Abstract
Aging is associated with sensory, motor and cognitive impairments that may lead to reduced daily life functioning including gait disturbances, falls, injuries and mobility restrictions. A strong need exists for implementing effective evidence-based interventions for healthy aging. Therefore, the aim of this study was to (i) evaluate the feasibility and usability of an in-home multicomponent exergame training and (ii) explore its effects on physical functions, cognition and cortical activity. Twenty-one healthy and independently living older adults were included (11 female, 74.4 ± 7.0 years, range: 65–92 years) and performed 24 trainings sessions (each 40 min) over eight weeks. The first part was conducted in a living lab (home-like laboratory environment), the second part at participants’ home. The multicomponent exergame included Tai Chi-inspired exercises, dance movements and step-based cognitive games to train strength, balance and cognition. Attendance and attrition rates were calculated and safety during training was evaluated to determine feasibility. Participants rated the usability of the exergame (System Usability Scale) and reported on their game experience (Game Experience Questionnaire). Physical and cognitive functions and cortical activity (resting state electroencephalopathy) were assessed pre and post intervention. Results showed a high training attendance rate for the living lab and the home-based setting (91.7 and 91.0%, respectively) with a rather high attrition rate (28.6%, six drop-outs). Half of the drop-out reasons were related to personal or health issues. System usability was rated acceptable with a mean score of 70.6/100. Affective game experience was rated favorable. Significant improvements were found for minimal toe clearance, short-term attentional span, and information processing speed (p < 0.05). No significant pre-post differences were found for cortical activity. To summarize, the exergame is generally feasible and usable for healthy older adults applied in an in-home setting and provides an overall positive emotional game experience. Nevertheless, flawless technical functionality should be a mandatory consideration. Additionally, the training might have potential positive influence on specific functions in older adults. However, the efficacy has to be evaluated in a future randomized controlled trial assessing the behavioral and neuroplastic changes in a larger population after a longer training period.
Highlights
As life expectancy is increasing, the number of people aged 60 years and older is rapidly growing
The drop-outs were comparable to the rest of the participants regarding their characteristics except of age (U = 75.50, p = 0.017) and self-evaluated balance at baseline [χ2(df) = 9.64(3), p = 0.022]
Our study results showed a general high feasibility and usability of the adapted Active@Home exergame and an overall positive emotional game experience in a living lab as well as in a home-based setting. These results lead to the conclusion that the presence of a supervisor might not be a crucial factor regarding training compliance and motivation
Summary
As life expectancy is increasing, the number of people aged 60 years and older is rapidly growing. According to the World Health Organization, the number of older adults aged 60 years and above was about 9% of the worldwide population in 2015 and will more than double to 22% by 2050 (National Institutes of Health, 2011). Considering the rapid growth in the elderly population, the maintenance and improvement of health and independence of older adults is important for social and economic reasons. Falling can lead to serious adverse consequences as injuries, movement restrictions, and part to full loss of independence (Peel, 2011). Considering the significant impact on individual lives and on healthcare costs, a strong need exists to develop and examine interventions that aim to support healthy aging and prevent falls in older adults
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