A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults Improving Walking, Muscle Strength, and Balance in the Elderly with an Exergame Using Kinect: A Randomized Controlled Trial. A Randomized Controlled Pilot Study of Home-Based Step Training in Older People Using Videogame Technology Interactive Cognitive-Motor Step Training Improves Cognitive Risk Factors of Falling in Older Adults – A Randomized Controlled Trial Effects of Exergames on Balance, Functional Mobility, and Quality of Life of Geriatrics Versus Home Exercise Programme: Randomized Controlled Study. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial. ICT-based system to predict and prevent falls (iStoppFalls): results from an international multicenter randomized controlled trial Wii-Fit for Improving Gait and Balance in an Assisted Living Facility: A Pilot Study Effects of balance training using a virtual-reality system in older fallers Feasibility of Wii Fit training to improve clinical measures of balance in older adults Individualized feedback-based virtual reality exercise improves older women's self-perceived health: a randomized controlled trial. Wii Fit® training vs. Adapted Physical Activities: which one is the most appropriate to improve the balance of independent senior subjects? A randomized controlled study Wii‐Hab for Pre‐Frail Older Adults Interactive video gaming compared with health education in older adults with mild cognitive impairment: a feasibility study. Aerobic and Cognitive Exercise (ACE) Pilot Study for Older Adults: Executive Function Improves with Cognitive Challenge While Exergaming. Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs. Effectiveness of Exergaming Training in Reducing Risk and Incidence of Falls in Frail Older Adults With a History of Falls. The effect of virtual reality gaming on dynamic balance in older adults. Effects of traditional physical training and visual computer feedback training in frail elderly patients. A randomized intervention study. Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial Effects of an Interactive Computer Game Exercise Regimen on Balance Impairment in Frail Community-Dwelling Older Adults: A Randomized Controlled Trial
Abstract Background : Falls and fall-related injuries are symptomatic of an aging population . This study aim ed to design , develop , and deliver a novel method of balance training , using an interactive game-based system to promote engagement , with the inclusion of older adults at both high and low risk of experiencing a fall . Study Design : Eighty-two older adults ( 65 years of age and older ) were recruited from sheltered accommodation and local activity groups . Forty volunteers were r and omly selected and received 5 weeks of balance game training ( 5 males , 35 females ; mean , 77.18 ± 6.59 years ) , whereas the remaining control participants recorded levels of physical activity ( 20 males , 22 females ; mean , 76.62 ± 7.28 years ) . The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments . Results : Balance game training had a significant effect on levels of functional balance and balance confidence ( P < 0.05 ) . This was further demonstrated in participants who were deemed at high risk of falls . The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls . Conclusions : Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population BACKGROUND Many issues prevent elderly individuals from exercising in daily life . There is a need for a system that allows elderly individuals to engage in exercise regularly at a low cost . We developed an exergame that uses a Kinect ( ® ) sensor ( Microsoft Corp. , Redmond , WA ) and conducted a r and omized controlled trial of the effects of using this exergame on muscle strength and balance in healthy elderly individuals . SUBJECTS AND METHODS We enrolled 57 healthy elderly individuals and r and omly divided them into an  intervention group ( n=29 ) and a  control group ( n=28 ) using a table of r and om numbers . All participants underwent gait analyses and were examined using the Berg Balance Scale ( BBS ) , Functional Reach Test ( FRT ) , and the 30-second chair-st and ( CS-30 ) test before the intervention . Participants in the intervention group played the exergame once or twice a week , up to a total of 24 times . The tests were repeated after intervention , and the scores were compared with those obtained before intervention . RESULTS Our results indicated that walking , muscle strength , and motor function improved in participants in the intervention group . Decreased double st and ing time ( P=0.03 ) , minimum foot clearance ( P=0.04 ) , BBS scores ( P<0.01 ) , CS-30 scores ( P<0.01 ) , and FRT scores ( P<0.01 ) significantly improved in the intervention group compared with values in the control group . CONCLUSIONS The Kinect-based exergame developed in this study was found to be effective in improving walking , muscular strength , and balance in elderly people Background Stepping impairments are associated with physical and cognitive decline in older adults and increased fall risk . Exercise interventions can reduce fall risk , but adherence is often low . A new exergame involving step training may provide an enjoyable exercise alternative for preventing falls in older people . Purpose