Older adults make the largest demographic group requiring healthcare in the current society. This demographic puts a lot of pressure on the healthcare system and personnel because of the decrease in independence and the increasing number of health conditions. Falls and fall-related injuries, and this causes a loss of independence. The decline in physical abilities also causes many health issues. The American College of Sports Medicine advises that older adults should engage in 150 minutes of moderate exercise weekly (Taylor et al., 2018). Many elderly individuals cannot get 150 minutes of exercise because they lead a sedentary lifestyle or due to illnesses that reduce their activity levels. Active computer games (AVGs) are an alternative to exercise as they combine bodily movement with digital gaming. AVGs provide entertainment and encourage exercise in a fun way, and this is why health professionals recommend it. A VGs are an interesting form of exercise; the participants not only have fun but also benefit from improved balance, strength, and reduced cases of falls.
Lack of sufficient physical activity daily is a major risk of mortality. The ability to remain independent in old age relies on one’s level of physical activity. Maintaining physical activity is a challenge for all generations, but it is a bigger challenge for older adults. Various barriers, including the lack of social support, lack of motivation, and challenges in accessing exercise facilities, make it hard for the older generations to exercise ( Montero-Alía et al., 2019) . One of the solutions to these challenges is embracing home exercise by taking advantage of technology. The evolution of video games means that they can be played in a manner that involves full-body movements. Video games came as favorite pastime activities for children and young adults, but they are mainstream now with older adults playing video games. Physiotherapist and rehabilitation specialists have also taken advantage of video games to encourage exercise among certain demographics and patients with injuries. Video games are enjoyable, easily accessible, and can be easily learned.
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AVGs have the potential to improve balance in elderly individuals. Lamoth et al. (2011) define balance as the ability to remain in a position without losing control. One maintains balance by controlling the center of mass within the base of support. According to Carvalho et al. (2018), the postural control system is responsible for balance maintenance by using information from the visual, vestibular, and somatosensory systems. These systems provide information about the relative positions of body segments and the forces affecting the body.
Balance is a result of the relationship between one’s motor action and sensory information. As individuals age, maintaining balance decreases due to the changes in sensory, motor, and cognitive systems. Elderly individuals are no longer able to respond adequately to loss of balance; they often take a step too short or in the wrong direction. They are also slow in initiating volitional step responses because of muscle weaknesses and cognitive changes that affect balance.
Carvalho et al. (2018) conducted a study on the effects of video games on postural balance training among elderly individuals. The participants engaged in 30 minutes training session twice a week using Wii Fit by Nintendo ® and Wii Balance Board ®. They engaged in different games for postural training, including Penguin Slide, Table Tilt , and Tightrope (Carvalho et al., 2018). The games were meant to increase balance by putting the participants in challenging positions. For instance, in Penguin Slide , the participants try to catch fish while maintaining balance on a piece of ice that keeps shifting weight side to side. In Tightrope, the players have to cross a tightrope by jumping to avoid obstacles. The participants created profiles to track their performance and progress over time. The study found that video games had a positive effect on balance and gait. The participants experienced an increase in gait speed and a consistent decrease in TUG time within three months. Improvement in balance is associated with the decrease in risk of falls, injuries, dependency, and a general improvement in the quality of life.
There are specific AVGs that are used for balance training. The AVGs will enable the participants to engage in static and dynamic ability postures, reducing the base of support, such as one-leg stands, changing the height of gravity, and wobble boards, among other exercises (Lamoth et al., 2011). These exercises can also improve balance among young people, but they are more helpful to elderly individuals. AVGs incorporate anticipatory postural adjustments and responses, cognitive challenges, muscle loading, and transitioning into different poses. Various studies, including Bisson et al. (2007) and Rendon et al. (2012) found that AVGs and virtual training improved dynamic balance and balance confidence among the participants (Carvalho et al., 2018).
AVGs engage the players in physical activity, thus improving strength. AVGs are not like traditional video games, and they are a combination of mixed and augmented reality to pervasive games. They combine video games and exercise, exertion games, simulated dance, physical video games, and other types that necessitate them to engage in physical activities.
Wiemeyer & Kiliem (2012) note that AVGs improve strength and the ability to do different tasks and processes among older adults. For example, motion controllers such as Wii help the players gain strength by performing semi-structured routines of exercises. Traditional games were associated with a sedentary lifestyle, while AVGs require motor play that was traditionally experienced in exercise and sporting activities. The time spent playing AVGs is equated to the time spent exercising as AVGs improve strength and ability to do day to day activities among the elderly. The design for AVGs supports the motion range. Players must engage in different movements associated with the sport or the main activity in the game. For example, if the AVG is a tennis game, the players have to mimic the movements associated with a tennis game in real life. After a few sessions, the players build their skills and strength. In certain AVGs, the movement of the players is converted to be a part of the game. A movement is a form of full-body exercise and this how AVGs also improve physical strength.
Smith & Schoene (2012) add that AVGs and other forms of exercise are crucial to the elderly because the aging processes come with structural and functional changes to the skeletal and muscular systems that impair their ability to be active and dependent. The decline in aerobic activity and loss of muscle tissue results in reduced strength. Reduced strength has negative implications on the quality of life, independence, and mortality. Increased strength from regular exercise and taking part in AVGs increases one’s VO2 max. In comparison to individuals leading a sedentary lifestyle (Smith & Schoene, 2012). Some of the AVGs requiring physical coordination and motor coordination, such as moving forward or lifting, have shown positive improvements in the participants’ physical strengths.
AVGs have the potential to reduce falls among the elderly. Falls are a major health problem among the elderly because of the physical injuries and psychological trauma (Bell et al., 2011). Many cases of hospitalization, hospitalizations, and sometimes mortality are associated with fall-related injuries. According to Pietrzak et al. (2014), 30% of adults over 65 fall at least one, and these incidents have an adverse impact on their health. It is estimated that by 2030, 3 million older people over 65 will be in nursing homes by 2030 because of the decreasing independence and increasing cases of falls. Falls reduce mobility leading to subsequent falls and injuries. The cost of rehabilitation for falls is high, estimated to reach $54.9 billion by 2020 (Pietrzak et al., 2014).
Physical exercises to improve coordination and balance are an effective intervention for reducing falls among the elderly. The Nintendo Wii, combined with the Nintendo WiiFit game and Wii Balance Board, has shown the possibility of improving balance and reducing falls. There is a variety of AVGs to meet the diverse needs of elderly individuals. AVGs enable participants to work towards personalized goals, and they provide feedback on performance in comparison to traditional interventions. A systematic review by Neri et al. (2017) evaluated the effects of AVGs and virtual reality games on the elderly. The review found that video games are more superior in comparison to traditional exercises for improving balance. Video games significantly improved mobility compared to the no-intervention group (Neri et al., 2017). They also had a positive effect on the fear of falling.
Physical therapists are finding ways to incorporate video games to exercise routines for the elderly. Various research studies have shown the positive effects of AVGs on reducing falls. Pietrzak et al. (2014) conducted a 3-month study to evaluate the impact of video games on falls in eighteen assisted living facilities. The program was supported by physiotherapists and assistants who helped the older adults learn how to take part in the intervention. The balance was measured using the Berg Balance Scale (BBS), and other outcomes included the fear of falling, mobility, fall risk, and awareness and incidence of falls. The participants showed a significant improvement in BBS and also an improvement in the secondary outcomes in comparison to the no-intervention group (Pietrzak et al., 2014). Within the three months, fall rates dropped significantly in the intervention group, and they reported an improvement in balance and a reduction in fear of falling.
While AVGs have demonstrated the potential to improve balance, strength, and reduce falls among the elderly. AVGs are proving to be useful in managing some of the common health conditions among elderly individuals. Wii-Fit is now a common intervention among patients with Stroke, Parkinson’s disease, and Alzheimer’s disease (Pietrzak et al., 2014). Aside from the positive physical effects, AVGs have social benefits for the participants. Most elderly people take part in AVG in a group setting, which gives them a chance to interact with others in a fun environment. However, some studies have concluded that AVGs have no positive effect, and some have reported adverse effects (Montero-Alia et al., 2019). Some of the studies that reported “no impact” also added that AVGs put undue pressure on elderly individuals with negative physical impacts such as musculoskeletal strain.
In conclusion, various studies on the effects of AVGs have demonstrated the positive effects of AVGs among older adults. AVGs and exergames are an emerging area of research and intervention among the elderly, but it is promising. Various studies have shown the positive effects of games on improving balance, increasing strength, and reducing falls. These three physical impacts of AVGs can make a big difference in the quality of life, mobility, independence, and mortality among the elderly. Adults over 65 are prone to falling because of the declining cognitive and muscular abilities, and AVGs help them address some of the areas they are not confident with. AVGs can target specific areas such as abnormal posture or slow reaction to falls to increase an individual’s confidence to prevent falls. Even studies that showed that AVGs have no effect on balance and falls found that AVGs helped reduce the fear of falling. AVGs increase self-efficacy in the individual’s ability to avoid falls, participate in physical activities, or remain independent. The benefits of AVGs are yet to be fully realized because it is not a mainstream intervention. Further research should be conducted on how to harness all the benefits of AVGs to improve quality of life among the elderly.
References
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