the type of combined training interventions that was supported by the utilized exergames. In the present review, thanks to a structured framework build around seven interacting constructs (stimuli, settings, targets, markers, outcomes, moderators, and mechanisms), which collectively afford a global picture of the determining factors of exergames training, we aimed to determine whether and under which conditions exergames could be more effective than conventional training. Twenty three studies were finally selected for review and analyzed. We concluded that, in spite of their potential to improve brain and cognition, beneficial factors contributing to exergaming efficacy as well as its underlying mechanisms need to be investigated more systematically thanks to common experimental designs based on gold standards. We proposed some directions in this respect.
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Chu CH, Biss RK, Cooper L, Quan AML, Matulis H. Exergaming Platform for Older Adults Residing in Long-Term Care Homes: User-Centered Design, Development, and Usability Study. JMIR Serious Games 2021; 9:e22370. [PMID: 33687337 PMCID: PMC7988392 DOI: 10.2196/22370] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/12/2020] [Accepted: 02/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background Older adults (OAs) residing in long-term care (LTC) homes are often unable to engage in adequate amounts of physical activity because of multiple comorbidities, including frailty and severe cognitive impairments. This level of physical inactivity is associated with declines in cognitive and functional abilities and can be further compounded by social isolation. Exergaming, defined as a combination of exercise and gaming, has the potential to engage OAs in exercise and encourage social interaction. However, previously used systems such as the Nintendo Wii are no longer commercially available, and the physical design of other exergames is not suitable for OAs (ie, fall risks, accessibility issues, and games geared toward a younger population) with diverse physical and cognitive impairments. Objective This study aims to design and develop a novel, user-centered, evidence-based exergaming system for use among OAs in LTC homes. In addition, we aim to identify facilitators and barriers to the implementation of our exergaming intervention, the MouvMat, into LTC homes according to staff input. Methods This study used a user-centered design (UCD) process that consisted of 4 rounds of usability testing. The exergame was developed and finalized based on existing evidence, end user and stakeholder input, and user testing. Semistructured interviews and standardized and validated scales were used iteratively to evaluate the acceptability, usability, and physical activity enjoyment of the MouvMat. Results A total of 28 participants, 13 LTC residents, and 15 staff and family members participated in the UCD process for over 18 months to design and develop the novel exergaming intervention, the MouvMat. The iterative use of validated scales (System Usability Scale, 8-item Physical Activity Enjoyment Scale, and modified Treatment Evaluation Inventory) indicated an upward trend in the acceptability, usability, and enjoyment scores of MouvMat over 4 rounds of usability testing, suggesting that identified areas for refinement and improvement were appropriately addressed by the team. A qualitative analysis of semistructured interview data found that residents enjoyed engaging with the prototype and appreciated the opportunity to increase their PA. In addition, staff and stakeholders were drawn to MouvMat’s ability to increase residents’ autonomous PA. The intended and perceived benefits of MouvMat use, that is, improved physical and cognitive health, were the most common facilitators of its use identified by study participants. Conclusions This study was successful in applying UCD to collaborate with LTC residents, despite the high number of physical and sensory impairments that this population experiences. By following a UCD process, an exergaming intervention that meets diverse requirements (ie, hardware design features and motivation) and considers environmental barriers and residents’ physical and cognitive needs was developed. The effectiveness of MouvMat in improving physical and cognitive abilities should be explored in future multisite randomized controlled trials.
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Affiliation(s)
- Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Renée K Biss
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Lara Cooper
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Amanda My Linh Quan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Henrique Matulis
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
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10
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Zheng L, Li G, Wang X, Yin H, Jia Y, Leng M, Li H, Chen L. Effect of exergames on physical outcomes in frail elderly: a systematic review. Aging Clin Exp Res 2020; 32:2187-2200. [PMID: 31520334 DOI: 10.1007/s40520-019-01344-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022]
Abstract
AIM The aim of this systematic review was to understand the exergames that can be applied to the pre-frail and frail elderly people, to evaluate whether these games have a positive impact on physical outcomes in pre-frail and frail older adults, and to explore user's subjective feelings and compliance. METHODS PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane Library were searched until January 15, 2019. Only randomized controlled trials published in English for human beings were eligible. The review included studies which examined the effects of exergames on physical outcomes, feasibility and/or subjective feelings of pre-frail and frail older adults. Two researchers assessed the risk bias of all articles independently using the Cochrane collaboration's tool for assessing risk of bias. RESULTS Seven randomized controlled trials with 243 pre-frail and frail older adults met inclusion criteria and were included in this review. Results of the studies were heterogeneous. Physical outcomes (included muscle strength, balance ability, mobility function, gait and falls), subjective feeling outcomes, feasibility, attendance and some other functional outcomes were reported. CONCLUSION Exergames improved balance and mobility function of frail elderly, and it showed a tendency to increase muscle strength when combined with resistance training. As far as the limited evidence was concerned, exergames were feasible and generally accepted by participants.