To assess the feasibility and safety of unsupervised , home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people . Design Single-blinded two-arm r and omized controlled trial comparing step pad training with control ( no-intervention ) . Setting / Participants Thirty-seven older adults residing in independent-living units of a retirement village in Sydney , Australia . Intervention Intervention group ( IG ) participants were provided with a computerized step pad system connected to their TVs and played a step game as often as they liked ( with a recommended dose of 2–3 sessions per week for 15–20 minutes each ) for eight weeks . In addition , IG participants were asked to complete a choice stepping reaction time ( CSRT ) task once each week . Main Outcome Measures CSRT , the Physiological Profile Assessment ( PPA ) , neuropsychological and functional mobility measures were assessed at baseline and eight week follow-up . Results Thirty-two participants completed the study ( 86.5 % ) . IG participants played a median 2.75 sessions/week and no adverse events were reported . Compared to the control group , the IG significantly improved their CSRT ( F31,1 = 18.203 , p<.001 ) , PPA composite scores ( F31,1 = 12.706 , p = 0.001 ) , as well as the postural sway ( F31,1 = 4.226 , p = 0.049 ) and contrast sensitivity ( F31,1 = 4.415 , p = 0.044 ) PPA sub-component scores . In addition , the IG improved significantly in their dual-task ability as assessed by a timed up and go test/verbal fluency task ( F31,1 = 4.226 , p = 0.049 ) . Conclusions Step pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments . Trial Registration Australian New Zeal and Clinical Trials Registry ACTRN12611001081909 Purpose Interactive cognitive-motor training ( ICMT ) requires individuals to perform both gross motor movements and complex information processing . This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults . Methods A single-blinded r and omized controlled trial was conducted in community-dwelling older adults ( N = 90 , mean age 81.5±7 ) without major cognitive impairment . Participants in the intervention group ( IG ) played four stepping games that required them to divide attention , inhibit irrelevant stimuli , switch between tasks , rotate objects and make rapid decisions . The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home . Participants in the control group ( CG ) received an evidence -based brochure on fall prevention .  Measures of processing speed , attention/executive function ( EF ) , visuo-spatial ability , concerns about falling and depression were assessed before and after the intervention . Results Eighty-one participants ( 90 % ) attended re- assessment . There were no improvements with respect to the Stroop Stepping Test ( primary outcome ) in the intervention group . Compared to the CG , the IG improved significantly in measures of processing speed , visuo-spatial ability and concern about falling . Significant interactions were observed for measures of EF and divided attention , indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance . The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline . Additionally , low and high-adherer groups differed in their baseline performance and responded differently to the intervention . Compared to high adherers , low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF . Conclusions This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people . Low adherers improved in less complex functions while high-adherers improved in EF . Trial Registration Australian New Zeal and Clinical Trials Registry AIM To compare the effects of exergames ( EGs ) using the Xbox Kinect ™ device and home exercise ( HE ) on balance , functional mobility , and quality of life of individuals aged 65 years or older . METHOD One hundred participants who met the inclusion criteria were r and omized to the EG or HE group . The EG group took part in a 6-week programme using the Xbox360Kinect ™ device , and the HE group took part in a 6-week balance exercise programme at home 5 days a week  . The Berg Balance Scale ( BBS ) was used to assess balance , the Timed Up and Go ( TUG ) test was used to evaluate functional walking , and the Short Form 36 ( SF-36 ) was used to assess quality of life . RESULTS Forty-eight participants in the EG group and 42 participants in the HE group completed the study . The groups were similar in terms of age , sex , and pretreatment values of BBS , TUG , and SF-36 . Although the BBS scores of both groups improved significantly ( all p<0.05 ) , the post-treatment scores of the EG group were better than those of the HE group . The TUG scores improved only in the EG group ( p<0.05 ) . The increase in the BBS scores and decrease in the TUG test scores were significant only in the EG group ( all p<0.05 ) . A significant improvement was also observed in the quality of life parameters of physical functioning , social role functioning , physical role restriction , general health perceptions , and physical component scores in the post-exercise evaluations of the EG group . The participants commented that they found the EG programme very entertaining . CONCLUSION The EG can be considered a safe , entertaining and sustainable alternative to HE programmes , and it may have positive effects on balance , functional walking and quality of life in geriatric subjects OBJECTIVE To evaluate the effects of two exercise approaches , Tai Chi ( TC ) and computerized balance training ( BT ) , on specified primary outcomes ( biomedical , functional , and psychosocial indicators of frailty ) and secondary outcomes ( occurrence of falls ) . DESIGN The Atlanta FICSIT ( Frailty and Injuries : Cooperative Studies of Intervention Techniques ) , a prospect i ve , r and omized , controlled clinical trial with three arms ( TC , BT , and education [ ED ] . Intervention length was 15 weeks , with primary outcomes measured before and after intervention and at 4-month follow-up . Falls were monitored continuously throughout the study . SETTING Persons aged 70 and older living in the community . PARTICIPANTS A total of 200 participants , 162 women and 38 men ; mean age was 76.2 . MEASUREMENTS Biomedical ( strength , flexibility , cardiovascular endurance , body composition ) , functional ( IADL ) , and psychosocial well-being ( CES-D scale , fear of falling question naire , self-perception of present and future health , mastery index , perceived quality of sleep , and intrusiveness ) variables . RESULTS Grip strength declined in all groups , and lower extremity range of motion showed limited but statistically significant changes . Lowered blood pressure before and after a 12-minute walk was seen following TC participation . Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P = .046 and P = .058 , respectively ) . After adjusting for fall risk factors , TC was found to reduce the risk of multiple falls by 47.5 % . CONCLUSIONS A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty . This intervention can also have favorable effects upon the occurrence of falls .  Tai Chi warrants further study as an exercise treatment to improve the health of older people Background Cognitive impairment is a health problem that concerns almost every second elderly person .  Physical and cognitive training have differential positive effects on cognition , but have been rarely applied in combination . This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults . We hypothesized that simultaneous cognitive – physical components would add training specific cognitive benefits compared to exclusively physical training . Methods Seniors , older than 70 years , without cognitive impairment , were r and omly assigned to either : 1 ) virtual reality video game dancing ( DANCE ) , 2 ) treadmill walking with simultaneous verbal memory training ( MEMORY ) , or 3 ) treadmill walking ( PHYS ) . Each program was complemented with strength and balance exercises . Two 1-hour training sessions per week over 6 months were applied . Cognitive performance was assessed at baseline , after 3 and 6 months , and at 1-year follow-up . Multiple regression analyses with planned comparisons were calculated . Results Eighty-nine participants were r and omized to the three groups initially , 71 completed the training , while 47 were available at 1-year follow-up . Advantages of the simultaneous cognitive – physical programs were found in two dimensions of executive function . “ Shifting attention ” showed a time × intervention interaction in favor of DANCE/MEMORY versus PHYS ( F[2 , 68 ] = 1.95 , trend P=0.075 , r=0.17 ) ; and “ working memory ” showed a time × intervention interaction in favor of DANCE versus MEMORY ( F[1 , 136 ] = 2.71 , trend P=0.051 , R2=0.006 ) . Performance improvements in executive functions , long-term visual memory ( episodic memory ) , and processing speed were maintained at follow-up in all groups . Conclusion Particular executive functions benefit from simultaneous cognitive – physical training compared to exclusively physical multicomponent training . Cognitive – physical training programs may counteract widespread cognitive impairments in the elderly Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = .041 , r = .45 ) and for single support time ( U = 24 , P = .029 , r = .48 ) during the fast walking dual task condition in favor of the dance group . No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy . Conclusions There was a significant interaction in favor of the dance video game group for improvements in step time . Significant improved fast walking performance under dual task conditions ( velocity , double support time , step length ) was observed for the dance video game group only . These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program . Trial registration This trial has been registered under IS RCT N05350123 ( http://www.controlled-trials.com BACKGROUND Older adults show increased risk of falling and major risk factors include impaired lower extremity muscle strength and postural balance . However , the potential positive effect of biofeedback-based Nintendo Wii training on muscle strength and postural balance in older adults is unknown . METHODS This r and omized controlled trial examined postural balance and muscle strength in community-dwelling older adults ( 75±6 years ) pre- and post-10 weeks of biofeedback-based Nintendo Wii training ( WII , n = 28 ) or daily use of ethylene vinyl acetate copolymer insoles ( controls [ CON ] , n = 30 ) . Primary end points were maximal