Dataset Information

Effectiveness of exergames for improving mobility and balance in older adults: a systematic review and meta-analysis.

ABSTRACT:

Background

Exergaming is a fun, engaging, and interactive form of exercising that may help overcome some of the traditional exercise barriers and help improve adherence on the part of older adults, providing therapeutic applications for balance recovery and functional mobility. The purpose of this systematic review is to summarize the effects of exergames on mobility and balance in older adults.

Methods

The PRISMA guidelines for systematic reviews were followed. The following databases were searched from inception to August 2019: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro, CINAHL, and INSPEC. We selected randomized controlled trials that assessed the effects of exergames on balance or mobility of older adults without neurological conditions, in comparison to no intervention or health education. Two review authors independently screened the trials' titles and abstracts and identified trials for inclusion according to the eligibility criteria. An almost perfect agreement between the authors was observed with respect to interrater reliability of trial selection (kappa = 0.84; P < 0.001). We performed descriptive analysis of the quantitative data to summarize the evidence. Meta-analysis was carried out using RevMan. A random effects model was used to compute the pooled prevalence with 95% confidence intervals.

Results

After screening 822 records, 12 trials comparing exergames with no intervention were included. A total of 1520 older adults participated in the studies, with a mean age of 76 ± 6 years for the experimental group and 76 ± 5 years for the control group. Quantitative synthesis showed significant improvements in balance and mobility based on the center of pressure sway (SMD = - 0.89; 95%CI = - 1.26 to - 0.51; P = 0.0001; I² = 58%), Berg Balance Scale (MD = 2.15; 95%CI = 1.77 to 2.56; P = 0.0001; I² = 96%), and on Timed Up and Go test (MD = - 2.48; 95%CI = - 3.83 to - 1.12; P = 0.0003; I² = 0).

Conclusions

Exergames improved balance and mobility in older adults without neurological disorders and motivate patients to keep performing balance exercises. High quality studies with standardized assessment protocols are necessary to improve the strength of the evidence.

SUBMITTER: Pacheco TBF

PROVIDER: S-EPMC7368979 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

Effectiveness of exergames for improving mobility and balance in older adults: a systematic review and meta-analysis.

Pacheco T B F TBF de Medeiros C S P CSP de Oliveira V H B VHB Vieira E R ER de Cavalcanti F A C FAC

Systematic reviews 20200718 1

<h4>Background</h4>Exergaming is a fun, engaging, and interactive form of exercising that may help overcome some of the traditional exercise barriers and help improve adherence on the part of older adults, providing therapeutic applications for balance recovery and functional mobility. The purpose of this systematic review is to summarize the effects of exergames on mobility and balance in older adults.<h4>Methods</h4>The PRISMA guidelines for systematic reviews were followed. The following data ...[more]

PMID: 32682439

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Project description:Exergames are a fun, viable, attractive, and safe way to engage in physical exercise for most patient populations, including older adults. Their use in the home environment enables an expanded understanding about its applicability and its impact on clinical outcomes that can contribute to improved functionality and quality of life in this population. This systematic review aimed to synthesize the evidence on the usability of exergames as a tool for home-based balance training in older adults. The search was realized in 6 electronic databases and were included 1) randomized controlled trials with exergames home-based training as intervention, 2) studies involving older adults (aged 60 years or older) described as having impaired static or dynamic balance, 3) that compared the effects of exergames to usual care, health education or no intervention, and 4) reported usability and balance outcomes. The Cochrane Risk of Bias tool for randomized trials version 2 and the Grading of Recommendations Assessment, Development, and Evaluation were used to evaluate the methodological quality of studies and levels of evidence for outcomes. After screening 1107 records, we identified 4 trials were included. The usability score of exergames was classified as an acceptable, good, and feasible tool. The pooled effect indicated improvements in favor of the exergame group for functional balance by TUG test (MD = -5.90; 95%CI = -10.29 to -1.51) with low-certainty evidence and Tinetti scale (MD = 4.80; 95%CI = 3.36 to 6.24) with very low-certainty evidence. Analyzing the different immersion level, it was observed a significant difference in the experimental group for the immersive exergames (MD = -9.14; 95%CI = -15.51 to -2.77) with very low-certainty evidence. Exergames applied at home showed good usability and had significant effects on functional balance compared to usual care or no intervention, especially in the immersive modality. PROSPERO registration number: CRD42022343290.

