Abstract
BackgroundNovel balance-targeting exergames controlled with off-the-shelf hardware, were developed based on current recommendations for balance training in healthy older adults and documented shortcomings of existing games. The aim of this study was to explore the feasibility of these novel exergames as training tool for elderly and, more specifically whether these games can elicit more challenging weight shifts and higher levels of muscle activity compared to existing off-the-shelf exergames. Furthermore, the motivational pull in these new games was studied.MethodsSixteen healthy older adults were recruited to play the novel games and two reference games that were found to be the most challenging ones in terms of weight shifts or muscle activity in previous studies. Weight shifts were expressed relative to participants’ Functional Limits of Stability (FLOS). Muscular challenge of the games was quantified by dividing the signal into 200 ms blocks and determining the average muscle activity within these blocks. The muscle activity was normalized to maximal voluntary contractions (MVC) to categorize the blocks in zones of < 40, 40–60, 60–80 and > 80% MVC. Subsequently, the number of blocks per intensity level and the number of consecutive blocks above 40% were determined. Motivation to play the games was assessed using the Intrinsic Motivation Inventory (IMI) and scores between the games were analyzed using Generalized Estimated Equations (GEE).ResultsThe novel exergames successfully elicited center of mass (COM) displacements with medians of around 80% of FLOS or higher for all directions. Furthermore, the COM displacements in the novel games were larger for each direction than in the reference games, although for one game the sideward left direction reached significance only at the third trial. Compared to the existing games, longer blocks of muscle activation above 40% MVC were found, but overall intensity remained low. IMI scores were high on all subscales, indicating that older adults experienced the games as motivating.ConclusionWe conclude that affordable hardware can be used to create challenging and enjoyable balance training programs using exergames. The exergames that were successful in eliciting challenging weight shifts and muscle activity should now be further studied in longitudinal randomized controlled interventions, to assess effects on balance, muscle strength and eventually fall risk in healthy older adults.
Highlights
Novel balance-targeting exergames controlled with off-the-shelf hardware, were developed based on current recommendations for balance training in healthy older adults and documented shortcomings of existing games
It can be seen that the difficulty of the game was successfully set to the skill level of the participants, namely above 80% of their maximum and with a small range of data. This should make the Virbal game more effective for balance training compared to the Kinski game, since the latter one mainly focuses on ML-movements and has a lack of anterior posterior (AP) induced movements
This study shows that balance training using exergames can be optimized to elicit more challenging movements, as measured by weight shifts and muscle activity, it remains unknown how much challenge in terms of weight shifts and muscle activity is exactly needed to ensure improvements in balance, strength and eventually reduce fall risk
Summary
Novel balance-targeting exergames controlled with off-the-shelf hardware, were developed based on current recommendations for balance training in healthy older adults and documented shortcomings of existing games. Major risk factors for falling are an age-related decrease in functional capabilities, especially in balance control and muscle strength [4, 5]. Multidimensional training programs have been shown to ameliorate these risk factors and reduce fall risk in older adults. This is especially the case when strength training and sufficiently challenging balance exercises are provided for at least 3 h per week [1, 2, 6, 7]. Adherence to traditional home-based training programs is low due to the repetitive nature of the exercises, lack of perceived usefulness and motivation [8, 9]
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