muscle strength ( maximal voluntary contraction ) and center of pressure velocity moment during bilateral static stance . RESULTS Intention-to-treat analysis with adjustment for age , sex , and baseline level showed that the WII group had higher maximal voluntary contraction strength ( 18 % ) than the control group at follow up ( between-group difference = 269 N , 95 % CI = 122 ; 416 , and p = .001 ) . In contrast , the center of pressure velocity moment did not differ ( 1 % ) between WII and CON at follow-up ( between-group difference = 0.23 mm(2)/s , 95 % CI = -4.1 ; 4.6 , and p = .92 ) . For secondary end points , pre-to-post changes favoring the WII group were evident in the rate of force development ( p = .03 ) , Timed Up and Go test ( p = .01 ) , short Falls Efficacy Scale-International ( p = .03 ) , and 30-second repeated Chair St and Test ( p = .01 ) . Finally , participants rated the Wii training highly motivating at 5 and 10 weeks into the intervention . CONCLUSIONS Biofeedback-based Wii training led to marked improvements in maximal leg muscle strength ( maximal voluntary contraction ; rate of force development ) and overall functional performance in community-dwelling older adults . Unexpectedly , static bilateral postural balance remained unaltered with Wii training . The high level of participant motivation suggests that biofeedback-based Wii exercise may ensure a high degree of compliance to home- and /or community-based training in community-dwelling older adults Abstract Background Falls and fall-related injuries are a serious public health issue . Exercise programs can effectively reduce fall risk in older people . The iStoppFalls project developed an Information and Communication Technology-based system to deliver an unsupervised exercise program in older people ’s homes . The primary aims of the iStoppFalls r and omized controlled trial were to assess the feasibility ( exercise adherence , acceptability and safety ) of the intervention program and its effectiveness on common fall risk factors . Methods A total of 153 community-dwelling people aged 65 + years took part in this international , multicentre , r and omized controlled trial . Intervention group participants conducted the exercise program for 16 weeks , with a recommended duration of 120 min/week for balance exergames and 60 min/week for strength exercises . All intervention and control participants received educational material including advice on a healthy lifestyle and fall prevention . Assessment s included physical and cognitive tests , and question naires for health , fear of falling , number of falls , quality of life and psychosocial outcomes . Results The median total exercise duration was 11.7 h ( IQR = 22.0 ) over the 16-week intervention period . There were no adverse events . Physiological fall risk ( Physiological Profile Assessment , PPA ) reduced significantly more in the intervention group compared to the control group ( F1,127 = 4.54 , p = 0.035 ) . There was a significant three-way interaction for fall risk assessed by the PPA between the high-adherence ( > 90 min/week ; n = 18 , 25.4 % ) , low-adherence ( < 90 min/week ; n = 53 , 74.6 % ) and control group ( F2,125 = 3.12 , n = 75 , p = 0.044 ) . Post hoc analysis revealed a significantly larger effect in favour of the high-adherence group compared to the control group for fall risk ( p = 0.031 ) , postural sway ( p = 0.046 ) , stepping reaction time ( p = 0.041 ) , executive functioning ( p = 0.044 ) , and quality of life ( p for trend = 0.052 ) . Conclusions The iStoppFalls exercise program reduced physiological fall risk in the study sample . Additional subgroup analyses revealed that intervention participants with better adherence also improved in postural sway , stepping reaction , and executive function . Trial registration Australian New Zeal and Clinical Trials Registry Trial ID : ACTRN12614000096651 International St and ard R and omised Controlled Trial Number : IS RCT Objectives . To determine the effects on balance and gait of a Wii-Fit program compared to a walking program in subjects with mild Alzheimer 's dementia ( AD ) . Methods . A prospect i ve r and omized ( 1 : 1 ) pilot study with two intervention arms was conducted in an assisted living facility with twenty-two mild AD subjects . In both groups the intervention occurred under supervision for 30 minutes daily , five times a week for eight weeks . Repeated measures ANOVA and paired t-tests were used to analyze changes . Results . Both groups showed improvement in Berg Balance Scale ( BBS ) , Tinetti Test ( TT ) and Timed Up and Go ( TUG ) over 8 weeks . However , there was no statistically significant difference between the groups over time . Intragroup analysis in the Wii-Fit group showed significant improvement on BBS ( P = 0.003 ) , and TT ( P = 0.013 ) . The walking group showed a trend towards improvement on BBS ( P = 0.06 ) and TUG ( P = 0.07 ) and significant improvement in TT ( P = 0.06 ) . Conclusion . This pilot study demonstrates the safety and efficacy of Wii-Fit in an assisted living facility in subjects with mild AD . Use of Wii-Fit result ed in significant improvements in balance and gait comparable to those in the robust monitored walking program . These results need to be