Skip to main content

Table 1 Overview technologies and results of studies evaluating exergames for balance training in elderly and adults

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

  Sample characteristics & Study type Technologies used Game elements and tasks Intervention design Internal outcome measures External outcome measures Results
Feedback to user (FB)
Studenski [30] E: Healthy elderly (N = 36)
Age: 80.1 ± 5.4
Study type: UCT
Dance pad containing four panels Dance game (DancetownTM) controlled by stepping movements in forward, backward left and right directions. 24 x 30 min sessions over 3 months.
Total = 720 min.
Not used
FB user: Game performance
- BMI
- blood pressure
- Pulse
- SPPB
- NWT
- Digit symbol substitution test
- SF36 PMC
- ABC scale
SF 36 PMC, NWT and ABC scale improved (p < 0.05)
No significant effects on other outcome measures
Smith [31] E 1: Healthy elderly (N = 26)
Age: 78.9 ± NR
E 2 and E 3: Healthy elderly (N = 20)
Age: 79.6 ± NR
C: Young adults (N = 20)
Age: 28.4 ± NR
Study type: CT
Dance mat containing four panels E 1: Stepping to the left, right, left forward or right forward on panels corresponding to arrows shown on a display. Arrow drift speed varied.
E 2: Same game with constant arrow speed.
E 3: Manipulated arrow speed and appearance
E 1: 4 min
E 2 and E 3: 5 x 4 min trials < 1 hr.
Total Studies 2 and 3 = 80 min.
-Step timing
-% missed targets
FB user: not reported
Not used Step timing improved (p < 0.05) after multiple trials & group effect; young outperformed elderly (p < 0.05).
% missed targets decreased after multiple trials (p < 0.05) & group effect; young adults outperformed elderly (p < 0.05).
Kosse [33]1 E: Healthy elderly (N = 9)
Age: 77 ± 5.0
Study type: ITS
Wobble board Moving a ball through a maze using weight shifts without lifting the feet 18 x 20 min. over 6 weeks
Total =360 min.
Not used
FB user: Game performance
- BBS
- FOE
- TS EO and EC
- OLS EO and EC
BBS and FOE improved (p < 0.01)
TS and OLS EC & EO did not improve
Fitzgerald [24] E: Healthy adults (N = 11)
Age: 25.4 ± 2.1
C: Healthy adults (N = 11)
Age: 26.9 ± 3.2
Study type: RCT
Wobble board E: Controlling a ball using weight shifts without lifting the feet
C: Postural stability training on a wobble board.
3 x 15 min. p/wk for 4 weeks
Total = 180 min.
Not used
FB user: Game performance
- DPSI
- SEBT
- Intrinsic motivation inventory
DPSI and SEBT: no group effects.
Intrinsic motivation: higher (p < 0.01) score on interest/enjoyment category
Lamoth [25]1 E: Healthy elderly (N = 9)
Age: 77 ± 5.0
Study type: ITS
Wobble board Moving a ball through a maze using weight shifts without lifting feet. 18 x 20 min over 6 weeks
Total = 360 min.
Not used
FB user: Game performance
- DT
- Standing FP& TS: trunk acceleration patterns in AP and ML: variability, regularity, smoothness.
Performance on DT improved (p < 0.05), Postural control indexed by variability, regularity and smoothness improved (P < 0.05)
Betker [23] Healthy Adults (N = 8)
Neurological patients (N = 7)
Age: 15 – 72
Study type: CT
Pressure mat, 53 × 53 cm, 256 pressure sensors. Weight shifts in AP and ML direction with cognitive tasks. 3 × 10 min.
Total = 30 min.
During gameplay: game performance, COP position
After gameplay total ROM ML & AP directions.
- Questionnaire: 9 questions about enjoyment, motivation to exercise, game difficulty Internal outcome measures: NR Questionnaire: Games are challenging, attractive and more appealing than traditional exercises.
Bisson [38] E 1: Healthy elderly (N = 12)
Age: 74.4 ± 3.65
E 2: Healthy elderly (N = 12)
Age: 74.4 ± 4.92
Study type: ITS
Camera tracks red gloves, player projected in Virtual Environment. Force platform measures COP. E 1: Moving cursor using weight shifts
E 2: Catch 'Falling’ balls by reaching the arms without lifting feet
2 x 30 min. p/wk for 10 weeks
Total = 600 minutes
Not used
FB user: Game performance
- Sway variability AP and ML
- CB&M
- RT
Sway variability: no significant group effect.
CB&M and RT: both groups improved (P < 0.05)
Lange [40] E: Healthy adults (N = 7)
Age: 16-43
Study type: UCT
