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. |