confirmed in a larger , method ologically sound study Poor balance is considered a challenging risk factor for falls in older adults . Therefore , innovative interventions for balance improvement in this population are greatly needed . The aim of this study was to evaluate the effect of a new virtual-reality system ( the Balance Rehabilitation Unit [ BRU ] ) on balance , falls , and fear of falling in a population of community-dwelling older subjects with a known history of falls . In this study , 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic , Nepean Hospital ( Penrith , NSW , Australia ) . Subjects were r and omly assigned to either the BRU-training or control groups . Both groups received the usual falls prevention care . The BRU-training group attended balance training ( two sessions/week for 6 weeks ) using an established protocol . Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program . Both groups were assessed 9 months after their initial assessment ( month 0 ) . Adherence to the BRU-training program was 97 % . Balance parameters were significantly improved in the BRU-training group ( P < 0.01 ) . This effect was also associated with a significant reduction in falls and lower levels of fear of falling ( P < 0.01 ) . Some components of balance that were improved by BRU training showed a decline after 9 months post-training . In conclusion , BRU training is an effective and well-accepted intervention to improve balance , increase confidence , and prevent falls in the elderly Background and purpose Numerous interventions have been proposed to improve balance in older adults with varying degrees of success . A novel approach may be to use an off-the-shelf video game system utilizing real-time force feedback to train older adults . The purpose of this study is to investigate the feasibility of using Nintendo ’s Wii Fit for training to improve clinical measures of balance in older adults and to retain the improvements after a period of time . Methods Twelve healthy older adults ( aged > 70 years ) were r and omly divided into two groups . The experimental group completed training using Nintendo ’s Wii Fit game three times a week for 3 weeks while the control group continued with normal activities . Four clinical measures of balance were assessed before training , 1 week after training , and 1 month after training : Berg Balance Scale ( BBS ) , Fullerton Advanced Balance ( FAB ) scale , Functional Reach ( FR ) , and Timed Up and Go ( TUG ) . Friedman two-way analysis of variance by ranks was conducted on the control and experimental group to determine if training using the Wii Balance Board with Wii Fit had an influence on clinical measures of balance . Results Nine older adults completed the study ( experimental group n = 4 , control group n = 5 ) . The experimental group significantly increased their BBS after training while the control group did not . There was no significant change for either group with FAB , FR , and TUG . Conclusion Balance training with Nintendo ’s Wii Fit may be a novel way for older adults to improve balance as measured by the BBS OBJECTIVES Individualized feedback-based virtual reality ( IFVR ) exercise is gaining attention as a cost-effective self-management strategy , however little is known about whether older adults themselves perceive IFVR exercise effective in improving their health . Therefore , we studied the effect of IFVR exercise on health-related quality of life ( HRQoL )  in older women . METHODS Fifty-four older women aged ≥65 years were r and omized to either IFVR exercise group ( IFVRG , n=26 ) or group-based exercise group ( GG , n=28 ) . Both groups received a 60-min intervention three times a week for eight weeks . The Short-Form Health Survey ( SF-36 ) was administered . To identify the possible placebo effect , 30-Second Chair St and Test ( 30SCST ) , 8-Foot Up- and -Go Test ( 8FUGT ) , and 2-Minute Step Test ( 2MST ) were also administered . RESULTS intention-to-treat analysis with adjustment for baseline levels revealed that IFVRG showed greater improvement in mental health ( p=0.029 ) and lower body strength ( p=0.042 ) , compared to GG . Within-group analysis for HRQoL revealed that IFVRG showed an increase in role-physical ( p=0.015 ) , bodily pain ( p=0.017 ) , general health ( p=0.004 ) , vitality ( p=0.010 ) , role-emotional ( p=0.007 ) , and mental health ( p<0.001 ) , whereas GG showed an increase in role-physical ( p=0.022 ) , general health ( p=0.023 ) , and social functioning ( p = 0.023 ) . Both groups showed an increase in 30SCST , 2MST and 8FUGT ( all p<0.001 ) . CONCLUSION IFVR exercise  improved HRQoL  in older women , in addition to improving physical fitness . Therefore , it might be recommended to older women as an effective self-management strategy Objective : To compare the effectiveness of three protocol s ( Adapted Physical Activities , Wii Fit ® , Adapted Physical Activities + Wii Fit ® ) on the balance of independent senior subjects . Design : Case comparison study . Setting s : Healthy elderly subjects living in independent community dwellings . Subjects : Thirty-six subjects , average age 75.09 ± 10.26 years , took part in this study , and were r and omly assigned to one of the four experimental groups : G1 followed