Background
Methods
Study design and participants
Exergame intervention
Primary outcome
Questionnaires
Training observation and feedback
Training compliance
Secondary outcomes
Physical functions
Cognitive functions
Cortical activity and analysis
Other outcome measures
Statistical analysis
Results
Participant characteristics | n = 19 |
---|---|
Age in years | 71.4 ± 6.1 (65–91) |
Weight [kg] | 69.7 ± 19.5 (42–122) |
Height [cm] | 169.9 ± 8.8 (150–181) |
BMI [kg/m2] | 24.3 ± 5.0 (17–37) |
Daily physical activitya | 7410 ± 2079 (4605–12,247) |
MOCA Score | 28.1 ± 1.4 (26–30) |
Female [n, %] | 10 (52.6) |
Education [n, %] | |
Primary school | 1 (5.3) |
Upper school | 0 (0.0) |
Apprenticeship | 9 (47.4) |
Gymnasium | 2 (10.5) |
University | 7 (36.8) |
Fear of falling [n, %] | |
Never | 14 (73.7) |
Sometimes | 5 (26.3) |
Often | 0 (0.0) |
Always | 0 (0.0) |
Number of falls during last monthb [n, %] | |
Never | 17 (89.5) |
Once | 2 (10.5) |
More than once | 0 (0.0) |
Self-evaluation of health state [n, %] | |
Very good | 4 (21.1) |
Good | 14 (73.7) |
Medium | 1 (5.3) |
Bad | 0 (0.0) |
Self-evaluation of balance [n, %] | |
Very good | 5 (26.3) |
Good | 8 (42.1) |
Medium | 6 (31.6) |
Bad | 0 (0.0) |
Self-evaluation of muscle strength [n, %] | |
Very good | 0 (0.0) |
Good | 18 (94.7) |
Medium | 0 (0.0) |
Bad | 1 (5.3) |
Primary outcome results
Questionnaires | T2 (n = 20) | T3 (n = 19) | z | p | r |
---|---|---|---|---|---|
System Usability Scale (SUS) | 75.0 (67.5; 87.5) | 75.0 (70.0; 85.0) | −0.240 | .823 | 0.04 |
Game Experience Quesionnaire (GEQ) | |||||
Competence | 2.5 (2.2; 2.7) | 2.3 (2.2; 3.0) | −0.081 | .945 | 0.01 |
Immersion | 1.9 (1.5; 2.5) | 2.3 (1.5; 2.7) | −0.881 | .395 | 0.14 |
Flow | 1.3 (0.7; 1.8) | 1.0 (0.7; 1.5) | −1.281 | .210 | 0.21 |
Tension | 0.2 (0.0; 0.5) | 0.2 (0.0; 0.3) | −1.279 | .229 | 0.21 |
Challenge | 1.2 (1.0; 1.5) | 1.2 (0.7; 1.5) | −1.455 | .157 | 0.24 |
Negative Affect | 0.2 (0.0; 0.6) | 0.5 (0.2; 0.8) | −3.134 | .001* | 0.51 |
Positive Affect | 2.8 (2.4; 3.2) | 2.8 (2.0; 3.3) | −0.569 | .590 | 0.09 |
Criteria | Positive aspects | Negative aspects |
---|---|---|
Functionality and interaction with the system | − Good and stable connection of laptop (with system software) to TVa | − Technical issues (as system crashes or frozen pictures on the screen)a,b |
− Simple set upb | − Unstable (Bluetooth) connection of IMUs to the systema,b | |
− Easy usable game compositionb | − Navigation via laptop keyboard instead by IMUs (as cursors)a | |
− Inaccurate evaluation of movements by IMUs (evaluation algorithms)a | ||
IMUs | − Comfortable to wear (participants did not notice them during training)b | − Suboptimal material of IMU cover (cover expanded after heating up while charging)a |
− Suboptimal material of IMU fixation strap (difficult to clean the Velcro fixation, material sticks to some clothes)a,b | ||
− Difficulties to attach the IMUs with the Velcro fixation (especially at wrists)a,b | ||
Design | − Exciting game story of travelling around Europe to different citiesb | − No variation in musicb |
− Pleasant musicb | − No explanation about feedback system (colour code, performance score)b | |
− Helpful cues (arrows) to prepare the next movementb | ||
− Virtual instructor guiding through exercisesb | ||
− Helpful indication of number of exercise repetitionsb | ||
Training principles | − Visual feedback with colour code (green, orange, red) during exercisingb | − No specific feedback regarding exercise execution and single body part movementsa,b |
− Performance score as feedback after exercisingb | − Training load and progression determined by supervisors (no automatic progression)a | |
− Low variability in exercisesa,b | ||
− Training load even in high levels not exhausting1,2 | ||
Exercises | − Clear structure of exercise levelsb | − No proper introduction of exercises (just start copying the movements of the virtual instructor)a,b |
− Complex exercises with additional arm movements provide more fun than simple (boring) movementsb | − Only frontal view of exercises (side view missing)b | |
− No further information about exercise (e.g. muscles involved)b | ||
Emotions | − General enjoyment and funa,b | − Frustrated and displeased by technical issues and inaccurate evaluation of movementsa,b |
− Increased motivation through virtual instructor (better than train alone)b | − Missing challenge due to easy exercisesa,b | |
− Happy when seeing a progress or achieving higher performance scorea,b | − Bored of low training variabilitya,b |
