Abstract
BackgroundThere is good evidence that balance challenging exercises can reduce falls in older people. However, older people often find it difficult to incorporate such programs in their daily life. Videogame technology has been proposed to promote enjoyable, balance-challenging exercise. As part of a larger analysis, we compared feasibility and efficacy of two exergame interventions: step-mat-training (SMT) and Microsoft-Kinect® (KIN) exergames.Methods148 community-dwelling people, aged 65+ years participated in two exergame studies in Sydney, Australia (KIN: n = 57, SMT: n = 91). Both interventions were delivered as unsupervised exercise programs in participants’ homes for 16 weeks. Assessment measures included overall physiological fall risk, muscle strength, finger-press reaction time, proprioception, vision, balance and executive functioning.ResultsFor participants allocated to the intervention arms, the median time played each week was 17 min (IQR 32) for KIN and 48 min (IQR 94) for SMT. Compared to the control group, SMT participants improved their fall risk score (p = 0.036), proprioception (p = 0.015), reaction time (p = 0.003), sit-to-stand performance (p = 0.011) and executive functioning (p = 0.001), while KIN participants improved their muscle strength (p = 0.032) and vision (p = 0.010), and showed a trend towards improved fall risk scores (p = 0.057).ConclusionsThe findings suggest that it is feasible for older people to conduct an unsupervised exercise program at home using exergames. Both interventions reduced fall risk and SMT additionally improved specific cognitive functions. However, further refinement of the systems is required to improve adherence and maximise the benefits of exergames to deliver fall prevention programs in older people’s homes.Trial registrationsACTRN12613000671763 (Step Mat Training RCT)ACTRN12614000096651 (MS Kinect RCT)
Highlights
There is good evidence that balance challenging exercises can reduce falls in older people
There is no study investigating the impact of cognitive training on falls, but robust evidence suggests that physical exercise may improve cognition [3]
Additional challenges arise when conducting unsupervised exercise programs in home settings where factors such as adherence, progression, safety, quality and dosage are harder to control compared to exercise under supervision of an exercise professional
Summary
There is good evidence that balance challenging exercises can reduce falls in older people. There is strong systematic review evidence that exercise interventions including high intensity balance training (i.e., exercises that reduce the base of support, minimize upper limb support and include weight shifting) are most effective in preventing falls in older people [2]. One study found that an exercise program known to reduce falls led to improved response inhibition in addition to physical improvements of balance and muscle strength [4]. It has been suggested that in order to reduce falls, older people should engage in at least 2 h of strength and balance training per week over an extended period of time [5]. Additional challenges arise when conducting unsupervised exercise programs in home settings where factors such as adherence, progression, safety, quality and dosage are harder to control compared to exercise under supervision of an exercise professional
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