Effectiveness of exergames for improving mobility and balance in older adults: a systematic review and meta-analysis

T B F Pacheco, C S P de Medeiros, V H B de Oliveira, E R Vieira, F A C de Cavalcanti, T B F Pacheco, C S P de Medeiros, V H B de Oliveira, E R Vieira, F A C de Cavalcanti

Abstract

Background: Exergaming is a fun, engaging, and interactive form of exercising that may help overcome some of the traditional exercise barriers and help improve adherence on the part of older adults, providing therapeutic applications for balance recovery and functional mobility. The purpose of this systematic review is to summarize the effects of exergames on mobility and balance in older adults.

Methods: The PRISMA guidelines for systematic reviews were followed. The following databases were searched from inception to August 2019: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro, CINAHL, and INSPEC. We selected randomized controlled trials that assessed the effects of exergames on balance or mobility of older adults without neurological conditions, in comparison to no intervention or health education. Two review authors independently screened the trials' titles and abstracts and identified trials for inclusion according to the eligibility criteria. An almost perfect agreement between the authors was observed with respect to interrater reliability of trial selection (kappa = 0.84; P < 0.001). We performed descriptive analysis of the quantitative data to summarize the evidence. Meta-analysis was carried out using RevMan. A random effects model was used to compute the pooled prevalence with 95% confidence intervals.

Results: After screening 822 records, 12 trials comparing exergames with no intervention were included. A total of 1520 older adults participated in the studies, with a mean age of 76 ± 6 years for the experimental group and 76 ± 5 years for the control group. Quantitative synthesis showed significant improvements in balance and mobility based on the center of pressure sway (SMD = - 0.89; 95%CI = - 1.26 to - 0.51; P = 0.0001; I2 = 58%), Berg Balance Scale (MD = 2.15; 95%CI = 1.77 to 2.56; P = 0.0001; I2 = 96%), and on Timed Up and Go test (MD = - 2.48; 95%CI = - 3.83 to - 1.12; P = 0.0003; I2 = 0).

Conclusions: Exergames improved balance and mobility in older adults without neurological disorders and motivate patients to keep performing balance exercises. High quality studies with standardized assessment protocols are necessary to improve the strength of the evidence.

Keywords: Aging; Balance; Gait; Video games.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart for study selection
Fig. 2
Fig. 2
Risk of bias graph, review authors’ judgements about each risk of bias item presented as percentages across all included studies
Fig. 3
Fig. 3
Risk of bias summary, review authors’ judgements about each risk of bias item for each included study
Fig. 4
Fig. 4
Effect of exergame in comparison to control group on the following outcomes: a) Center of Pressure sway. Note: * indicates the effect on CoP sway assessed in eyes closed condition and + indicates the same outcome assessed with eyes open. b) Berg Balance Scale; c) Timed up and Go. The squares indicate the study-specific effect estimate. Bars indicate the width of the corresponding 95%confidence interval. The diamond centered on the summary effect estimate, and the width indicates the corresponding 95% confidence interval

