Abstract
ObjectivePhysical 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.MethodsA 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.ResultsTwenty 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).ConclusionThe 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.
Highlights
Falls are a global public health problem in the older adult population, oftentimes leading to mobility limitation, diminished quality of life, as well as increased mortalityChen et al Journal of NeuroEngineering and Rehabilitation (2021) 18:164 and morbidity [1–4]
1404 records: PubMed (n = 80), EMBASE (n = 53), Web of Science (n = 501), Cochrane Library (n = 407), MEDLINE (n = 355), and manual search (n = 8). 562 repetitive publications were excluded, leaving 842 articles; 716 irrelevant articles were excluded after checking inclusion and exclusion criteria; 126 articles were further excluded by reviewing the whole paper; 20 articles were identified for inclusion in the systematic review and metaanalysis (Fig. 1)
One potential reason is that traditional physical exercise mainly focuses on physical function, while exergame intervention (EI) concentrate on both physical function and other functions that are important to prevent the incidence of falls, such as balance, mobility, cognitive function, and mood [19, 44–49]
Summary
Falls are a global public health problem in the older adult population, oftentimes leading to mobility limitation, diminished quality of life, as well as increased mortalityChen et al Journal of NeuroEngineering and Rehabilitation (2021) 18:164 and morbidity [1–4]. One of the main factors leading to falls is the loss of balance when standing and walking [5–7]. Strategies designed to improve standing and walking performance will help reduce fall risk in older adults. Studies have shown that traditional physical training (PT), such as balance and strength training, as well as Tai Chi, can help reduce fall risks by improving the standing and walking performance [8–10]. El-Khoury et al [8] found that a 2-year balance intervention could reduce the incidence of injurious falls in older women compared to the control, and the participants showed improved balance as measured by faster time to complete the timed-up-and-go test and walk 6-m test, and longer time in single-leg stance test. Studies suggested that the traditional PT is time-consuming, and the training procedure is not always enjoyable for older adults, oftentimes resulting in low compliance and high drop-out rate of participants [11, 12]
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