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Should We Wii? an Overview of the Exergame Approach to Fall Risk

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Should We Wii? an Overview of the Exergame Approach to Fall Risk Hands up who has bought a Wii for use Should in falls research/practice? we ? an overview of the exerciseexergaming gaming approach to falls research Keep them up it works the way you’d like it to Stuart Smith Smith, ANZFPS, Dunedin 2010 What are exergames? What are exergames? Why use them? Who is using them in a health (falls) context? Where to from here? Smith, ANZFPS, Dunedin 2010 Smith, ANZFPS, Dunedin 2010 What are exergames? Amiga/Atari Joyboard What are exergames? (1982) Sensors used to transduce body movements into control of video game play Smith, ANZFPS, Dunedin 2010 Smith, ANZFPS, Dunedin 2010 Why use video games? Why use video games? Video games have often received bad press with respect to health EffectiveBecause Exercise for the Preventionthey of Falls: A Systematic Review and Meta-Analysis Ãw § w increased aggression and violence Catherine Sherrington,are PhD, FUNz Julie C. Whitney, MSc, Stephen R. Lord, DSc, à w Robert D. Herbert, PhD, Robert G. Cumming, PhD,z and Jacqueline C. T. Close, MD k addiction to gameplay OBJECTIVES: To determine the effects of exercise on falls Key words: falls; exercise; meta-analysis increased sedentary behaviour prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls. DESIGN: Systematic review with meta-analysis. Random- epileptic seizures ized controlled trials that compared fall rates in older peo- ple who undertook exercise programs with fall rates in those who did not exercise were included. he development and implementation of effective and Wii knee, haemothorax and ruptured tendons SETTING: Older people. Tcost-efficient strategies to prevent falls in older people PARTICIPANTS: General community and residential care. is an urgent global health challenge. In developed countries, life expectancy for people aged 65 years old is approxi- MEASUREMENTS: Fall rates. mately 17 years for men and 21 years for women. At least RESULTS: The pooled estimate of the effect of exercise one-third of people aged 65 and older fall at least once Smith, ANZFPS, Dunedin 2010 Smith, ANZFPS, Dunedin 2010 was that it reduced the rate of falling by 17% (44 trials with annually,1 and falls account for more than half of the injury- 9,603 participants, rate ratio (RR) 5 0.83, 95% confidence 2 2 related hospitalizations for older people. Fall rates in the interval (CI) 5 0.75–0.91, Po.001, I 5 62%). The great- general older population are reported to be 1.2 falls per est relative effects of exercise on fall rates (RR 5 0.58, 95% person year.3 CI 5 0.48–0.69, 68% of between-study variability ex- Falls in older people are not purely random events but plained) were seen in programs that included a combina- can be predicted by assessing a number of risk factors.4,5 tion of a higher total dose of exercise (450 hours over the Some of these risk factors (e.g., reduced muscle strength and trial period) and challenging balance exercises (exercises impaired balance and gait) can be modified using exercise, conducted while standing in which people aimed to stand whereas others (e.g., poor vision, psychoactive medication with their feet closer together or on one leg, minimize use of use) require different intervention approaches. Exercise their hands to assist, and practice controlled movements of can be used as a stand-alone falls prevention intervention or the center of mass) and did not include a walking program. as a component of a multifaceted program. Multifaceted CONCLUSION: Exercise can prevent falls in older people. interventions can prevent falls in the general community, Greater relative effects are seen in programs that include in those at greater risk of falls, and in residential care exercises that challenge balance, use a higher dose of ex- facilities.4,6 ercise, and do not include a walking program. Service pro- Many trials have sought to establish the specific effect viders can use these findings to design and implement of exercise on fall rates, but a large proportion of these trials exercise programs for falls prevention. J Am Geriatr Soc have been underpowered. The best way to interpret these 56:2234–2243, 2008. Why use video games? trials mayInterventions be to pool their for preventing data in falls a meta-analysis, in older people living but trials in the Promote adherence Why use video games? of the effects of exercise oncommunity fall rates (Review) vary in their quality, From the ÃMusculoskeletal Division, The George Institute for International have been conducted on a range of populations, and employ Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH Health and zSchool of Public Health, University of Sydney, Sydney, Australia; exercise programs that differ greatly in their aims and con- wFalls and Balance Research Group, Prince of Wales Medical Research