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Affiliation(s)
- Lufang Zheng
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, 130021, Jilin, China
| | - Guichen Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, 130021, Jilin, China
| | - Xinxin Wang
- The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Huiru Yin
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, 130021, Jilin, China
| | - Yong Jia
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, 130021, Jilin, China
| | - Minmin Leng
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, 130021, Jilin, China
| | - Hongyan Li
- The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Li Chen
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, 130021, Jilin, China.
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China.
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Ambrosino P, Fuschillo S, Papa A, Di Minno MND, Maniscalco M. Exergaming as a Supportive Tool for Home-Based Rehabilitation in the COVID-19 Pandemic Era. Games Health J 2020; 9:311-313. [PMID: 32876489 DOI: 10.1089/g4h.2020.0095] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Antimo Papa
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Anders P, Bengtson EI, Grønvik KB, Skjæret-Maroni N, Vereijken B. Balance Training in Older Adults Using Exergames: Game Speed and Cognitive Elements Affect How Seniors Play. Front Sports Act Living 2020; 2:54. [PMID: 33345045 PMCID: PMC7739609 DOI: 10.3389/fspor.2020.00054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/16/2020] [Indexed: 11/21/2022] Open
Abstract
Falls in older adults are a serious threat to their health and independence, and a prominent reason for institutionalization. Incorrect weight shifts and poor executive functioning have been identified as important causes for falling. Exergames are increasingly used to train both balance and executive functions in older adults, but it is unknown how game characteristics affect the movements of older adults during exergaming. The aim of this study was to investigate how two key game elements, game speed, and the presence of obstacles, influence movement characteristics in older adults playing a balance training exergame. Fifteen older adults (74 ± 4.4 years) played a step-based balance training exergame, designed specifically for seniors to elicit weight shifts and arm stretches. The task consisted of moving sideways to catch falling grapes and avoid obstacles (falling branches), and of raising the arms to catch stationary chickens that appeared above the avatar. No steps in anterior-posterior direction were required in the game. Participants played the game for eight 2 min trials in total, at two speed settings and with or without obstacles, in a counterbalanced order across participants. A 3D motion capture system was used to capture position data of 22 markers fixed to upper and lower body. Calculated variables included step size, step frequency, single leg support, arm lift frequency, and horizontal trunk displacement. Increased game speed resulted in a decrease in mean single support time, step size, and arm lift frequency, and an increase in cadence, game score, and number of error messages. The presence of obstacles resulted in a decrease in single support ratio, step size, cadence, frequency of arm lifts, and game score. In addition, step size increased from the first to the second trial repetition. These results show that both game speed and the presence of obstacles influence players' movement characteristics, but only some of these effects are considered beneficial for balance training whereas others are detrimental. These findings underscore that an informed approach is necessary when designing exergames so that game settings contribute to rather than hinder eliciting the required movements for effective balance training.
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Affiliation(s)
- Phillipp Anders
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Espen Ingvald Bengtson
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
| | - Karoline Blix Grønvik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nina Skjæret-Maroni
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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13
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Effects of Playful Exercise of Older Adults on Balance and Physical Activity: a Randomized Controlled Trial. JOURNAL OF POPULATION AGEING 2020. [DOI: 10.1007/s12062-020-09273-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractThere is evidence that one of the most important approaches to improving the healthy ageing of older adults is for them to carry out daily physical activity. However, motivation to engage in physical activity is often low in old age. This study investigated the potential of engaging older adults in playful exercise to increase physical activity and balance. A randomised control trial (RCT) was performed with 26 independently living older adults (initially 38, but 12 were lost to illness or death during the course of the project), mean age 83.54 (SD: 7.12), 19 women. Participants were randomly allocated to intervention (n = 16) or control (n = 12) (originally 19 in each group). The intervention consisted of playful exercise on Moto tiles 6 * 2 min twice a week over 10 weeks, while control group participants engaged in normal daily activities.The intervention group participants improved functional balance (Berg’s Balance Score) by an average of 5.02 points, and the control group by 2.58 points (p = 0.11). No between-group difference was observed in physical activities outside exercise sessions (p = 0.82). The difference in gain of balance as measured by BBS was below statistical significance, as a result of the sample size being too small. However, trial results suggest that older pre-frail and frail adults who engage in a moderate playful exercise programme over at least 10 weeks may potentially experience a modest gain in balance. Moreover, the playful exercise created a joyous social atmosphere among the participants who spontaneously remarked that the play sessions were much more fun than their standard light exercise programme of one hour twice a week. This motivational outcome is important for adherence to any exercise programme and indeed for general well-being.
