Exergames versus self-regulated exercises with instruction leaflets to improve adherence during geriatric rehabilitation: a randomized controlled trial

Abstract

BackgroundImproving mobility in elderly persons is a primary goal in geriatric rehabilitation. 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. The primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance during walking.MethodsDesign: single center parallel group non-blinded randomized controlled trial with central stratified randomization. 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). During two 30 min sessions 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 before and after the treatment phase 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) with 95% CIs were used to evaluate between-group effects over time. Alpha was set at 0.05.ResultsFrom June 2014 to December 2015 217 patients were evaluated and 54 included, 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.ConclusionsSelf-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.Trial registrationClinicalTrials.gov, NCT02077049, 6 February 2014.

Virtual Reality in Pain Therapy: A Requirements Analysis for Older Adults with Chronic Back Pain

“…For this reason, it is important to take away the fear of new technologies in this vulnerable group if they are to use a VR exergame. Oesch et al [29] showed in their study that self-regulated exercise using instruction lea ets were superior to exergames regarding adherence in a geriatric inpatient rehabilitation setting.…”

Virtual Reality in Pain Therapy: A Requirements Analysis for Older Adults with Chronic Back Pain

“…For this reason, it is important to take away the fear of new technologies in this vulnerable group if they are to use a VR exergame. Oesch et al [29] showed in their study that selfregulated exercise using instruction leaflets were superior to exergames regarding adherence in a geriatric inpatient rehabilitation setting. However, this study was not tested with a VR system but with a Microsoft Kinect exergame, through the effect of immersion this result should be tested with a VR system, because different effects could occur.…”

Co-designing technology for ageing in place: A systematic review

“…Only five studies evaluated health and well-being related outcomes (81)(82)(83)(84)(85). Studies tended to limit to measuring product usability and end-user satisfaction.…”

“…Results of the Cochrane risk of bias assessment are presented in Figure 2. High performance and detection bias were identified in two trials (81) (84), high reporting bias in one trial (81) and high allocation concealment bias in one trial (84).…”

“…Five Randomised Controlled Trials (RCTs) evaluated health or well-being outcomes(81)(82)(83)(84)(85). Outcome measures fell into four categories: Balance and falls, level of physical activity(including compliance)and physical function, Quality of Life (QOL) and mental health and clinical measures.…”