Oesch P1, Kool J1, Fernandez-Luque L2,3, Brox E3, Evertsen G3, Civit A4, Hilfiker R5, Bachmann S1,6
1Rehabilitation Centre Valens, Valens, Switzerland, 2Hamad Bin Khalifa University, Qatar Computing Research Institute, Doha, Qatar, 3Northern Research Institute NORUT, Tromsö, Norway, 4University of Seville, Architecture and Computer, Seville, Spain, 5University of Applied Sciences and Arts of Western Switzerland Valais, (HES-SO Valais-Wallis), Sion, Switzerland, 6University of Bern, Inselspital Department of Geriatrics, Bern, Switzerland
Background: Improving mobility in elderly persons is a primary goal in geriatric rehabilitation. Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low. Exergames may improve adherence.
Purpose: To compare exergames with self-regulated exercise using instruction leaflets. The primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance during Walking.
Methods: Design: Single center parallel group non-blinded randomized controlled trial with central stratified randomization. Setting: center for geriatric inpatient rehabilitation. Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise. Patients were assigned to self-regulated exercise using a) exergames on Windows Kinect® (exergame group EG) or b) instruction leaflets (conventional group CG). During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty minutes during ten working days. Patients reported adherence (primary outcome), enjoyment and motivation daily. Balance during walking was measured blind before and after the treatment phase with an accelerometer. Analysis was by intention to treat. Repeated measures mixed models and Cohen's d effect sizes (ES, moderate if >0.5, large if > 0.8) with 95% CIs were used to evaluate between-group effects over time. Alpha was set at 0.05.
Results: From June 2014 to December 2015 217 patients were evaluated and 54 included, 26 in the EG and 28 in the CG. Adverse effects were observed in two patients in the EG who stopped because of pain during exercising. Adherence was comparable at day one (38 min. in the EG and 42 min. in the CG) and significantly higher in the CG at day 10 (54 min. in the CG while decreasing to 28 min. in the EG, p = 0.007, ES 0.94, 0.39-0.151). Benefits favoring the CG were also observed for enjoyment (p = 0.001, ES 0.88, 0.32 - 1.44) and motivation (p = 0.046, ES 0.59, 0.05-1.14)). There was no between-group effect in balance during walking.
Conclusion(s): Self-regulated exercise using instruction leaflets is superior to exergames regarding adherence, enjoyment and motivation in a geriatric inpatient rehabilitation setting. Effects were moderate to large. There was no between group difference in balance during walking.
Implications: Improvements in exergames, and randomized controlled trials evaluating their effectiveness compared with other methods of providing self-regulated exercise, are needed before general use in a geriatric rehabilitation setting can be considered.
Keywords: Exergames, geriatric rehabilitation, randomized controlled trial
Funding acknowledgements: European research and development joint program “Ambient Assisted Living” AAL-2011-4-090
Purpose: To compare exergames with self-regulated exercise using instruction leaflets. The primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance during Walking.
Methods: Design: Single center parallel group non-blinded randomized controlled trial with central stratified randomization. Setting: center for geriatric inpatient rehabilitation. Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise. Patients were assigned to self-regulated exercise using a) exergames on Windows Kinect® (exergame group EG) or b) instruction leaflets (conventional group CG). During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty minutes during ten working days. Patients reported adherence (primary outcome), enjoyment and motivation daily. Balance during walking was measured blind before and after the treatment phase with an accelerometer. Analysis was by intention to treat. Repeated measures mixed models and Cohen's d effect sizes (ES, moderate if >0.5, large if > 0.8) with 95% CIs were used to evaluate between-group effects over time. Alpha was set at 0.05.
Results: From June 2014 to December 2015 217 patients were evaluated and 54 included, 26 in the EG and 28 in the CG. Adverse effects were observed in two patients in the EG who stopped because of pain during exercising. Adherence was comparable at day one (38 min. in the EG and 42 min. in the CG) and significantly higher in the CG at day 10 (54 min. in the CG while decreasing to 28 min. in the EG, p = 0.007, ES 0.94, 0.39-0.151). Benefits favoring the CG were also observed for enjoyment (p = 0.001, ES 0.88, 0.32 - 1.44) and motivation (p = 0.046, ES 0.59, 0.05-1.14)). There was no between-group effect in balance during walking.
Conclusion(s): Self-regulated exercise using instruction leaflets is superior to exergames regarding adherence, enjoyment and motivation in a geriatric inpatient rehabilitation setting. Effects were moderate to large. There was no between group difference in balance during walking.
Implications: Improvements in exergames, and randomized controlled trials evaluating their effectiveness compared with other methods of providing self-regulated exercise, are needed before general use in a geriatric rehabilitation setting can be considered.
Keywords: Exergames, geriatric rehabilitation, randomized controlled trial
Funding acknowledgements: European research and development joint program “Ambient Assisted Living” AAL-2011-4-090
Topic: Older people; Robotics & technology; Disability & rehabilitation
Ethics approval required: Yes
Institution: Swiss Ethical Committee
Ethics committee: Eastern Switzerland
Ethics number: EKSG 13/081/1B
All authors, affiliations and abstracts have been published as submitted.