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14
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Giannouli E, Morat T, Zijlstra W. A Novel Square-Stepping Exercise Program for Older Adults (StepIt): Rationale and Implications for Falls Prevention. Front Med (Lausanne) 2020; 6:318. [PMID: 31993435 PMCID: PMC6970979 DOI: 10.3389/fmed.2019.00318] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 12/13/2019] [Indexed: 01/03/2023] Open
Abstract
The ability to effectively execute compensatory steps is critical for preventing accidental falls, and consequently stepping training is an essential ingredient of fall prevention programs. In this paper, we propose a concept for stepping training that aims to maximize training effects by taking into account recent research evidence and a precise dosing of training ingredients. The concept addresses motor as well as cognitive falls-related aspects, it is suitable for individual as well as group based training, and it does not require costly equipment. Theory and evidence behind all of the training principles is reviewed, and an example of an exercise protocol is described in detail. Participants are presented with stepping patterns which they have to memorize and implement on a mat. In order to enable investigation of dose-response effects, the difficulty level systematically and gradually increases session by session based on four principles: execution speed, pattern complexity, pattern length and execution in dual-/multi-tasking conditions. The presented concept can be used as a framework for the development of further prevention and/or rehabilitation stepping exercise programs. Further studies using this exercise regimen or modified versions of it are encouraged.
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Affiliation(s)
- Eleftheria Giannouli
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Tobias Morat
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
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15
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Ogawa E, Huang H, Yu LF, You T. Physiological responses and enjoyment of Kinect-based exergames in older adults at risk for falls: A feasibility study. Technol Health Care 2019; 27:353-362. [PMID: 31033470 DOI: 10.3233/thc-191634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exergaming has the potential to improve physical function, cognition and dual-task function, and could be an effective new strategy for reducing risk of falling in older adults. OBJECTIVE To evaluate and test custom Microsoft Kinect-based motion-tracking exergames in older adults at risk for falls. METHODS Community-dwelling older adults who reported mobility difficulties or had fallen in the past year played three newly developed exergames (Target Trackers, Double Decision, and Visual Sweeps, 5 minutes each) in random order. Heart rate (HR) was measured during, and blood pressures (BPs), rating of perceived exertion (RPE), and rating of the enjoyment were recorded immediately after each exergame. RESULTS Seven participants (median age 75 y; 4 females) completed the study. There were no adverse events reported during the exergaming session. Exercise HRs and RPEs were statistically significantly higher than resting for all exergames (p< 0.05). The differences were not significant for BPs. Enjoyment ratings ranged from 79.6-90.6% and there were no statistically significant differences between the exergames. CONCLUSIONS The newly developed exergames were light in exercise intensity and enjoyable for older adults at risk for falls. Future intervention studies are warranted to examine the benefits of exergames for this special population.
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Affiliation(s)
- Elisa Ogawa
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Haikun Huang
- Department of Computer Science, College of Science and Mathematics, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Lap-Fai Yu
- Department of Computer Science, College of Science and Mathematics, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Tongjian You
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
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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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17
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Exergame Experience of Young and Old Individuals Under Different Difficulty Adjustment Methods. COMPUTERS 2018. [DOI: 10.3390/computers7040059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this work, we compare the exergaming experience of young and old individuals under four difficulty adjustment methods. Physical inactivity is a leading cause of numerous health conditions including heart diseases, diabetes, cancer, and reduced life expectancy. Committing to regular physical exercise is a simple non-pharmaceutical preventive measure for maintaining good health and sustaining quality of life. Incorporating exercise into games, studies frequently used exergames as an intervention tool over the last decades to improve physical functions and to increase adherence to exercise. While task difficulty optimization is crucial to exergame design, researchers consistently overlooked age as an element which can significantly influence the nature of end results. We use the Flow State Scale to analyze the mental state of young and old individuals to compare constant difficulty with ramping, performance-based, and biofeedback-based difficulty adjustments. Our results indicate that old individuals are less likely to experience flow compared to young under the same difficulty adjustment methods. Further investigation revealed that old individuals are likely to experience flow under ramping and biofeedback-based difficulty adjustments whereas performance-based adjustments were only feasible for young.
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18
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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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