Abstract
ObjectiveThe objective of this review was to systematically evaluate the effectiveness of exergaming on walking in older adults. In addition, the aim was to investigate the relationship between the exergaming effect and age, baseline walking performance, exercise traits, technology used, and the risk of bias.MethodsA literature search was carried out in the databases MEDLINE, CINAHL, CENTRAL, EMBASE, WoS, PsycInfo, and PEDro up to January 10, 2020. Studies with a randomized controlled trial design, people ≥60 years of age without neurological disorders, comparison group with other exercise or no exercise, and walking-related outcomes were included. Cochrane RoB2, meta-analysis, meta-regression, and Grading of Recommendations, Assessment, Development and Evaluation were used to estimate quality, treatment effect, covariates’ effect, and the certainty of evidence, respectively.ResultsIn the studies included (n = 66), the overall risk of bias was low (n = 2), unclear (n = 48), or high (n = 16). Compared with comparison groups, exergaming interventions were more effective for walking improvements (standardized mean difference = −0.21; 95% CI = −0.36 to −0.06; 3102 participants, 58 studies; moderate-quality evidence) and more or equally effective (standardized mean difference = −0.32; 95% CI = −0.64 to 0.00; 1028 participants, 13 studies; low-quality evidence) after nonexergaming follow-up. The strongest effect for covariates was observed with the type of comparison group, explaining 18.6% of the variance.ConclusionFor older adults without neurological disorders, exergame-based training improved walking, and improvements were maintained at follow-up. Greater benefits were observed when exergaming groups were compared with inactive comparison groups. To strengthen the evidence, further randomized controlled trials on the effectiveness of gamified exercise intervention are needed.ImpactExergaming has an effect equivalent to other types of exercising on improving walking in older adults. Physical therapists and other rehabilitation professionals may consider exergaming as a promising form of exercise in this age group.
Highlights
Walking is the leading form of mobility for older adults
Evidence demonstrates that physical activity and exercise reduce the risk of age-related loss of physical functioning[6] and multicomponent training, including strength and balance training, improves or maintains walking in older adults.[7,8]
Theses and conference proceeding abstracts, studies focusing on patients with neurological disorders, studies using accelerometers or actual locations in the intervention to encourage and to record physical activity, and studies of exergames driven by player’s eyes, head, or fine physical movements were excluded from the review
Summary
Walking is the leading form of mobility for older adults. It is one of the main areas of physical functioning that enables physical activity and independence,[1] social participation,[2] and good quality of life[3] in older adults. In rehabilitation, exergaming may be targeted to enhance the physical functioning, such as walking performance,[10] of different patient groups,[11] and it may be carried out in a variety of settings, such as in unsupervised conditions.[12,13] Exercising with exergames has been shown to be engaging[14] and enjoyable[15] among older adults and may increase training volume and contribute to the effectiveness of physical rehabilitation
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