Controlled trial of balance training using a video game console in community-dwelling older adults

Abstract

Background gamification is a potentially attractive option for improving balance and reducing falls. Objectives to assess the effect of balance training using the NintendoTM Wii game console on balance (primary outcome), falls and fear of falling. Design quasi-randomised, open-label, controlled clinical trial in parallel groups, carried out on community-dwelling patients over 70 years, able to walk independently. Participants were assigned 1:1 to the intervention or control group. Balance training was conducted using the Nintendo WiiFit TM twice a week for 3 months. Balance was assessed using the Tinetti balance test (primary outcome), the unipedal stance and the Wii balance tests at baseline, 3 months and 1 year. Falls were recorded and Fear of falling was assessed by the Falls Efficacy Scale (Short-FES-I). Results 1,016 subjects were recruited (508 in both the intervention and the control group; of whom 274 and 356 respectively completed the 3-month assessment). There was no between-group difference in the Tinetti balance test score, with a baseline mean of 14.7 (SD 1.8) in both groups, and 15.2 (1.3) at 3 months in the intervention group compared to 15.3 (1.7) in controls; the between-group difference was 0.06 (95% CI 0.30–0.41). No differences were seen in any of the other balance tests, or in incident falls. There was a reduction in the fear of falling at 3 months, but no effect at 1 year. Conclusions the study found no effect of balance training using the Nintendo TM Wii on balance or falls in older community-dwelling patients. The study protocol is available at clinicaltrials.gov under the code NCT02570178.

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

“…The other instruments used were the Functional Reaching Test (33), the Activities-specific Balance Confidence Scale (32,35), the Tinetti balance test and the unipedal stance test (36), the MiniBESTest and the functional gait assessment (34). The center of pressure based balance parameters the were assessed using force plates were velocity (31), sway (29,30,37) and limits of stability (37).…”

“…Two studies showed low risk of bias for sequence generation, and unclear for allocation concealment (1,40). The level of risk of bias was unclear in four studies (29,33,35,37), and high in one study (36).…”

“…Regarding the exergame type, most studies used the commercial non-immersive Nintendo Wii ® system (1,(29)(30)(31)(32)(33)(34)(35)(36). The remaining studies used the following serious games: the Balance Rehabilitation Unit (BRU TM ) -a customized rehabilitation program that contains a immersive environment in which the user interact through three dimensional glasses (37); the LegSys™ (BioSensics LLC, MA, USA) -an interactive exergame interface with five wearable joint angle and position sensors (30); and two studies used Kinect-based exergames -the iStoppfalls system (38), and the exergame program with the following serious games: apple game, tightrope standing, balloon popping and one-leg stand (39).…”

“…(Ethylene Vinyl Acetate) insoles in their shoes everyday (31). In three studies, the control group received education on falls prevention and physical activity (36)(37)(38). The intervention characteristics are detailed in table 2.…”

“…The effects of exergaming on the BBS was evaluated in three studies (32,33,39 In respect to other types of balance assessment, is was observed inconsistent findings on the effect of exergames based on changes in the Activity-specific Balance Confidence Scale (ABC) scores (32,35) Also, no between groups' difference was observed using the Tinetti's balance test (36) the MiniBEST Test (34)…”