Project description:BackgroundExecutive functions are one of the known cognitive abilities that decline with age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses.ObjectiveThis study aims to investigate the effectiveness of serious games for improving executive functions among older adults with cognitive impairment.MethodsA systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies.ResultsOf 548 publications identified, 16 RCTs were eventually included in this review. Of the 16 studies, 14 studies were included in 6 meta-analyses. Our meta-analyses showed that serious games are as effective as no or passive interventions at improving executive functions (P=.29). Surprisingly, conventional exercises were more effective than serious games at improving executive functions (P=.03). Our subgroup analysis showed that both types of serious games (cognitive training games, P=.08; exergames, P=.16) are as effective as conventional exercises at improving executive functions. No difference was found between adaptive serious games and nonadaptive serious games for improving executive functions (P=.59).ConclusionsSerious games are not superior to no or passive interventions and conventional exercises at improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by health care providers nor used by patients for improving executive functions among older adults with cognitive impairment. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment.Trial registrationPROSPERO CRD42021272757; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272757.

Project description:BackgroundMemory, one of the main cognitive functions, is known to decline with age. Serious games have been used for improving memory in older adults. The effectiveness of serious games in improving memory has been assessed by many studies. To draw definitive conclusions about the effectiveness of serious games, the findings of these studies need to be pooled and aggregated.ObjectiveThis study aimed to assess the effectiveness of serious games in improving memory in older adults with cognitive impairment.MethodsA systematic review of randomized controlled trials was carried out. The search sources included 8 databases, the reference lists of the included studies and relevant reviews, and the studies that cited the included studies. In total, 2 reviewers (AA and MH) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (ie, multilevel meta-analysis), as appropriate.ResultsOf the 618 citations retrieved, 18 (2.9%) met the eligibility criteria for this review. Of these 18 studies, 15 (83%) randomized controlled trials were included in 10 multilevel meta-analyses. We found that serious games were more effective than no or passive interventions in improving nonverbal memory (P=.02; standardized mean difference [SMD]=0.46, 95% CI 0.09-0.83) and working memory (P=.04; SMD=0.31, 95% CI 0.01-0.60) but not verbal memory (P=.13; SMD=0.39, 95% CI -0.11 to 0.89). The review also showed that serious games were more effective than conventional exercises in improving verbal memory (P=.003; SMD=0.46, 95% CI 0.16-0.77) but not nonverbal memory (P=.30; SMD=-0.19, 95% CI -0.54 to 0.17) or working memory (P=.99; SMD=0.00, 95% CI -0.45 to 0.45). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=.14; SMD=0.66, 95% CI -0.21 to 1.54), nonverbal memory (P=.94; SMD=-0.01, 95% CI -0.32 to 0.30), and working memory (P=.08; SMD=0.37, 95% CI -0.05 to 0.78) among older adults with cognitive impairment. Finally, the effect of adaptive serious games on working memory was comparable with that of nonadaptive serious games (P=.08; SMD=0.18, 95% CI -0.02 to 0.37).ConclusionsSerious games have the potential to improve verbal, nonverbal, and working memory in older adults with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as a supplement to existing proven and safe interventions rather than as a complete substitute until further, more robust evidence is available. Future studies should investigate the short- and long-term effects of serious games on memory and other cognitive abilities among people of different age groups with or without cognitive impairment.

Dataset Information

Effectiveness of exergames for improving mobility and balance in older adults: a systematic review and meta-analysis.

Background

Methods

Results

Conclusions

Publications

Effectiveness of exergames for improving mobility and balance in older adults: a systematic review and meta-analysis.

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