Exergaming improves dynamic balance in community dwelling elderly

Objective. Improving and maintaining balance is essential for the elderly population, as impaired balance is a major risk factor for falling. In daily-life settings, balance control is no aim by itself, but postural adjustments of the whole body are continuously required for many goal-directed movements. Exergaming, the notion of exercise combined with video games, is popular in health care practice to improve balance and suggested to help avoid falls in the elderly. When exercising by playing a balance game people do not pay attention to the physical exercise and their own movements but on the outcome of their movements in the projected environment. However scarce, some evidence is available for the direct beneficial effect of playing an active video game with a balance board as a peripheral on postural control. Therefore, the objective of the study was to assess the effect of 6 weeks exergaming based balance training program on balance performance in a group of elderly community dwelling persons. Methods. Nine healthy elderly participated in this study (age >65 years). A balance training device was used which integrates video gaming with balance control on a moveable platform. By subtly shifting weight on the balance board the person virtually tilts a maze to guide a ball to a target. An interrupted A1BA2 time series design was used, with a three weeks baseline period A1 preceding the intervention B and one baseline period A2 was following the 6 weeks intervention. Before, after and during the intervention phase balance was assessed with the figure-of-eight walking test, the Berg Balance Scale, duration of tandem and one leg stance with eyes open and closed. In addition pleasure in and motivation for exergaming was assessed using visual analogue scales (VAS). Intervention effects were examined using multilevel modelling statistics. Results. The dynamic balance performance, measured by the figure-of-eight walking test and the Berg Balance Scale improved significantly after the training (p <0.05). Participants with low balance scores at the start of the program, improved more across time than the best scoring participants. These patients also played the game at lower level of difficulty during the entire intervention than the patients with better balance performance. All subjects reported to be highly motivated to exercise balance because they found the gaming challenging and enjoyable. Conclusion. Elderly without a specific pathology can benefit from a videogame based exercise program aimed at improving balance, where people had to move a platform in response to stimulation from a game that was fun to play. A major advantage is the ability to adapt the exercise interventions to the performance level of the older adults; that is, it provides individualized training. Future studies, will be aimed at studying not only balance but also the interplay between posture and the environment, in other words the ability to orient oneself in space, using exergames.