Validation of a Motor-Cognitive Assessment for a Stepping Exergame in Older Adults: Use of Game-Specific, Internal Data Stream

Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: a randomized controlled trial

“…Training-induced gains were maintained 10 weeks after training cessation, indicating the long-term effectiveness of the stepping exergame training to sustainably improve exergame-based stepping performances which may be highly relevant for avoiding falls. To the best of our knowledge, this is the first study to provide data on the effectiveness and sustainability of a stepping exergame training in improving complex motorcognitive stepping performances assessed by comprehensively validated internal outcome measures [19]. Stepping reaction times were log-transformed to satisfy the normality assumption for statistical analysis * calculated as follows: ((retest scorebaseline score) / baseline score) × 100 † P-values and effect sizes (η p 2 ) are given for group effects with adjustment for baseline covariates as calculated by analysis of covariance (ANCOVA).…”

“…Identical stepping exergame tasks were used for training and assessment purposes. The assessment strategy specifically tailored to the specific training tasks included outcome measures directly derived from the internal game-based data stream, which has previously successfully and comprehensively validated in older adults, showing good feasibility, test-retest reliability and construct validity, as well as excellent sensitivity to change [19]. Primary outcome measures were defined as stepping reaction time (SRT) and game scores.…”

“…This interaction between multiple functional systems is similar to that required to initiate step responses to prevent falls [18], which seems more difficult to reproduce through traditional stepping exercises. Further advantages of exergame-based stepping exercises compared to traditional stepping exercises involve the opportunity to track players' performance during interactive gameplay on various specific parameters by means of internalsoftware-generated data, which can be used not only to provide real-time immediate performance feedback but also to adjust the task difficulty to the specific performance level of the individual participant or be used for highly-specific assessment of the multimodal, motorcognitive task characteristics of the specific exergame [19][20][21][22]. Furthermore, the playful and entertaining character of interactive exergaming can make training routine more engaging and enjoyable therefore increasing motivation to exercise [23] shifting participants' attention to positive experience of movement [18], which might help to encourage older people to participate in physical activity [24] and to enhance the low participation and intervention adherence observed for conventional exercise programs [25].…”

“…Stepping exergame task cueing a forward step. (from Litz et al Games Health J 2019[19], with permission of Mary Ann Liebert, Inc. Copyright© 2019 Mary Ann Liebert, Inc.)…”

Using shoe-mounted inertial sensors and stepping exergames to assess the motor-cognitive status of older adults: A correlational study

“… 17 , 18 Although their effects are traditionally assessed using external outcome measures after gameplay, 17 , 18 parameters extracted directly from the exergames may be used to monitor both the cognitive and the physical state of older adults. 19 , 20 For example, parameters extracted from a balance training exergame employing a three-dimensional movable plate presented moderate-to-high correlations with established motor and cognitive tests in older adults with mild-to-moderate dementia. 19 Similar results were obtained for an exergame training program applied to cognitively intact older adults that used a stepping platform to detect multidirectional steps.…”