an Adapted Physical Activities training programme , while the second group ( G2 ) participated in Wii Fit ® training and the third one ( G3 ) combined both methods . There was no training for the fourth group ( G4 ) . All subjects trained once a week ( 1 hour ) for 20 weeks and were assessed before and after treatment . Main measures : The Tinetti test , unipedal tests and the Wii Fit ® tests . Results : After training , the scores in the Tinetti test decreased significantly ( P < 0.05 ) for G1 , G2 and G3 respectively in static conditions and for G1 and G3 in dynamic conditions . After training , the performance in the unipedal tests decreased significantly ( P < 0.05 ) for G1 and G3 . The position of the centre of gravity was modified significantly ( P < 0.05 ) for G2 and G3 . Conclusion : After 20 training sessions , G1 ( Adapted Physical Activities ) , G2 ( Wii Fit ® ) and G3 ( Adapted Physical Activities and Wii Fit ® ) improved their balance . In addition , G1 and G3 increased their dynamic balance . The findings suggest that Adapted Physical Activities training limits the decline in sensorial functions in the elderly Purpose : To examine the effectiveness of a novel intervention aim ed at decreasing indices related to frailty through systematic , Progressive Functional Rehabilitation ( PFR ) . Methods : Pre‐frail volunteers were recruited to participate in a 15 week exercise intervention or control group .  Those who met study criteria and consented were r and omized into one of three groups : control , seated exercise , or Wii ® ‐fit . Test measures were completed before and after the 15 week intervention period on all participants . Measures included : Senior Fitness Test , Body Weight , Balance Efficacy Scale , CHAMPS , Late‐Life Function and Disability Index , MOS SF‐36 . Attendance was also recorded . Results : There were improvements on several of the measures included in the Senior Fitness Test including chair st and s , arm curls , step 2 , six minute walk , sit and reach , and the timed up and go . A few participants did lose weight . All of the differences reflected improved physical functional status in the seated exercise or Wii‐fit groups compared with the control group . Discussion : Increased physical activity was beneficial for all who participated . There were improvements in physical performance scores on several of the measures on the senior fitness test in both the seated exercise and Wii‐fit groups . Participants in the Wii‐fit group also showed improvement in their reported caloric expenditure and balance confidence . Conclusion : This pilot study suggests a rehabilitation effect that was similar to the effect of community based senior fitness classes . A home video game console system with weight vest could be an effective alternative for pre‐frail senior adults to group exercise classes OBJECTIVE We evaluated the feasibility of a trial of Wii interactive video gaming , and its potential efficacy at improving cognitive functioning compared with health education , in a community sample of older adults with neuropsychologically defined mild cognitive impairment . METHODS Twenty older adults were equally r and omized to either group-based interactive video gaming or health education for 90 min each week for 24 weeks . Although the primary outcomes were related to study feasibility , we also explored the effect of the intervention on neuropsychological performance and other secondary outcomes . RESULTS All 20 participants completed the intervention , and 18 attended at least 80 % of the sessions . The majority ( 80 % ) of participants were " very much " satisfied with the intervention . Bowling was enjoyed by the most participants and was also rated the highest among the games for mental , social , and physical stimulation . We observed medium effect sizes for cognitive and physical functioning in favor of the interactive video gaming condition , but these effects were not statistically significant in this small sample . CONCLUSION Interactive video gaming is feasible for older adults with mild cognitive impairment , and medium effect sizes in favor of the Wii group warrant a larger efficacy trial Dementia cases are increasing worldwide ; thus , investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life . Extensive research confirms the benefits of physical exercise for brain health , yet only a fraction of older adults exercise regularly . Interactive mental and physical exercise , as in aerobic exergaming , not only motivates , but has also been found to yield cognitive benefit above and beyond traditional exercise . This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning . Sixty-four community based older adults ( mean age=82 ) were r and omly assigned to pedal a stationary bike , while interactively engaging on-screen with : ( 1 ) a low cognitive dem and task ( bike tour ) , or ( 2 ) a high cognitive dem and task ( video game ) .  