Exergaming as a Viable Therapeutic Tool to Improve Static and Dynamic Balance among Older Adults and People with Idiopathic Parkinson’s Disease: A Systematic Review and Meta-Analysis

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.

[1]  R. Newton,et al.  Use of the Berg Balance Test to predict falls in elderly persons. , 1996, Physical therapy.

[2]  N. A. Borghese,et al.  Usability and Effects of an Exergame-Based Balance Training Program. , 2014, Games for health journal.

[3]  Kathleen A Bieryla,et al.  Feasibility of Wii Fit training to improve clinical measures of balance in older adults , 2013, Clinical interventions in aging.

[4]  P. Kahlbaugh,et al.  Effects of Playing Wii on Well-Being in the Elderly: Physical Activity, Loneliness, and Mood , 2011 .

[5]  E. Park,et al.  The effects of virtual reality game exercise on balance and gait of the elderly , 2015, Journal of physical therapy science.

[6]  Paul McCrory,et al.  Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. , 2010, Gait & posture.

[7]  Jaebum Son,et al.  Unsupervised virtual reality-based exercise program improves hip muscle strength and balance control in older adults: a pilot study. , 2013, Archives of physical medicine and rehabilitation.

[8]  Houeto Jean-Luc.  [Parkinson's disease]. , 2022, La Revue du praticien.

[9]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[10]  A. Geurts,et al.  Definition dependent properties of the cortical silent period in upper-extremity muscles, a methodological study , 2014, Journal of NeuroEngineering and Rehabilitation.

[11]  Huong Q. Nguyen,et al.  A Pilot Study of Wii Fit Exergames to Improve Balance in Older Adults , 2011, Journal of geriatric physical therapy.

[12]  R. Walker,et al.  Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study , 2002, Journal of neurology, neurosurgery, and psychiatry.

[13]  Michael R. Wells,et al.  Resistance Training and Gait Function in Patients with Parkinson’s Disease , 2001, American journal of physical medicine & rehabilitation.

[14]  M. Hoehn,et al.  Parkinsonism , 1998, Neurology.

[15]  B. Rajaratnam,et al.  Effects of balance-focused interactive games compared to therapeutic balance classes for older women , 2012, Climacteric : the journal of the International Menopause Society.

[16]  Andrew M. Johnson,et al.  The Effects of a Home-Based Virtual Reality Rehabilitation Program on Balance Among Individuals with Parkinson's Disease , 2013 .

[17]  K. Jacobs,et al.  The effect of the Nintendo Wii Fit and exercise in improving balance and quality of life in community dwelling elders. , 2012, Technology and health care : official journal of the European Society for Engineering and Medicine.

[18]  Mark V Albert,et al.  Wii Fit Balance Board Playing Improves Balance and Gait in Parkinson Disease , 2013, PM & R : the journal of injury, function, and rehabilitation.

[19]  Andrew B West,et al.  Molecular pathophysiology of Parkinson's disease. , 2005, Annual review of neuroscience.

[20]  Jeffrey M. Hausdorff,et al.  Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? , 2011, The journals of gerontology. Series A, Biological sciences and medical sciences.

[21]  K. Berg.  Measuring balance in the elderly: preliminary development of an instrument , 1989 .

[22]  Hamid Bateni,et al.  Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study. , 2012, Physiotherapy.

[23]  P. Olivier,et al.  Retraining function in people with Parkinson’s disease using the Microsoft kinect: game design and pilot testing , 2014, Journal of NeuroEngineering and Rehabilitation.

[24]  Heidi Sveistrup,et al.  Functional Balance and Dual-Task Reaction Times in Older Adults Are Improved by Virtual Reality and Biofeedback Training , 2007, Cyberpsychology Behav. Soc. Netw..

[25]  Yves Lajoie,et al.  Games-based biofeedback training and the attentional demands of balance in older adults. , 2010, Aging clinical and experimental research.

[26]  A. Betker,et al.  Game-based Exercises for Dynamic Short-Sitting Balance Rehabilitation of People With Chronic Spinal Cord and Traumatic Brain Injuries , 2007, Physical Therapy.

[27]  A. Zwinderman,et al.  Prospective assessment of falls in Parkinson's disease , 2001, Journal of Neurology.

[28]  Dalton L. Wolfe,et al.  A scoping review of video gaming in rehabilitation , 2015, Disability and rehabilitation. Assistive technology.

