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Effectiveness of Exergame Intervention on Walking in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

ABSTRACT:

Objective

The objective of this review was to systematically evaluate the effectiveness of exergaming on walking in older adults. In addition, the aim was to investigate the relationship between the exergaming effect and age, baseline walking performance, exercise traits, technology used, and the risk of bias.

Methods

A literature search was carried out in the databases MEDLINE, CINAHL, CENTRAL, EMBASE, WoS, PsycInfo, and PEDro up to January 10, 2020. Studies with a randomized controlled trial design, people ≥60 years of age without neurological disorders, comparison group with other exercise or no exercise, and walking-related outcomes were included. Cochrane RoB2, meta-analysis, meta-regression, and Grading of Recommendations, Assessment, Development and Evaluation were used to estimate quality, treatment effect, covariates' effect, and the certainty of evidence, respectively.

Results

In the studies included (n = 66), the overall risk of bias was low (n = 2), unclear (n = 48), or high (n = 16). Compared with comparison groups, exergaming interventions were more effective for walking improvements (standardized mean difference = -0.21; 95% CI = -0.36 to -0.06; 3102 participants, 58 studies; moderate-quality evidence) and more or equally effective (standardized mean difference = -0.32; 95% CI = -0.64 to 0.00; 1028 participants, 13 studies; low-quality evidence) after nonexergaming follow-up. The strongest effect for covariates was observed with the type of comparison group, explaining 18.6% of the variance.

Conclusion

For older adults without neurological disorders, exergame-based training improved walking, and improvements were maintained at follow-up. Greater benefits were observed when exergaming groups were compared with inactive comparison groups. To strengthen the evidence, further randomized controlled trials on the effectiveness of gamified exercise intervention are needed.

Impact

Exergaming has an effect equivalent to other types of exercising on improving walking in older adults. Physical therapists and other rehabilitation professionals may consider exergaming as a promising form of exercise in this age group.

SUBMITTER: Janhunen M

PROVIDER: S-EPMC8459884 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background and Objectives:Mobility limitation is common and has been linked to high energetic requirements of daily activities, including walking. The study objective was to determine whether two separate forms of exercise could reduce the energy cost of walking and secondary outcomes related to activity and participation domains among older adults with mobility limitation. Research Design and Methods:Community-dwelling older adults with self-reported mobility limitation (n = 72) were randomized to 12 weeks of twice-weekly, group-based, instructor-led timing and coordination, aerobic walking, or stretching and relaxation (active control) programs. The primary outcome was the energy cost of walking (mL O2/kg/m), assessed by a 5-minute treadmill walking test (0.8 m/s). Secondary outcomes were fatigability, physical activity, endurance, physical function, and life-space. Baseline-adjusted ANCOVAs were used to determine mean differences between exercise and control groups at 12 and 24 weeks. Results:Exercise session attendance was high: 86% for timing and coordination, 81% for aerobic walking, and 90% for stretching and relaxation. At 12 weeks, timing and coordination reduced the mean energy cost of walking by 15% versus stretching and relaxation (p = .008). Among those with high baseline cost, timing and coordination reduced mean energy cost by 20% versus stretching and relaxation (p = .055). Reductions were sustained at 24 weeks. Aerobic walking had no effect on the energy cost of walking at 12 or 24 weeks. At 12 weeks, there was a trend toward faster gait speed (by 0.1 m/s) in timing and coordination versus stretching and relaxation (p = .074). Fatigability, physical activity, endurance, physical function, and life-space did not change with timing and coordination or aerobic walking versus stretching and relaxation at 12 or 24 weeks. Discussion and Implications:Twelve weeks of timing and coordination, but not aerobic walking, reduced the energy cost of walking among older adults with mobility limitation, particularly among those with high baseline energy cost; reductions in energy cost were sustained following training cessation. Timing and coordination also led to a trend toward faster gait speed.