Executive function ( indices from Trails , Stroop and Digit Span ) was assessed before and after a single-bout and 3-month exercise intervention . Significant group × time interactions were found after a single-bout ( Color Trails ) and after 3 months of exergaming ( Stroop ; among 20 adherents ) . Those in the high cognitive dem and group performed better than those in the low cognitive dose condition . Everyday function improved across both exercise conditions . Pilot data indicate that for older adults , cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge OBJECTIVE To compare the impacts of Tai Chi , a st and ard balance exercise program , and a video game balance board program on postural control and perceived falls risk . DESIGN R and omized controlled trial . SETTING Research laboratory . PARTICIPANTS Independent seniors ( N=40 ; 72.5±8.40 ) began the training , 27 completed . INTERVENTIONS Tai Chi , a st and ard balance exercise program , and a video game balance board program . MAIN OUTCOME MEASURES The following were used as measures : Timed Up & Go , One-Leg Stance , functional reach , Tinetti Performance Oriented Mobility Assessment , force plate center of pressure ( COP ) and time to boundary , dynamic posturography ( DP ) , Falls Risk for Older People-Community Setting , and Falls Efficacy Scale . RESULTS No significant differences were seen between groups for any outcome measures at baseline , nor were significant time or group × time differences for any field test or question naire . No group × time differences were seen for any COP measures ; however , significant time differences were seen for total COP , 3 of 4 anterior/posterior displacement and both velocity , and 1 displacement and 1 velocity medial/lateral measure across time for the entire sample . For DP , significant improvements in the overall score ( dynamic movement analysis score ) , and in 2 of the 3 linear and angular measures were seen for the sample . CONCLUSIONS The video game balance board program , which can be performed at home , was as effective as Tai Chi and the st and ard balance exercise program in improving postural control and balance dictated by the force plate postural sway and DP measures . This finding may have implication s for exercise adherence because the at-home nature of the intervention eliminates many obstacles to exercise training OBJECTIVE To use Nintendo 's Wii Fit balance board to determine the effectiveness of exergaming training in reducing risk and incidence of falls in older adults with a history of falls . DESIGN R and omized controlled trial . SETTING Nursing home for older adults . PARTICIPANTS Adults aged 65 years and older ( N=60 ) . INTERVENTIONS Participants who lived in a nursing home had 6 weeks of balance training with either Wii Fit equipment or conventional exercise . MAIN OUTCOME MEASURES Physiological Profile Assessment scores and incidence of falls were observed with subsequent intention-to-treat statistical analyses . RESULTS Physiological Profile Assessment scores and incidence of falls improved significantly in both groups after the intervention ( all P<.01 ) , but participants in the Wii Fit training group showed a significantly greater improvement in both outcome measures ( P=.004 and P<.001 , respectively ) . CONCLUSIONS In institutionalized older adults with a history of falls , Wii Fit balance training was more effective than conventional balance training in reducing the risk and incidence of falls BACKGROUND physical therapy interventions that increase functional strength and balance have been shown to reduce falls in older adults . AIM this study compared a virtual reality group ( VRG ) and a control group ( CG ) . DESIGN r and omised controlled 6-week intervention with pre- and post-test evaluations . SETTING outpatient geriatric orthopaedic and balance physical therapy clinic . POPULATION forty participants were r and omised into two groups . METHOD the VRG received three different Nintendo ® Wii FIT balance interventions three times per week for 6 weeks and the CG received no intervention . RESULTS compared with the CG , post-intervention measurements showed significant improvements for the VRG in the 8-foot Up & Go test [ median decrease of 1.0 versus -0.2 s , ( P=0.038 ) and the Activities-specific Balance Confidence Scale ( 6.9 versus 1.3 % ) ( P=0.038 ) ] . CONCLUSION virtual reality gaming provides clinicians with a useful tool for improving dynamic balance and balance confidence in older adults BACKGROUND Physical training to increase muscle strength and balance is considered useful for prevention of falls in older people . AIM This study compares conventional balance training with visual computer feedback training . DESIGN This was a r and omized controlled 12-week intervention trial with pre- and post-training evaluations . SETTING Out- patients referred to a geriatric falls and balance clinic . POPULATION Thirty-five patients were r and omized into two training groups . METHODS Both groups received progressive resistance muscle strength training and physical fitness training . Additionally , one group received traditional balance training and the other group received computer feedback balance training .  