Webcams, LED markers, custom step-based game. Dance and step-based exercises in forward, backward, left, right and diagonal directions Not specified Not used
FB user: Not reported
- Semi-structured interviews about game experience All participants reported enjoying the experience
Nitz [41] E: Healthy adults (N = 8)
Age: 46.6 ± 9.9
Study type: UCT
Wii balance board WiiFit: Yoga, balance, aerobic and strength pre-programmed activities. 2 x 30 min p/wk for 10 weeks.
Total = 600 min.
Not used
FB user: Game performance
- 6MWT
- TUG
- TUGcognitive
- Step test
- BS (foam, EC)
- OLS (EO)
- LOS
- RT
- Ankle dorsiflexion
- LLS
- Body weight
OLS for both limbs and lower limb strength improved (P < 0.05)
Other outcome measures: no significant improvement.
Williams [42] E: Elderly with increased fall risk (N = 15)
Age: 76.8 ± 5.2
C: Elderly with increased fall risk (N = 6)
Age: 76.5 ± 4.8
Study type: CT
Nintendo Wii, Wii balance board, walking frame. E: WiiFit, balance and aerobic exercises controlled using stepping on the board, shifting weight and performing poses.
C: Standard care exercise/education programme
E: 2 game sessions per week for 12 weeks.
Total = Not reported C: 12 week exercise/education programme
Wii Age; number calculated by the Nintendo Wii based on game results.
FB user: Game performance, Wii Age.
- BBS
- TBA
- FES-I
No group effect on BBS and TBA. Control group improved on FES-I (P < 0.05). Game group improved on Wii-age (P < 0.05)
Young [43] E: Healthy elderly (N = 6)
Age: 84.1 ± 5.1
Study type: ITS
Wii balance board, custom games. Catching apples and popping balloons using COP shifts without lifting feet. 10 x 20 min. over 4 weeks
Total = 200 min.
Not used
FB user: Real-time visual FB of current COP position
- Sway variability AP EO & EC
- Sway variability ML EO & EC
- FES
Sway variability AP EC improved (p < 0 .05)
Other sway measures and FES showed trend towards improvement.
Heiden [44] E: Healthy elderly (N = 9)
C: Healthy elderly (N = 6)
Age : 77 ± NR
Study type: CT
2 Force plates (25x10x1.5 cm) E: Playing tennis game 'Pong’ controlled using weight shifts in AP and ML directions and a dynamic stepping routine + chair exercise program.
C: Chair exercise program.
E: 2x (16 x 60 min. chair exercises + 30 min. exergaming) p/wk for 8 weeks.
Total exercise = 1440 min. and gaming = 480 min.
C: 16 x 60 min. over 8 weeks
Total = 960 min
Not used
FB user: Real time visual FB of COP movement
- Postural sway AP
- Postural sway ML
- RT dual task
- CB&M
- 6MWT
RT during dual task and CB&M improved (p < 0.05) in intervention group
Both groups improved on the 6MWT (p < 0.05).
Agmon [75] E: Balance impaired elderly (N = 7)
Age: 84 ± 5
Study type: ITS
Nintendo Wii, Wii balance board 4 balance games controlled using weights shifts and stepping on the balance board 3x30 min p/w for 3 months.
Total = 1170 min
Not used
FB user: Game performance
- BBS
- Timed 4-meter walk test
- PACES
BBS and walking speed improved (P < 0.05).
No effect on PACES.
  1. E = Experimental group; C = Control group; N = Number of participants; RCT = Randomized controlled trial; UCT = Uncontrolled trial; CT = Controlled trial; ITS = Interrupted time series design. When no p values are presented in the table, they were not provided in the paper, 1=Same data set; NR = Not reported; ROM = Range of movement; ML = Medio-lateral; AP = Anterior-posterior; COP = Centre of pressure; SF36 PMC = SF 36 physical & mental component; NWT = Narrow walk time; DPSI = Dynamic postural stability index; SEBT = Star excursion balance test; FOE = Figure of eight; EO = Eyes open; EC = Eyes closed; DT = Dot task; RT = Reaction time; LLS = Lower limb strength; TUG = Timed-up-and-go; 6MWT = 6 minute walk test; LOS = Limits of stability; BMI = Body mass index; SPPB = Short physical performance battery; FES-I = Falls efficacy scale international; ABC scale = Activities specific balance confidence scale; BBS = Berg balance scale; TBA = Tinetti balance assessment; FES = Falls efficacy scale; CB&MS = Community balance and mobility scale; FP = Feet parallel; TS = Tandem stance; OLS = One-leg stance; BS = Bilateral stance; PACES = Physical activity enjoyment scale.