References

    1. Alfieri FM, Riberto M, Gatz LS, Ribeiro CPC, Lopes JAF, Santarém JM, et al. Functional mobility and balance in community-dwelling elderly submitted to multisensory versus strength exercises. Clin Interv Aging. 2010;5:181–185.
    1. Lockhart TE, Woldstad JC, Smith JL. Effects of age-related gait changes on the biomechanics of slips and falls. Ergonomics. 2003;46(12):1136–1160.
    1. Masud T, Morris RO. Epidemiology of falls. Age Ageing. 2001;30(Suppl. 4):3–7.
    1. da Silva Almeida LM, Meucci RD, Dumith SC. Prevalence of falls in elderly people: a population based study. Rev Assoc Med Bras. 2019;65(11):1397–1403.
    1. Maillot P, Perrot A, Hartley A, Do M. The braking force in walking: age-related differences and improvement in older adults with exergame training. J Aging Phys Act. 2014;22(4):518–526.
    1. Sherrington C, Tiedemann A, Fairhall N, Hopewell S, Michaleff Z, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2016;11:1–15.
    1. Jones TS, Ghosh TS, Horn K, Smith J, Vogt RL. Primary care physicians perceptions and practices regarding fall prevention in adult’s 65 years and over. Accid Anal Prev. 2011;43(5):1605–1609.
    1. World Health Organization WHO Global Report on Falls Prevention in Older Age. World Health Organization; 2007. Available from: .
    1. Stemplewski R, Maciaszek J, Salamon A, Tomczak M, Osinski W. Effect of moderate physical exercise on postural control among 65–74 years old men. Arch Gerontol Geriatr. 2012;54(3):e279–e283.
    1. Patterson SL, Forrester LW, Rodgers MM, Ryan AS, Ivey FM, Sorkin JD, et al. Determinants of walking function after stroke: differences by deficit severity. Arch Phys Med Rehabil. 2007;88(1):115–119.
    1. Mustafaoʇlu R, Unver B, Karatosun V. Evaluation of stair climbing in elderly people. J Back Musculoskelet Rehabil. 2015;28(3):509–516.
    1. Cho S-H, Shin H-K, Kwon Y-H, Lee MY, Lee Y-H, Lee C-H, et al. Cortical activation changes induced by visual biofeedback tracking training in chronic stroke patients. NeuroRehabilitation. 2007;22(2):77–84.
    1. Levin MF. Can virtual reality offer enriched environments for rehabilitation ? Expert Rev Neurother Rehabil. 2011;11(2):153–155.
    1. Peñasco-Martín B, Reyes-Guzmán A, Gil-Agudo A, Bernal-Sahún A, Pérez-Aguilar B, Peña-González A. Aplicación de la realidad virtual en los aspectos motores de la neurorrehabilitación. Rev Neurol. 2010;51(8):481–488.
    1. Schultheis MT, Rizzo AA. The application of virtual reality technology in rehabilitation. Rehabil Psychol. 2001;46(3):296–311.
    1. Proffitt R, Lange B, Chen C, Winstein C. A comparison of older adults’ subjective experiences with virtual and real environments during dynamic balance activities. J Aging Phys Act. 2015;23(1):24–33.
    1. Wiemeyer J, Kliem A. Serious games in prevention and rehabilitation-a new panacea for elderly people? Eur Rev Aging Phys Act. 2012;9(1):41–50.
    1. Justine M, Azizan A, Hassan V, Salleh Z, Manaf H. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singap Med J. 2013;54(10):581–586.
    1. Hall CD, Clevenger CK, Wolf RA, Lin JS, Johnson TM, II, Wolf SL. Feasibility of a low-cost, interactive gaming system to assess balance in older women. J Aging Phys Act. 2016;24(1):111–118.
    1. Hsieh W-M, Chen C-C, Wang S-C, Tan S-Y, Hwang Y-S, Chen S-C, et al. Virtual reality system based on Kinect for the elderly in fall prevention. Technol Health Care. 2014;22(1):27–36.
    1. Bonnechère B, Jansen B, Omelina L, Van Sint Jan S. The use of commercial video games in rehabilitation. Int J Rehabil Res. 2016;39(4):277–290.
    1. Perrier-Melo RJ, Coelho TDAS, Brito-Gomes JL, de Oliveira SFM, Costa MDC. Active video games, balance and energy expenditure in elderly: a systematic review. ConScientiae Saúde. 2014;13(2):289–297.
