Background Improving mobility in elderly persons is a primary goal in geriatric rehabilitation (Bachmann 2010). Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low. Exergames may improve adherence. This study therefore compared exergames with self-regulated exercise using instruction leaflets.
Objectives To evaluate short-term effects of exergames versus self-regulated exercise using instruction leaflets. Primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance.
Methods Design: single center parallel group non-blinded randomized controlled trial with central stratified randomization (Hasselmann 2015). 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). 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 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) were used to evaluate between-group effects over time.
Results We evaluated 217 patients and included and 54, 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.
Conclusions 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.
Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340, c1718.
Hasselmann V, Oesch P, Fernandez-Luque L, Bachmann S. Are exergames promoting mobility an attractive alternative to conventional self-regulated exercises for elderly people in a rehabilitation setting? Study protocol of a randomized controlled trial. BMC Geriatr. 2015;15;108.
Acknowledgements The present study is part of the GameUp Project, focusing on game-based mobility training and motivation of elderly persons, and is co-funded by the European research and development joint program “Ambient Assisted Living” (AAL-2011–4-090). We thank Viviane Hasselman and Stine Staubach for data collection.
Disclosure of Interest None declared