By Katrien Verhoeven, Departement Healthcare, UC Leuven-Limburg, Belgium, Katrien.firstname.lastname@example.org
This paper was presented at The 7th Games for Health Europe Conference, 2 & 3 October 2017, TAC Eindhoven, Netherlands.
Of all people over 65 years 30-50% fall at least once a year. Regular physical activity can reduce the risk of falling significantly. However, older persons are often inactive, mainly because of a lack of motivation. Several studies have found a positive influence of exergaming on older people’s balance and cognition. Most exergame studies have used commercial exergames, but these exergames are not tailored to the elderly population.
In this study we tried to increase physical activity in older persons in a community center (N=17, mean age=76 years) by using exergames. We developed two programs: one program uses commercial KINECT exergames (Microsoft), one program uses customized MIRA exergames (MIRA rehab). We selected games that influence fall prevention risk indicators: balance, strength, mobility, flexibility, endurance and cognition. We evaluated the feasibility of both exergame programs and its influence on participants’ balance, their fear of falling and cognition. Balance improved in both exergame groups. Participants’ attitude towards physical activity also became more positive. No differences were found between commercial and customized exergames. A larger study is recommended.
Of all people over 65 years 30-50% fall at least once a year. These falls may cause people to cut down on their activities of daily living, which may in turn have a negative impact on their wellbeing. Regular physical activity can reduce the risk of falling significantly.
Older persons have to perform activities of moderate intensity for 30 minutes each day, according to global physical activity guidelines. They also have to engage in strength and balance exercises twice a week. Research has shown that the vast majority of this population does not comply with those health guidelines. Physical activity programs, are therefore needed to activate elderly.
Community centers offer a variety of activities to older persons living in the neighbourhood, including physical activity programs. These programs consist of traditional exercises and are often performed in large groups. However, the adherence to such exercise programs is low, mainly due to a lack of motivation. Previous research has shown that motivation can be increased by using exergames, or active video games (AVG). Furthermore, several studies have found a positive influence of exergaming on balance and cognition. Most exergame studies have used commercial exergames, but these exergames are not tailored to the elderly population. It is hypothesized that customized exergames, which are specifically designed for older persons, might be even more effective.
In this study we developed two physical activity programs which use exergames. One program uses commercial KINECT exergames (Microsoft). One program uses customized MIRA exergames (MIRA Rehab, www.mirarehab.com). We evaluated the feasibility of both programs and its influence on participants’ balance, cognition, and fear of falling.
- N=17 (7 males, 10 females, mean age=76,00 years, range=67-88 years)
- Inclusion criteria: 65+, no epilepsy, no dementia, able to walk 10 m and stand up 5 min. without help, permission of general physician to perform physical activity, not living in a long term care facility
- Randomized into 2 groups: KINECT program (N=8), MIRA program (N=9)
|Berg Balance Scale(BBS) (Berget al., 1992);Timed up and go (TUG) Podsiadlo & Richardson, 1991)|
|Fear of falling
|Falls Efficiency Scale International (FES-I) (Prevention of Falls Network Europe)|
|STROOP color-word Test(Stroop, 1935);
Digit span task (Wechsler,2005);
Dual task (TUG+ counting back from 50)
- Games were selected to influence fall prevention risk indicators: balance (B), strength (S), mobility (M) , flexibility (F), endurance (E) and cognition (C); selection feedback was given by physiotherapists; games were pretested by the population
- Frequency: 1,5 hour/session; 2 sessions/week; 8 weeks; played in small groups (2 to 4 players)
- 12 Customized exergames (MIRA Rehab)
- 7 Commercial KINECT games (Microsoft)
- High satisfaction with both programs
- Exergames of both programs were fun, not too difficult, varied and moderately intense
- No adverse effects were reported in both groups
- High adherence in both groups
- Both programs improved balance (seeTable1)
- Cognition and fear of falling did not improve
- Attitude towards physical activity became more positive in both groups
|Thinking more often about physical activity||87,5%||77,8%|
|Increased liking of physical activity||85,7%||88,9%|
|Increased ability to perform physical activity||87,5%||66,7%|
|Increased well being||71,4%||77,8%|
|Increased confidence to perform physical activity||71,4%||77,8%|
|Increased awareness of the importance of physical activity||62,5%||88,9%|
- Playing exergames has the potential to improve balance in elderly in a community center
- Playing exergames has positive effects on the participants’ attitude towards physical activity
- No difference occurred between commercial and customized exergames
- Confirmation of these findings in a larger study sample is recommended
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Bieryla, B., &Dold, N. (2013). Feasibility of Wii Fit training to improve clinical measures of balance in older adults. Clinical Interventions in Aging, 8, 775–781.
Maillot P. Et al. (2012). Effects of interactive physical-activity video-game training on physical and cognitive function in older adults. Psychology and Aging, 27, 589-600.
Rendon, A. et al. (2012). The effect of virtual reality gaming on dynamic balance in older adults. Age and Ageing, 41, 549-552.
Rosenberg, D. Et al. (2010). Exergames for subsyndromal depression in older adults: A pilot study of a novel intervention. The American Journal of Geriatric Psychiatry, 18, 221-226.
Verhoeven & Heyrman (2015). Woonzorgcentrum in beweging. UC Leuven-Limburg: www.ucll.be/healthyliving.
About the author
Katrien Verhoeven, Lector-Onderzoeker at UC Leuven-Limburg (NL)
She finished a master in Clinical Psychology in 2003, and obtained a teaching degree in 2004. In 2006 she started her PHD research on “pain experience and distraction in children and adolescents” at Ghent University. She complemented her doctoral degree with the international research training of the ‘Psychology and Health’ institute (The Netherlands).
In 2011 she joined UC Leuven-Limburg (UCLL) (Belgium), where she combines research with lecturing on (health)psychology, communication and research. From 2011-2014 she was the main researcher of the research project ‘Move Towards Health – Exergames’. This research project examined the (exer)game-experience of schoolchildren, and investigated whether playing these exergames could promote physical activity and a healthier lifestyle in these children. From 2014-2016 she was the main researcher of the project ‘Woonzorgcentrum in beweging’. This research project developed two physical activity programs that stimulate physical activity in older persons. One program used exergames, the other program used exercise cards. These programs were evaluated in the context of a long-term care institution. The past year she was the main researcher of the research project “Lokaal Dienstencentrum in beweging”. In this research project physical activity was stimulated in older persons in a community center. The feasibility and effectiveness of two exergame programs was investigated. One program used the exergame program that was previously used in the long term care facility, the other program used customized MIRA exergames.