    1. DeSmet A, Van Ryckeghem D, Compernolle S, Baranowski T, Crombez G, Poels K, et al. A meta-analysis of serious digital games for healthy lifestyle promotion. Prev Med. 2014;32:95–107.
    1. Donath L, Rossler R, Faude O. Effects of virtual reality training ( exergaming ) compared to alternative exercise training and passive control on standing balance and functional mobility in healthy community-dwelling seniors : a meta-analytical review. Sports Med. 2016;46(9):1293–1309.
    1. Laver K, Lange B, George S, Deutsch J, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation ( Review ) Cochrane Database Syst Rev. 2017;11(11):CD008349.
    1. Zeng N, Pope Z, Lee JE, Gao Z. A systematic review of active video games on rehabilitative outcomes among older patients. J Sport Health Sci. 2017;6:33–43.
    1. Choi SD, Guo L, Kang D, Xiong S. Exergame technology and interactive interventions for elderly fall prevention : a systematic literature review. Appl Ergon. 2017;65:570–558.
    1. Tahmosybayat R, Baker K, Godfrey A, Caplan N, Barry G. A systematic review and meta-analysis of outcome measures to assess postural control in older adults who undertake exergaming. Maturitas. 2017;98:35–45.
    1. Zheng L, Li G, Wang X, Yin H, Jia Y, Leng M, et al. Effect of exergames on physical outcomes in frail elderly : a systematic review. Aging Clin Exp Res. 2019;13:1–14.
    1. Moher D, Liberati A, Tetzlaff J, Altman D. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097.
    1. McHugh ML. Interrater reliability: the kappa statistic. Biochem Medica. 2012;22(3):276–282.
    1. The Cochrane Collaboration . Review Manager (RevMan) [computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre; 2014.
    1. Higgins JPT, Sally Green (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. 2011.
    1. Cho GH, Hwangbo G, Shin HS. The effects of virtual reality-based balance training on balance of the elderly. J Phys Ther Sci. 2014;26(4):615–617.
    1. Schwenk M, Grewal GS, Honarvar B, Schwenk S, Mohler J, Khalsa DS, et al. Interactive balance training integrating sensor-based visual feedback of movement performance: a pilot study in older adults. J NeuroEng Rehabil. 2014;11:164.
    1. Jorgensen MG, Laessoe U, Hendriksen C, Nielsen OBF, Aagaard P. Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013;68(7):845–852.
    1. Padala KP, Padala PR, Lensing SY, Dennis RA, Bopp MM, Parkes CM, et al. Efficacy of Wii-Fit on static and dynamic balance in community dwelling older veterans: a randomized controlled pilot trial. J Aging Res. 2017;2017:1–9.
    1. Jung D-I, Ko D-S, Jeong M-A. Kinematic effect of Nintendo Wii(TM) sports program exercise on obstacle gait in elderly women with falling risk. J Phys Ther Sci. 2015;27(5):1397–1400.
    1. Gomes GCV, do Socorro Simões M, Lin SM, JMR B, LAP V, Varise EM. Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM for frail older adults: a randomized feasibility clinical trial. Maturitas. 2018;118:20–28.
    1. Rendon AA, Lohman EB, Thorpe D, Johnson EG, Medina E, Bradley B. The effect of virtual reality gaming on dynamic balance in older adults. Age Ageing. 2012;41(4):549–552.
    1. Montero-Alía P, Miralles-Basseda R, López-Jiménez T, Muñoz-Ortiz L, Jiménez-González M, Prat-Rovira J, et al. Controlled trial of balance training using a video game console in community-dwelling older adults. Age Ageing. 2019;48(4):506–512.
    1. Duque G, Boersma D, Loza-Diaz G, Hassan S, Suarez H, Geisinger D, et al. Effects of balance training using a virtual-reality system in older fallers. Clin Interv Aging. 2013;8:257–263.
    1. Vaziri DD, Aal K, Gschwind YJ, Delbaere K, Weibert A, Annegarn J, et al. Analysis of effects and usage indicators for a ICT-based fall prevention system in community dwelling older adults. Int J Hum Comput Stud. 2017;106(May):10–25.
