A Pilot Study of an In-Home Multicomponent Exergame Training for Older Adults: Feasibility, Usability and Pre-Post Evaluation

Manuela Adcock, Melanie Thalmann, Alexandra Schättin, Federico Gennaro, Eling D de Bruin, Manuela Adcock, Melanie Thalmann, Alexandra Schättin, Federico Gennaro, Eling D de Bruin

Abstract

Aging is associated with sensory, motor and cognitive impairments that may lead to reduced daily life functioning including gait disturbances, falls, injuries and mobility restrictions. A strong need exists for implementing effective evidence-based interventions for healthy aging. Therefore, the aim of this study was to (i) evaluate the feasibility and usability of an in-home multicomponent exergame training and (ii) explore its effects on physical functions, cognition and cortical activity. Twenty-one healthy and independently living older adults were included (11 female, 74.4 ± 7.0 years, range: 65-92 years) and performed 24 trainings sessions (each 40 min) over eight weeks. The first part was conducted in a living lab (home-like laboratory environment), the second part at participants' home. The multicomponent exergame included Tai Chi-inspired exercises, dance movements and step-based cognitive games to train strength, balance and cognition. Attendance and attrition rates were calculated and safety during training was evaluated to determine feasibility. Participants rated the usability of the exergame (System Usability Scale) and reported on their game experience (Game Experience Questionnaire). Physical and cognitive functions and cortical activity (resting state electroencephalopathy) were assessed pre and post intervention. Results showed a high training attendance rate for the living lab and the home-based setting (91.7 and 91.0%, respectively) with a rather high attrition rate (28.6%, six drop-outs). Half of the drop-out reasons were related to personal or health issues. System usability was rated acceptable with a mean score of 70.6/100. Affective game experience was rated favorable. Significant improvements were found for minimal toe clearance, short-term attentional span, and information processing speed (p < 0.05). No significant pre-post differences were found for cortical activity. To summarize, the exergame is generally feasible and usable for healthy older adults applied in an in-home setting and provides an overall positive emotional game experience. Nevertheless, flawless technical functionality should be a mandatory consideration. Additionally, the training might have potential positive influence on specific functions in older adults. However, the efficacy has to be evaluated in a future randomized controlled trial assessing the behavioral and neuroplastic changes in a larger population after a longer training period.

Keywords: elderly; exergame; fall prevention; feasibility; healthy aging; usability.

Copyright © 2019 Adcock, Thalmann, Schättin, Gennaro and de Bruin.

Figures

FIGURE 1
FIGURE 1
Step-based cognitive training. The Active@Home exergame included step-based exercises to train specific cognitive functions (a task for inhibition training is shown in the picture). By stepping forward, backward, and to the right or left side, these games were played and controlled. The IMUs worn at ankles evaluated the stepping performance.
FIGURE 2
FIGURE 2
Study flow chart. Screening of participants for eligibility included an assessment of cognitive and health state. Physical and cognitive functions as well as brain activity were measured at pre- and post-measurement. Assessments and the first half of the intervention were performed at the living lab of ETH Hönggerberg (Zurich, Switzerland), the second half at participants’ home. Questionnaires assessing usability and game experience were filled in after the training period. Technical drop-out reasons included software problems, unstable IMU connections and inappropriate movement evaluation. Other drop-out reasons were related to injuries, sudden illness and family affairs. SUS, System Usability Scale; GEQ, Game Experience Questionnaire.
FIGURE 3
FIGURE 3
Primary outcome result of game experience. Data shown in the figure are means with standard deviations in each emotional category of the GEQ (n = 17). The two light-gray categories (tension, negative affect) have to be evaluated reversely which means a lower score is favorable. The GEQ ranges from 0 = “not at all” to 4 = “extremly”.

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