A Randomized Controlled Pilot Study of Home-Based Step Training in Older People Using Videogame Technology

Schoene, Daniel; Lord, Stephen R.; Delbaere, Kim; Severino, Connie; Davies, Thomas A.; Smith, Stuart · 2013 · OpenAlex-citations

DOI: 10.1371/journal.pone.0057734

archive: archived pipeline: cataloged verified

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Summary

This pilot randomized controlled trial investigated the feasibility, safety, and effectiveness of unsupervised, home-based step training using videogame technology (exergames) in older adults. The study was motivated by the high prevalence of falls in older populations and the frequent low adherence to traditional exercise interventions. The researchers hypothesized that an engaging step-pad game could improve stepping performance and reduce fall risk factors while maintaining high compliance. The study employed a single-blinded, two-arm randomized controlled design involving 37 older adults residing in independent-living units in Sydney, Australia. Participants were block-randomized into an intervention group (IG) or a control group (CG). The IG received a computerized step pad system connected to their televisions and was instructed to play a modified Dance Dance Revolution-style game for eight weeks, with a recommended dose of 2–3 sessions per week for 15–20 minutes. The game required participants to step accurately and timely on directional arrows while inhibiting responses to "bomb" distractors, thereby engaging both motor and cognitive systems. The CG continued usual activities. Outcome measures, assessed at baseline and eight weeks, included Choice Stepping Reaction Time (CSRT), the Physiological Profile Assessment (PPA), dual-task performance, and various cognitive and mobility tests. Thirty-two participants completed the study, with a retention rate of 86.5%. The intervention proved feasible and safe, with no adverse events reported and high enjoyment levels. Adherence was strong, with the IG playing a median of 2.75 sessions per week. The IG demonstrated significant improvements compared to the CG in several key areas. CSRT results showed significant reductions in reaction time, movement time, and overall response time. The IG also achieved significantly lower PPA composite scores, indicating reduced physiological fall risk, driven by improvements in postural sway and contrast sensitivity. Additionally, the IG showed significant improvement in dual-task ability, measured by a timed up-and-go test combined with a verbal fluency task. Participants who progressed to higher difficulty levels in the game showed greater improvements in PPA scores, suggesting a dose-response relationship. The findings indicate that home-based step pad training is a safe, feasible, and effective intervention for improving physical and cognitive parameters associated with fall risk in older adults without major impairments. The significant improvements in stepping speed, balance, and dual-task performance suggest that exergames can serve as a viable alternative to traditional exercise programs, potentially enhancing adherence through engagement. The study supports the potential for using videogame technology to mitigate fall risk in community-dwelling older people.

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• older driver retraining