    1. Sato K, Kuroki K, Saiki S, Nagatomi R. Improving walking, muscle strength, and balance in the elderly with an exergame using Kinect: a randomized controlled trial. Games Health J. 2015;4(3):161–167.
    1. Franco JR, Jacobs K, Inzerillo C, Kluzik J. The effect of the Nintendo Wii Fit and exercise in improving balance and quality of life in community dwelling elders. Technol Health Care. 2012;20(2):95–115.
    1. Bisson E, Contant B, Sveistrup H, Lajoie Y. Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training. Cyber Psychol Behav. 2007;10(1):16–23.
    1. Lucca LF. Virtual reality and motor rehabilitation of the upper limb after stroke: a generation of progress? J Rehabil Med. 2009;41(12):1003–1006.
    1. Saposnik G, Mamdani M, Bayley M, Thorpe KE, Hall J, Cohen LGY, et al. Effectiveness of Virtual Reality Exercises in STroke (EVREST): rationale, design, and protocol of a pilot randomized clinical trial assessing the wii gaming system. Int J Stroke. 2010;5(1):47–51.
    1. Merriman NA, Whyatt C, Setti A, Craig C, Newell FN. Successful balance training is associated with improved multisensory function in fall-prone older adults. Comput Hum Behav. 2015;45:192–203.
    1. Silva AS, Urbano JJ, De Oliveira EF, Vicente L, Oliveira F. Physical activity level, functional mobility and fall risk in the elderly. 2017;(313053):6–11.
    1. World Health Organization . International Classification of Functioning, Disability, and Health. Geneva: ICF; 2001.
    1. Panzer VP, Wakefield DB, Hall CB, Wolfson LI. Mobility assessment: Sensitivity and specificity of measurement sets in older adults. Arch Phys Med Rehabil. 2011;92(6):905–912. doi: 10.1016/j.apmr.2011.01.004.
    1. Levac S. Virtual reality for physical and motor rehabilitation. In: Virtual reality technologies for health and clinical applications. New York; 2014. p. 242. Available from: .
    1. Taylor LM, Kerse N, Frakking T, Maddison R. Active video games for improving physical performance measures in older people : a meta-analysis. J Geriatr Phys Ther. 2018;41(2):108–123.
    1. Neri SGR, Cardoso JR, Cruz L, Lima RM, de Oliveira RJ, Iversen MD, et al. Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis. Clin Rehabil. 2017;31(10):1292–1304.
    1. Darekar A, Mcfadyen BJ, Lamontagne A, Fung J. Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke : a scoping review. J Neuroeng Rehabil. 2015;12(46):1–14.
    1. Goršič M, Cikajlo I, Novak D. Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity. J Neuroeng Rehabil. 2017;14(1):23.
    1. Fitzgerald D, Trakarnratanakul PN, Smyth B, Caulfield PB. Effects of a wobble board-based therapeutic exergaming system for balance training on dynamic postural stability and intrinsic motivation levels. J Orthop Sport Phys Ther. 2010;40(1):11–19.
    1. Mihelj M, Novak D, Milavec M, Ziherl J, Olenšek A, Munih M. Virtual rehabilitation environment using principles of intrinsic motivation and game design. Presence. 2012;21(1):1–15.
    1. Madeira RN, Antunes A, Postolache O, Correia N. Serious…ly! Just kidding in personalised therapy through natural interactions with games. In: Cheok A, Inami M, Romão T, editors. Advances in computer entertainment technology. 2017th ed: ACE 2017; 2018. p. 726–45.
    1. Tarnanas I, Papagiannopoulos S, Kazis D, Wiederhold M, Widerhold B, Tsolaki M. Reliability of a novel serious game using dual-task gait profiles to early characterize aMCI. Front Aging Neurosci. 2015;7:1–15.
    1. Rahmani E, Boren S. Videogames and health improvement: a literature review of randomized controlled trials. Games Heal J. 2012;1(5):331–341.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다