[29]  Yen-Wei Hsieh,et al.  Randomized comparison trial of balance training by using exergaming and conventional weight-shift therapy in patients with chronic stroke. , 2014, Archives of physical medicine and rehabilitation.

[30]  Catherine Sherrington,et al.  Reliability of the PEDro scale for rating quality of randomized controlled trials. , 2003, Physical therapy.

[31]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[32]  Eric G. Johnson,et al.  The effect of virtual reality gaming on dynamic balance in older adults. , 2012, Age and ageing.

[33]  Tung-Wu Lu,et al.  Effects of Virtual Reality–Augmented Balance Training on Sensory Organization and Attentional Demand for Postural Control in People With Parkinson Disease: A Randomized Controlled Trial , 2011, Physical Therapy.

[34]  Yu-Ling Hsiao,et al.  Effects of interactive video-game based system exercise on the balance of the elderly. , 2013, Gait & posture.

[35]  Kathleen Zettergren,et al.  THE EFFECTS OF NINTENDO WII FIT TRAINING ON GAIT SPEED, BALANCE, FUNCTIONAL MOBILITY AND DEPRESSION IN ONE PERSON WITH PARKINSON'S DISEASE , 2011 .

[36]  Oddom Demontiero,et al.  Effects of balance training using a virtual-reality system in older fallers , 2013, Clinical interventions in aging.

[37]  Y. Scherer,et al.  Effects of Using Nintendo Wii™ Exergames in Older Adults , 2015, Journal of aging and health.

[38]  Wen-Dien Chang,et al.  Validity and Reliability of Wii Fit Balance Board for the Assessment of Balance of Healthy Young Adults and the Elderly , 2013, Journal of physical therapy science.

[39]  A. Zwinderman,et al.  Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson's disease , 1996, Movement disorders : official journal of the Movement Disorder Society.

[40]  Tatiana de Paula Oliveira,et al.  Effect of Nintendo Wii™-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial. , 2012, Physiotherapy.

[41]  M. Hely,et al.  Sydney multicenter study of Parkinson's disease: Non‐L‐dopa–responsive problems dominate at 15 years , 2005, Movement disorders : official journal of the Movement Disorder Society.

[42]  K. J. Miller,et al.  Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review. , 2014, Age and ageing.

[43]  Rachael D. Seidler,et al.  The effects of short term balance training on the postural control of older adults , 1997 .

[44]  Dara Meldrum,et al.  Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii® Fit Plus , 2012, Disability and rehabilitation. Assistive technology.

[45]  M. Guerraz,et al.  Evaluation of a visual biofeedback on the postural control in Parkinson's disease , 2014, Neurophysiologie Clinique/Clinical Neurophysiology.

[46]  Catherine Sherrington,et al.  Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). , 2002, The Australian journal of physiotherapy.

[47]  Tatiana de Paula Oliveira,et al.  Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study. , 2012, Physiotherapy.

[48]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[49]  B. MacWilliams,et al.  Maximal Speed Gait Initiation of Healthy Elderly Individuals and Persons With Parkinson Disease , 2004 .

[50]  J. Pompeu,et al.  Effect of Nintendo WiiTM-based motor and cognitive training on activities of daily living in patients with Parkinson ’ s disease : A randomised clinical trial , 2012 .

[51]  F. Owen Black,et al.  Clinical status of computerized dynamic posturography in neurotology , 2001 .

[52]  N. Olivier,et al.  Wii Fit® training vs. Adapted Physical Activities: which one is the most appropriate to improve the balance of independent senior subjects? A randomized controlled study , 2012, Clinical rehabilitation.

[53]  Oskar Hansson,et al.  Prediction of Falls and/or Near Falls in People with Mild Parkinson’s Disease , 2015, PloS one.

[54]  Gak Hwangbo,et al.  The Effects of Virtual Reality-based Balance Training on Balance of the Elderly , 2014, Journal of physical therapy science.

[55]  Neha Singh,et al.  Advances in the treatment of Parkinson's disease , 2007, Progress in Neurobiology.

[56]  M. Perracini,et al.  Levodopa effect upon functional balance of Parkinson's disease patients. , 2004, Parkinsonism & related disorders.

[57]  Lynn Rochester,et al.  The role of exergaming in Parkinson’s disease rehabilitation: a systematic review of the evidence , 2014, Journal of NeuroEngineering and Rehabilitation.