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Physical and cognitive declines are significant risk factors for falls. Promising evidence suggests that combined physical-cognitive training would be an effective fall risk reduction and cognitive improvement intervention. However, a limited number of studies have been conducted and findings have been inconclusive. This study investigated the effects of interactive physical-cognitive game-based training on the fall risk and cognitive performance of older adults. Forty participants were randomly allocated to the intervention (n = 20) and control (n = 20) groups. Participants in the intervention group performed a 1 h session, 3 times a week for 12 weeks of the interactive physical-cognitive game-based training program. Fall risk (Physiological Profile Assessment, PPA; and Timed Up and Go, TUG) and cognitive outcome (Montreal Cognitive Assessment, MoCA) were assessed at pre- and post-intervention. Thirty-nine participants (mean age = 69.81 ± 3.78 years) completed the study (97.5%). At the end of the trial, participants in the intervention group demonstrated significant improvement in the PPA fall risk score (p = 0.015), postural sway (p = 0.005), MoCA score (p = 0.001), and TUG-dual task (p = 0.045) compared to controls. In conclusion, the interactive physical-cognitive, game-based training was effective in reducing physiological fall risk and improving cognitive function in community-dwelling older adults.

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As gait adaptation is vital for successful locomotion, the development of field-based tools to quantify gait in challenging real-world environments are crucial. The aims of this study were to assess the reliability and validity of a smartphone-based gait and balance assessment while walking on unobstructed and obstructed terrains using two phone placements. Furthermore, age-related differences in smartphone-derived gait strategies when navigating different walking conditions and environments were evaluated. By providing a method for evaluating gait in the simulated free-living environment, results of this study can elucidate the strategies young and older adults utilize to navigate obstructed and unobstructed walking paths. A total of 24 young and older adults ambulated indoors and outdoors under three conditions: level walking, irregular surface walking, and obstacle crossing. Android smartphones placed on the body and in a bag computed spatiotemporal gait (i.e., velocity, step time, step length, and cadence) and balance (i.e., center of mass (COM) displacement), with motion capture and video used to validate parameters in the laboratory and free-living environments, respectively. Reliability was evaluated using the intraclass correlation coefficient and validity was evaluated using Pearson's correlation and Bland-Altman analysis. A three-way ANOVA was used to assess outcome measures across group, condition, and environment. Results showed that smartphones were reliable and valid for measuring gait across all conditions, phone placements, and environments (ICC2,1: 0.606–0.965; Pearson's r: 0.72–1.00). Although body and bag placement demonstrated similar results for spatiotemporal parameters, accurate vertical COM displacement could only be obtained from the body placement. Older adults demonstrated a longer step time and lower cadence only during obstacle crossing, when compared to young adults. Furthermore, environmental differences in walking strategy were observed only during irregular surface walking. In particular, participants utilized a faster gait speed and a longer step length in the free-living environment, compared to the laboratory environment. In conclusion, smartphones demonstrate the potential for remote patient monitoring and home health care. Along with being easy-to-use, inexpensive, and portable, smartphones can accurately evaluate gait during both unobstructed and obstructed walking, indoors and outdoors.

Background Declines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. Objective The aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. Methods In the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants’ characteristics and PACES scores. Results The results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. Conclusions These findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined.