A Pilot Study of Wii Fit Exergames to Improve Balance in Older Adults

University of Washington, Seattle, WA 98195, USA.
Journal of geriatric physical therapy (2001) 10/2011; 34(4):161-7. DOI: 10.1519/JPT.0b013e3182191d98
Source: PubMed


To determine the safety and feasibility of using Nintendo Wii Fit exergames to improve balance in older adults.
Seven older adults aged 84 (5) years with impaired balance (Berg Balance Scale [BBS] score < 52 points) were recruited from 4 continuing care retirement communities to participate in a single group pre- and postevaluation of Wii Fit exergames. Participants received individualized instructions (at least 5 home visits) on playing 4 exergames (basic step, soccer heading, ski slalom, and table tilt) and were asked to play these games in their homes at least 30 minutes 3 times per week for 3 months and received weekly telephone follow-up. They also completed a paper log of their exergame play and rated their enjoyment immediately after each session. Participants completed the BBS, 4-Meter Timed Walk test, and the Physical Activity Enjoyment Scale at baseline and 3 months. Semistructured interviews were conducted at the 3-month evaluation.
Participants safely and independently played a mean of 50 sessions, median session duration of 31 minutes. Two of the games were modified to ensure participants' safety. Participants rated high enjoyment immediately after exergame play and expressed experiencing improved balance with daily activities and desire to play exergames with their grandchildren. Berg Balance Scores increased from 49 (2.1) to 53 (1.8) points (P = .017). Walking speed increased from 1.04 (0.2) to 1.33 (0.84) m/s (P = .018).
Use of Wii Fit for limited supervised balance training in the home was safe and feasible for a selected sample of older adults. Further research is needed to determine clinical efficacy in a larger, diverse sample and ascertain whether Wii Fit exergames can be integrated into physical therapy practice to promote health in older adults.