tent. Meta-analysis should therefore involve exploration of § Institute, University of New South Wales, Sydney, Australia; Clinical Age whether these factors ‘‘explain’’ (are associated with) esti- ResearchWe Unit,know Kings College fall Hospital, risk London, can United Kingdom; and mates of the effect of exercise programs.7,8 kDepartment of Geriatric Medicine, Prince of Wales Hospital, Sydney, 6 Australia.be reduced by exercise A Cochrane review of fall prevention strategies con- Address correspondence to Dr. Catherine Sherrington, The George Institute ducted separate meta-analyses on different forms of exer- for International Health, PO Box M201, Missenden Road, Sydney NSW cise and concluded that some exercise programs can prevent Effective2050, Australia. Exercise E-mail: [email protected] for the Prevention of Falls: A Systematicfalls in Review community dwellers (e.g., home exercise program of andDOI: 10.1111/j.1532-5415.2008.02014.x Meta-Analysis balance and strength training, a Tai Chi group program) but Ãw § w Catherine Sherrington, PhD, z Julie C. Whitney, MSc, Stephen R. Lord, DSc, Tectrix VR bike à w Robert D. Herbert, PhD, Robert G. Cumming, PhD,z and Jacqueline C. T. Close, MD k JAGS 56:2234–2243, 2008 r 2008, Copyright the Authors 39 participants (21-60yo) Journal compilation r 2008, The American Geriatrics Society 0002-8614/08/$15.00 OBJECTIVES: To determine the effects of exercise on falls Key words: falls; exercise; meta-analysis prevention in older people and establish whether particular trial characteristics or components of exercise programs are This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library VR vs standard exercise bikes (upright, recumbent) associated with larger reductions in falls. 2009, Issue 4 http://www.thecochranelibrary.com DESIGN: Systematic review with meta-analysis. Random- ized controlled trials that compared fall rates in older peo- pleHigh who undertook dosage exercise programs withof fall exercise rates in is required (eg > 50 hrs those who did not exercise were included. he development and implementation of effective and Exercise 3x/week for 14 weeks, 20-30 mins/session SETTING: Older people. Tcost-efficient strategies to prevent falls in older people PARTICIPANTS:or twice/weekGeneral community and residential for care. 25is anweeks). urgent global health challenge. In developed countries, life expectancy for people aged 65 years old is approxi- Attendance greater for VR over standard bike exercise MEASUREMENTS: Fall rates. mately 17 years for men and 21 years for women. At least RESULTS: The pooled estimate of the effect of exercise one-third of people aged 65 and older fall at least once was that it reduced the rate of falling by 17% (44 trials with 1 Interventions for preventing falls in older people living inthecommunity(Review) annually, and falls account for more than half of theCopyright injury- © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 9,603 participants, rate ratio (RR) 5 0.83, 95% confidence related hospitalizations for older people.2 Fall rates in the (F6,32 = 6.01, p <0.02) 2 interval (CI) 5 0.75–0.91, Po.001, I 5 62%). The great- general older population are reported to be 1.2 falls per est relative effects of exercise on fall rates (RR 5 0.58, 95% person year.3 CI 5 0.48–0.69, 68%Video of between-study variabilitygames ex- Falls in older might people are not purely random offer events but a way to plained) were seen in programs that included a combina- can be predicted by assessing a number of risk factors.4,5 tion of a higher total dose of exercise (450 hours over the Some of these risk factors (e.g., reduced muscle strength and trial period) and challenging balance exercises (exercises impaired balance and gait) can be modified using exercise, 83% adherence for VR, 61% recumbent, 57% upright conducted while standing in which people aimed to stand ensure compliancewhereas others (e.g., poor vision, psychoactive with medication exercise with their feet closer together or on one leg, minimize use of use) require different intervention approaches. Exercise their hands to assist, and practice controlled movements of can be used as a stand-alone falls prevention intervention or the center of mass) and did not include a walking program. as a component of a multifaceted program. Multifaceted Smith, ANZFPS, Dunedin 2010 Smith,CONCLUSION: ANZFPS,Exercise Dunedin can prevent2010 falls in older people. interventions can prevent falls in the general community, Greater relative effects are seen in programs that include in those at greater risk of falls, and in residential care exercises that challenge balance, use a higher dose of ex- facilities.4,6 ercise, and do not include a walking program. Service pro- Many trials have sought to establish the specific effect viders can use these findings to design and implement of exercise on fall rates, but a large proportion of these trials exercise programs for falls prevention.
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