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Effects of the Wii on the Physical and Psychosocial Condition of Older Adults in a Senior

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Effects of the Wii on the Physical and Psychosocial Condition of Older Adults in a Senior This is the html version of the file https://ubirtest.acsu.buffalo.edu/xmlui/handle/10475/321. Google automatically generates html versions of documents as we crawl the web. Page 1 Effects of the Wii on the Physical and Psychosocial Condition of Older Adults in a Senior Residential Facility By Reiko Homma August 2009 A thesis submitted to the Faculty of the Graduate School of The State University of New York at Buffalo In partial fulfillment of the requirements for the Degree of Master of Science Department of Rehabilitation Science Page 2 Effect of the Wii ii ACKNOWLEDGEMENT I would like to express my sincere gratitude to Dr. Nadine Fisher, for her support throughout this research study. Her positive encouragement and constructive feedback kept me motivated throughout this process. I would like to thank Mary Matteliano for her valuable perspective as a clinical researcher, which helped me to develop the implications of this study to the field of occupational therapy. I would like to thank Dr. Machiko Tomita whose expertise and extensive experience in research helped me to analyze the data and interpret the results for this study. I am grateful to Jessie Shiah, who offered extensive support during the phases of data collection and intervention. I would like to thank my friends Mr. and Mrs. Nowlan who have been my best psychological support throughout my master s study. In the end, my acknowledgement extends to all my study participants. Their trust in my study protocol and willingness to participate were important factors in making this research a success. Page 3 Effect of the Wii iii TABLE OF CONTENTS Page Acknowledgements ii Table of Contents iii List of Tables vi Abstract vii Introduction 1 Literature Review 4 Theoretical Framework 4 Physiological Changes with Aging 9 Definition of Physical Activity 15 Physical Activity and Older Adults 17 Physical Activities to Promote Fitness 17 The Use of Computer Games as a Treatment Modality 18 The Nintendo Wii 20 Summary of Literature Review 21 Research Questions 22 Method 22 Study Design 22 Participants 23 Instruments 23 Procedure 29 Page 4 Effect of the Wii iv Statistical Analysis 30 Results 31 Participants 31 Physical Performance 31 Physical Activity 33 Perceived Pain 33 Depression 34 Perceived Improvements in Physical and Psychosocial Status 34 Discussion 36 Physical Performance 36 Physical Activity 38 Perceived Pain 39 Depression 39 Perceived Improvements in Physical and Psychosocial Status 39 Benefits of the Wii Exercise 42 Strengths and Weaknesses 44 Conclusion 45 References 46 Tables 55 Appendix A. Dynamic Gait Index 61 Appendix B. Yale Physical Activity Survey 64 Appendix C. Visual Analog Scale 70 Page 5 Effect of the Wii v Appendix D. Center for Epidemiologic Studies Depression Scale 72 Appendix E. Interview Questions 73 Appendix F. Recruiting Flyer 74 Appendix G. Consent Form 75 Page 6 Effect of the Wii vi LIST OF TABLES Table Title Page Table 1 Physical characteristics of the 12 participants 55 Table 2 Results for muscle strength 56 Table 3 Means and SDs for the 6MWT, TU&G, DGI, Reaction Time, YPAS, YPAS Energy Expenditure, VAS, CES-D 57 Table 4 Means and SDs for Joint Range of Motion (degrees) 59 Page 7 Effect of the Wii vii ABSTRACT The purpose of this study is to determine the effectiveness of the Wii on physical function, pain, activity level, depression, and perceived improvements in physical and psychosocial function in older adults living in a community. Twelve adults aged 76 and older who were living independently in a senior residential community were recruited. After assessing participants physical function, pain, activity level, and depression, each participant played the Wii for six weeks. After the training, the same assessments were administered and perceived improvements were assessed by a semi-structured interview. Significant differences were found for muscle strength. According to the results of the interview, all of the participants answered that they enjoyed playing the Wii. It was concluded that playing the Wii could improve the physical function of older adults and could be used as one of the enjoyable physical activities to maintain their fitness. Page 8 Effect of the Wii 1 INTRODUCTION Due to the decreased death rates among middle aged and older adults, our society s longevity is increasing and as a result, the population of older people is growing dramatically (Rowe & Kahn, 1998). The population of older adults, individuals 65 years or older, reached 37.3 million in 2006. This represents 12.4% of the entire population meaning that one in every eight Americans is an older adult. Since 1900, the number of older adults increased from 3.1 million to 37.3 million in 2006, which means the percentage of older adults increased from 4.1% in 1900 to 12.4% in 2006 (U.S. Department of Health and Human Services, 2007). As