Strength , physical endurance , balance and falls efficacy scale scoring were assessed before and after end of training . RESULTS Twenty-seven patients ( 77 % ) were available for the evaluation ; mean compliance was 71 % . In the combined group , significant mean improvement was observed in knee extension ( 19 % ) , ankle dorsiflexion ( 16 % ) , sitting to st and ing ( 16 % ) , and in the six-minute walk test ( 8 % ) . In the traditional balance training group , the static balance in the Modified Clinical Test of Sensory Interaction and Balance st and ing on a foam mat with closed eyes showed a significant increase ( 80 % ) . No increase occurred in the computer balance training group . However , the computer feed-back training group showed a marked improvement that was up to 400 % in the training specific performance . CONCLUSION Elderly frail patients were able to increase muscle strength and physical endurance . A limited improvement was seen in the static balance tests . The computer feedback group showed a remarkable increase in training specific performance . Clinical Rehabilitation Impact Purpose : To assess the feasibility of a physiotherapy intervention using an interactive gaming program compared with conventional physiotherapy for hospitalised older people . Methods : R and omised controlled pilot study in a geriatric rehabilitation unit within an acute public hospital . Participants were r and omly allocated to  physiotherapy using an interactive gaming program ( n = 22 ) or conventional physiotherapy in a ward-based gym ( n = 22 ) . Feasibility was assessed by comparing the effects of the intervention on clinical outcome measures ( primary outcome : mobility as assessed by the Timed Up and Go test , secondary outcomes : safety , adherence levels , eligibility and consent rates ) . Results : Participants ( n = 44 ) had a mean age of 85 years ( SD 4.5 ) and the majority ( 80 % ) were women . Univariable analyses showed no significant difference between groups following intervention . However , multivariable analyses suggested that participants using the interactive gaming program improved more on the Timed Up and Go test ( p = 0.048 ) than participants receiving conventional physiotherapy . There were no serious adverse events and high levels of adherence to therapy were evident in both groups . Only a small proportion of patients screened were recruited to the study . Conclusions : In this feasibility study , the use of a commercially available interactive gaming program by physiotherapists with older people in a hospital setting was safe and adherence levels were comparable with conventional therapy . Preliminary results suggest that further exploration of approaches using games as therapy for older people could include commonly used measures of balance and function . Implication s for Rehabilitation The use of an interactive gaming program by physiotherapists with hospitalised older people appeared to be safe and result ed in improvements in balance and mobility . Use of these programs may be limited to a relatively small proportion of older people , only those able to use and interested in this technological approach to therapy Background Due to the many problems associated with reduced balance and mobility , providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills . Objectives The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging , interactive video game paradigm . The intervention focused on performing targeted dynamic tasks , which included reactive balance controls and environmental interaction . Design This study was a r and omized controlled trial . Setting The study was conducted in a geriatric day hospital . Participants Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study . Interventions Participants were r and omly assigned to either a control group or an experimental group . The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital . The experimental group received a program of dynamic balance exercises coupled with video game play , using a center-of-pressure position signal as the computer mouse . The tasks were performed while st and ing on a fixed floor surface , with progression to a compliant sponge pad . Each group received 16 sessions , scheduled 2 per week , with each session lasting 45 minutes . Measurements Data for the following measures were obtained before and after treatment : Berg Balance Scale , Timed “ Up & Go ” Test , Activities-specific Balance Confidence Scale , modified Clinical Test of Sensory Interaction and Balance , and spatiotemporal gait variables assessed in an instrumented carpet system test . Results Findings demonstrated significant improvements in posttreatment balance performance scores for both groups , and change scores were significantly greater in the experimental group compared with the control group . No significant treatment effect was observed in either group for the Timed “ Up & Go ” Test or spatiotemporal gait variables . Limitations The sample size was small , and there were group differences at baseline in some performance measures . Conclusion Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise . This coupling , in turn , result ed in a greater improvement in dynamic st and ing balance control compared with the typical exercise program . However , there was no transfer of effect to gait function
Background Active computer gaming ( ACG ) is a method of facilitating physical activity in older people to improve health outcomes .
Purpose The purpose of this study was to up date and extend a systematic review of the evidence for ACG to determine its effects on physical and cognitive health in older adults .