Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy

Abstract

Background: There has been a rapid increase in research on the use of virtual reality (VR) and gaming technology as a complementary tool in exercise and rehabilitation in the elderly population. Although a few recent studies have evaluated their efficacy, there is currently no in-depth description and discussion of different game technologies, physical functions targeted, and safety issues related to older adults playing exergames. Objectives: This integrative review provides an overview of the technologies and games used, progression, safety measurements and associated adverse events, adherence to exergaming, outcome measures used, and their effect on physical function. Methods: We undertook systematic searches of SCOPUS and PubMed databases. Key search terms included "game", "exercise", and "aged", and were adapted to each database. To be included, studies had to involve older adults aged 65 years or above, have a pre-post training or intervention design, include ICT-implemented games with weight-bearing exercises, and have outcome measures that included physical activity variables and/or clinical tests of physical function. Results: Sixty studies fulfilled the inclusion criteria. The studies had a broad range of aims and intervention designs and mostly focused on community-dwelling healthy older adults. The majority of the studies used commercially available gaming technologies that targeted a number of different physical functions. Most studies reported that they had used some form of safety measure during intervention. None of the studies reported serious adverse events. However, only 21 studies (35%) reported on whether adverse events occurred. Twenty-four studies reported on adherence, but only seven studies (12%) compared adherence to exergaming with other forms of exercise. Clinical measures of balance were the most frequently used outcome measures. PEDro scores indicated that most studies had several methodological problems, with only 4 studies fulfilling 6 or more criteria out of 10. Several studies found positive effects of exergaming on balance and gait, while none reported negative effects. 2 function in older adults, with few reported adverse events. As there is large variability between studies in terms of intervention protocols and outcome measures, as well as several methodological limitations, recommendations for both practice and further research are provided in order to successfully establish exergames as an exercise and rehabilitation tool for older adults.

New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments

“…For a number of years, the possibility of applying serious games for rehabilitation purposes has been thoroughly investigated [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. It is often claimed that serious games reduce health system costs and efforts as they enable in-home rehabilitation without loss of medical monitoring, and in so doing provide an additional fun factor for patients [22,23,24].…”

“…It is often claimed that serious games reduce health system costs and efforts as they enable in-home rehabilitation without loss of medical monitoring, and in so doing provide an additional fun factor for patients [22,23,24]. Multiple reviews have summarized the very powerful contributions and reveal that the systems are generally evaluated as feasible, but no state of general applicability has yet been reached [2,3,5,7,11,13]. …”

Perceptions of Older Adults on the Use of an Interactive Video Game in Promoting Health and Well-Being

“…Originating between the years 2000 and 2005, exergaming is defined as playing interactive video games using physical exertion as a form of exercise: exer (cise) plus gaming (Dictionary.com, 2016;Nawaz et al, 2015). Health professionals have explored the role of gaming technology to improve physical function in older adults; however, the evidence to support the effectiveness of using video games to encourage physical performance, also called exergames, would benefit from further studies to provide stronger scientific evidence (Molina, Ricci, de Morales, & Perracini 2014;Skjaeret, et al, 2015). For the purposes of this study, the term interactive video games (IVGs), also known as exergaming, will be used for consistency and clarity .…”

“…Studies have found that further research is necessary to determine if the games are safe and which technology are most effective in improving physical functioning in older adults (Molina et al, 2014;Skjaeret et al, 2015). Most longitudinal studies with older adults have used Nintendo Wii platforms and off-the-shelf IVGs, which are popular among younger groups of gamers .…”

“…IVGs are potential tools for occupational therapy practitioners to improve balance and functional mobility and to increase engagement in meaningful activities in older adults (Karahan et al, 2015;Skjaeret et al, 2015). IVGs are an attractive and interactive way to motivate individuals to engage in physical activity by combining both cognitive and motor skills focusing on the outcome of movements in the game and not the movement itself (Lamoth, Caljouw, & Postema, 2011).…”