these demographic changes are expected to accelerate over the next two decades, the negative societal effects associated with aging are often seen as inevitable. Therefore, research on health promotion and disease prevention interventions for older adults has become more important (Ory, Hoffman, Hawkins, Sanner, & Mockenhaupt, 2003). Ory, Hoffman, Hawkins, Sanner and Mockenhaupt (2003) noted that the dissemination of successful health promotion activities and interventions largely depended on our understanding the lives of older adults. Rowe and Kahn (1998) described myths that represent negative bias toward older adults including: To be old is to be sick , you can t teach an old dog new tricks and the horse is out of the barn (p. 126). Although there is an absolute inevitability that the possibility of becoming sick and disabled increases as a person ages, the majority of older adults are healthy enough to live independently. They are able to learn new things, and continue to improve their lives by increasing physical activity. According to Gillis and MacDonald (2005), in addition to the deterioration due to Page 9 Effect of the Wii 2 the aging process, older adults decrease in activity levels (deconditioning) contributed to decreased functions. The maximal oxygen uptake of sedentary adults older than 60 years of age declines about 10% per decade. Skeletal muscle strength also declines. It begins to decrease at approximately age 50 and is associated with a 30% to 40% decrease in strength by 80 years of age. Loss of skeletal muscle mass below a critical level (sarcopenia) leads to functional impairment. The likelihood of functional impairment and disability is three times greater in older women with sarcopenia and two times greater in older men with sarcopenia than in older adults with normal skeletal muscle mass (Hughes et al., 2001). Huang et al. (1998) showed an inverse relationship between functional limitations and physical activities in a follow-up study of men and women aged 40 and older. Men and women of high and moderately high activity levels had a lower prevalence of functional limitations compared with the less active group after controlling for age, body mass index, smoking, alcohol consumption, and presence of chronic disease. In the Longitudinal Study of Aging, Miller, Rejeski, Reboussin, Tenhave, and Ettinger (2000) investigated how physical activities influenced lower body functional limitations and how those limitations became disabilities in a 6-year follow-up. The participants who reported walking 1.6 km (= 1mile) at least once per week had a greater probability of improving or sustaining current physical functions than less active participants. The authors suggested that performing routine physical activities might have a positive influence on physical functions and slow the progress of disabilities. Although functional impairments due to the aging process seem to be inevitable, functional limitations due to an inactive lifestyle might be reversible. Indeed, it has been Page 10 Effect of the Wii 3 suggested that physically active lifestyles may contribute to improving or maintaining health and wellness (Fletcher, Gulanick, & Braun, 2005). To obtain the maximum effect from a physically active lifestyle, it is important for older adults to perform activity on a regular basis. The key to prolonged engagement in an activity largely depends on whether the activity is motivating and enjoyable. King (1993) used a computer game to motivate her patients. She used either a computer game that required patients to pinch or grasp a controller to play the game or pinch and grip strengthening devices. Patients who participated in the game did significantly more repetitions than those who did the action without the game. Therefore, when promoting fitness of older adults, fun or enjoyment should be considered, as it may lead to better adherence to regular physical activity. The Wii is a new home video game console launched in September 2006 by Nintendo. The Wii is distinguished by its wireless controller known as the Wii remote, which is a handheld pointing device that can transmit three dimensional movement and its acceleration to the console. Therefore, when a person plays the Wii, he or she has to physically make a move to control the representing character on the TV screen. The Wii allows a person to play simulated sports, race car driving, fishing, and other games by using a combination of body movements and button clicks. This type of activity-enhancing video game has been used as an adjunct to rehabilitation therapy in various settings, including hospitals and skilled nursing facilities (Newton, 2008). The present study examines the use and effects of the Wii as a physical activity, which maintains physical and psychosocial functions of older adults in a senior Page 11 Effect of the Wii 4 residential facility. In occupational therapy practice, purposeful and meaningful activities are used to improve one s impaired ability and to promote health and wellness of individuals who engage in the activities.
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