Secondary outcome results
Assessed by | Pre (T1) | Post (T3) | z | p | r | |
---|---|---|---|---|---|---|
Physical functions | Gait analysis | |||||
Speed [m/s] | ||||||
ST walking | 1.42 (1.36; 1.61) | 1.52 (1.36; 1.62) | −0.684 | .515 | 0.11 | |
DT walking | 1.26 (1.17; 1.46) | 1.31 (1.22; 1.51) | −2.012 | .045* | 0.33 | |
DT costs in % | 6.4 (5.1; 17.6) | 8.4 (3.0; 18.2) | −1.449 | .156 | 0.24 | |
Cadence [steps/min] | ||||||
ST walking | 117.2 (114.6; | 120.7 (115.1; 126.1) | −1.529 | .134 | 0.25 | |
DT walking | 125.7) | 113.2 (109.5; 120.4) | −1.690 | .096 | 0.27 | |
DT costs in % | 111.7 (105.4; 116.9) 4.0 (1.8; 8.7) | 3.5 (1.0; 9.0) | −1.046 | .312 | 0.17 | |
Stride length [m] | ||||||
ST walking | 1.48 (1.41; 1.56) | 1.47 (1.41; 1.56) | −0.402 | .709 | 0.07 | |
DT walking | 1.36 (1.28; 1.50) | 1.36 (1.33; 1.49) | −1.610 | .113 | 0.26 | |
DT costs in % | 3.8 (2.1; 10.3) | 4.2 (0.0; 9.2) | −1.006 | .332 | 0.16 | |
Minimal toe clearance [cm] | ||||||
ST walking | 2.3 (2.1; 3.1) | 2.9 (2.0; 3.4) | −1.891 | .060 | 0.31 | |
DT walking | 2.2 (1.7; 2.7) | 2.7 (1.6; 3.2) | −1.248 | .225 | 0.20 | |
DT costs in % | 3.9 (−4.9; 16.6) | 6.7 (−7.1; 19.3) | −0.241 | .829 | 0.04 | |
Extended SPPB | ||||||
Total score | 14 (13; 15) | 14 (13; 15) | −0.266 | .797 | 0.04 | |
Balance score | 6 (6; 8) | 7 (5; 7) | −0.134 | .947 | 0.02 | |
4 m-gait score | 4 (4; 4) | 4 (4; 4) | 0.000 | 1.000 | < 0.01 | |
4 m-gait time [s] | 3.3 (2.9; 3.7) | 3.2 (2.8; 3.6) | −1.449 | .153 | 0.24 | |
5-chair rises score | 4 (3; 4) | 4 (3; 4) | −0.816 | .750 | 0.13 | |
5-chair rises time [s] | 10.5 (8.3; 12.8) | 8.8 (7.3; 12.3) | −2.853 | .003* | 0.46 | |
Cognitive functions | Test of Attentional Performance | |||||
Working memory | ||||||
RT [ms] | 741 (597; 843) | 677 (603; 840) | −0.348 | .742 | 0.06 | |
Errors | 3 (0; 6) | 3 (1; 5) | −0.416 | .696 | 0.07 | |
Omissions | 3 (2;4) | 3 (1; 4) | −1.719 | .088 | 0.28 | |
Divided attention | ||||||
RT auditory [ms] | 652 (584; 769) | 594 (580; 714) | −2.495 | .011* | 0.40 | |
RT visual [ms] | 893 (822; 948) | 881 (834; 945) | −0.080 | .945 | 0.01 | |
Errors | 1 (0; 3) | 1 (0; 2) | −0.641 | .541 | 0.10 | |
Omissions | 1 (0; 3) | 1 (1; 2) | −1.388 | .190 | 0.23 | |
Selective attention | ||||||
RT [ms] | 454 (397; 487) | 468 (396; 504) | −0.543 | .602 | 0.09 | |
Errors | 1 (0; 2) | 0 (0; 2) | −0.265 | .848 | 0.04 | |
Omissions | 0 (0; 0) | 0 (0; 0) | −1.890 | .125 | 0.31 | |
Mental flexibility | ||||||
RT [ms] | 932 (798; 1124) | 848 (786; 1018) | −1.610 | .113 | 0.26 | |
Errors | 3 (1; 9) | 3 (1; 4) | −1.163 | .258 | 0.19 | |
Cortical activity | Resting state EEG | |||||
Peak alpha frequency [Hz] | 9.3 (8.4; 9.9) | 9.3 (8.7; 10.0) | −1.274 | .232 | 0.26 | |
Center of gravity [Hz] | 9.2 (8.5; 9.7) | 9.3 (8.4; 9.6) | −1.013 | .340 | 0.20 | |
Alpha spectral power [μV2] | 20.5 (16.1; 35.7) | 27.0 (16.8; 46.9) | −0.078 | .970 | 0.02 |
Other outcome results
Discussion
Usability of the exergame training
Exploration of potential effects of the exergame training
Limitations
Implications
-
A mature concept should be composed including game design, technology and training aspects.
-
The system set-up should be simple and age-appropriate (e.g. regarding technological devices, screen size, game design, in-program navigation).
-
If technological devices as IMUs are attached to players’ bodies, material and fixation must be optimized, user-friendly, comfortable and size-adjustable.
-
Easy applicable charging solutions should be used for technological devices as IMUs.
-
Players should be sufficiently informed about the game story, goals, evaluation and feedback system.
-
Exercises have to be well explained and instructed before and during their execution (e.g. exercise tutorial with frontal and side view, further information about exercise goals, cues during execution, and time indications).
-
Including music in exergames might be important and motivating provided that the music is appropriate and fits the game story, training content and movements.
-
Performance feedback has to be accurate, easy to understand and as detailed as possible, since feedback is one of the most important motivational factors and necessary for training benefits.
-
Games and exercises should be challenging for a wide range of player prerequisites.
-
Automatic configuration of optimal training load and progression is desirable.
-
A high variability in games and exercise options is needed.