Exergaming for balance training of elderly: state of the art and future developments

Abstract

Fall injuries are responsible for physical dysfunction, significant disability, and loss of independence among elderly. Poor postural control is one of the major risk factors for falling but can be trained in fall prevention programs. These however suffer from low therapy adherence, particularly if prevention is the goal. To provide a fun and motivating training environment for elderly, exercise games, or exergames, have been studied as balance training tools in the past years. The present paper reviews the effects of exergame training programs on postural control of elderly reported so far. Additionally we aim to provide an in-depth discussion of technologies and outcome measures utilized in exergame studies. Thirteen papers were included in the analysis. Most of the reviewed studies reported positive results with respect to improvements in balance ability after a training period, yet few reached significant levels. Outcome measures for quantification of postural control are under continuous dispute and no gold standard is present. Clinical measures used in the studies reviewed are well validated yet only give a global indication of balance ability. Instrumented measures were unable to detect small changes in balance ability as they are mainly based on calculating summary statistics, thereby ignoring the time-varying structure of the signals. Both methods only allow for measuring balance after the exergame intervention program. Current developments in sensor technology allow for accurate registration of movements and rapid analysis of signals. We propose to quantify the time-varying structure of postural control during gameplay using low-cost sensor systems. Continuous monitoring of balance ability leaves the user unaware of the measurements and allows for generating user-specific exergame training programs and feedback, both during one game and in timeframes of weeks or months. This approach is unique and unlocks the as of yet untapped potential of exergames as balance training tools for community dwelling elderly.

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“…These results are consistent with other studies of different interventions with exergame (Duque et al, 2013;Maillot et al, 2012;Padala et al, 2012;Pichierri et al, 2012;Schoene et al, 2013;Van Diest, Lamoth, Stegenga, Verkerke, & Postema, 2013) and independent of how the balance was evaluated. In some studies (Padala et al, 2012;Van Diest et al, 2013) the interventions were carried out by means of balance games, using a Wii balance board. Padala et al (2012) compared the results of the exergame (balance games) to an active control group, as in this study, and showed that the results for the TUG test were similar to the results of the group that performed aerobic walking exercise.…”

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

“…Exercise through video games, socalled exergames, is used progressively more to increase physical activity and improve health and physical function in older adults (1,(3)(4)(5), and there is growing interest in using exergames as a potential rehabilitation tool to facilitate specific exercises in different clinical groups (6)(7)(8). Studies suggest that exergaming promotes improvements in mobility (9,10), muscular strength of the lower limbs (11), balance control (2,12,13), and cognition (14) in older adults.…”

The Benefits of Active Video Games for Educational and Physical Activity Approaches: A Systematic Review

“…First of all, this literature review clearly suggests that most researchers were interested in the improvement of fitness because physical inactivity among adults (e.g., Bonetti, Drury, Danoff, & Miller, 2010;Diest et al, 2013) and children is a major contributor to diseases associated with obesity (World Health Organization, 2010). There was a great number of studies that have investigated AVGs participation in PA and its positive effects in reducing the risk of obesity (e.g., Maloney, Threlkeld, & Cook, 2012;Goersch et al, 2013), hypertension (e.g., Chen & Wilkosz, 2014), congestive heart failure (e.g., Klompstra, Jaarsma, & Strömberg, 2014;Tripette et al, 2014), atherosclerosis (e.g., Laufer, Dar, & Kodesh, 2014) and cardiovascular disease (e.g., Thompson, Gordon, & Pescatello, 2010).…”

“…A growing body of literature shows that AVGs are considered a valuable additional component to programs enhancing general health, physical fitness and psychomotor functioning (Gioftsidou et al, 2013;Peng, Crouse, & Lin, 2013;Vernadakis et al, 2012) as well as therapy and rehabilitation procedures (Klompstra, Jaarsma, & Strömberg, 2013;Sin & Lee, 2013;Van Diest, Lamoth, Stegenga, Verkerke, & Postema, 2013). However, there is still very limited empirical evidence that exergames can facilitate motor skill acquisition, or can provide an alternative to motor skill enhancing physical activity (Barnett, Hinkley, Okely, Hesketh, & Salmon, 2012;Papastergiou, 2009).…”