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    • "The usability of a home-based training with the Kinect and video instructions (Ofli et al., 2015), as well as with tablets (Silveira et al., 2013a), has been studied with the older population. These solutions, ranging from using a computer with mouse and keyboard, to tablets and game consoles (e.g., Wii, Kinect (Agmon et al., 2011)), were reported to be usable and effective by healthy older adults. However, despite the availability of usable technology, motivating older adults to exercise is a challenge. "
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    ABSTRACT: Regular physical activity can substantially improve the physical wellbeing of older adults, preventing several chronic diseases and increasing cognitive performance and mood. However, research has shown that older adults are the most sedentary segment of society, spending much of their time seated or inactive. A variety of barriers make it difficult for older adults to maintain an active lifestyle, including logistical difficulties in going to a gym (for some adults, leaving home can be challenging), reduced functional abilities, and lack of motivation. In this paper, we report on the design and evaluation of Gymcentral. A training application running on tablet was designed to allow older adults to follow a personalized home-based exercise program while being remotely assisted by a coach. The objective of the study was to assess if a virtual gym that enables virtual presence and social interaction is more motivating for training than the same virtual gym without social interaction. Methods. A total of 37 adults aged between 65 and 87 years old (28 females and 9 males, mean age = 71, sd = 5.8) followed a personalized home-based strength and balance training plan for eight weeks. The participants performed the exercises autonomously at home using the Gymcentral application. Participants were assigned to two training groups: the Social group used an application with persuasive and social functionalities, while the Control group used a basic version of the service with no persuasive and social features. We further explored the effects of social facilitation, and in particular of virtual social presence, in user participation to training sessions. Outcome measures were adherence, persistence and co-presence rate. Results. Participants in the Social group attended significantly more exercise sessions than the Control group, providing evidence of a better engagement in the training program. Besides the focus on social persuasion measures, the study also confirms that a virtual gym service is effective for supporting individually tailored home-based physical training for older adults. The study also confirms that social facilitation tools motivate users to train together in a virtual fitness environment. Discussion. The study confirms that Gymcentral increases the participation of older adults in physical training compare to a similar version of the application without social and persuasive features. In addition, a significant increase in the co-presence of the Social group indicates that social presence motivates the participants to join training sessions at the same time with the other participants. These results are encouraging, as they motivate further research into using home-based training programs as an opportunity to stay physically and socially active, especially for those who for various reasons are bound to stay at home.
    Full-text · Article · Nov 2015 · PeerJ
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    • "Exergaming has the potential to increase exercise adherence, balance confidence, and exercise enjoyment (Barry et al., 2014; Miller et al., 2014; Ravenek et al., 2015), but it is unclear if it can improve the balance of people with IPD (Agmon et al., 2011; Meldrum et al., 2012; Holmes et al., 2013; Barry et al., 2014). There is limited evidence to suggest exergaming is an efficacious rehabilitation method for balance and postural issues experienced by older people and people with IPD. "
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    ABSTRACT: The use of virtual reality games (known as “exergaming”) as a neurorehabilitation tool is gaining interest. Therefore, we aim to collate evidence for the effects of exergaming on the balance and postural control of older adults and people with idiopathic Parkinson’s disease (IPD). Six electronic databases were searched, from inception to April 2015, to identify relevant studies. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were used to calculate effect sizes between experimental and control groups. I2 statistics were used to determine levels of heterogeneity. 325 older adults and 56 people with IPD who were assessed across 11 ­studies. The results showed that exergaming improved static balance (SMD 1.069, 95% CI 0.563–1.576), postural control (SMD 0.826, 95% CI 0.481–1.170), and dynamic balance (SMD −0.808, 95% CI −1.192 to −0.424) in healthy older adults. Two IPD studies showed an improvement in static balance (SMD 0.124, 95% CI −0.581 to 0.828) and postural control (SMD 2.576, 95% CI 1.534–3.599). Our findings suggest that exergaming might be an appropriate therapeutic tool for improving balance and postural control in older adults, but more ­large-scale trials are needed to determine if the same is true for people with IPD.
    Full-text · Article · Sep 2015 · Frontiers in Aging Neuroscience
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    • "Thus, we performed a randomized controlled trial (RCT) to determine if IFVR exercise is effective in improving HRQoL in older women when compared to group-based exercise. In addition, we examined its effect on physical fitness to identify any possible placebo effects, and to add robust evidence to the results of previous studies that analyzed the effect of IFVR exercise on physical health using case studies (Agmon et al., 2011; Studenski et al., 2010; Williams et al., 2011), or comparisons with non-exercise groups (so had a risk of bias) (Duque et al., 2013; Jorgensen et al., 2013; Kim et al., 2013; Rendon et al., 2012). "
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    ABSTRACT: Individualized feedback-based virtual reality (IFVR) exercise is gaining attention as a cost-effective self-management strategy, however little is known about whether older adults themselves perceive IFVR exercise effective in improving their health. Therefore, we studied the effect of IFVR exercise on health-related quality of life (HRQoL) in older women. Fifty-four older women aged ≥65 years were randomized to either IFVR exercise group (IFVRG, n=26) or group-based exercise group (GG, n=28). Both groups received a 60-min intervention three times a week for eight weeks. The Short-Form Health Survey (SF-36) was administered. To identify the possible placebo effect, 30-Second Chair Stand Test (30SCST), 8-Foot Up-and-Go Test (8FUGT), and 2-Minute Step Test (2MST) were also administered. intention-to-treat analysis with adjustment for baseline levels revealed that IFVRG showed greater improvement in mental health (p=0.029) and lower body strength (p=0.042), compared to GG. Within-group analysis for HRQoL revealed that IFVRG showed an increase in role-physical (p=0.015), bodily pain (p=0.017), general health (p=0.004), vitality (p=0.010), role-emotional (p=0.007), and mental health (p<0.001), whereas GG showed an increase in role-physical (p=0.022), general health (p=0.023), and social functioning (p = 0.023). Both groups showed an increase in 30SCST, 2MST and 8FUGT (all p<0.001). IFVR exercise improved HRQoL in older women, in addition to improving physical fitness. Therefore, it might be recommended to older women as an effective self-management strategy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Jun 2015 · Archives of gerontology and geriatrics
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