How gamified exercise can help to prevent falls

Falls in older people can be reduced by gamified step exercises, a large randomised control trial has found.

With a steadily aging population, the researchers say scalable and effective fall prevention strategies are needed to address the growing impact of falls in the community.

A trial conducted by a team of Neuroscience Research Australia (NeuRA) and UNSW researchers made use of smart±step, an exercise gaming console that anyone can use without requiring assistance from a therapist. smart±step is connected to a television screen, and once a game of choice is selected, it requires the person to step on target panels on a step mat, just like one would with a game controller.

During the trial, it was found that those over the age of 65 who participated in these at-home gamified step exercises were less likely to suffer a fall. In fact, the number of falls was reduced by 26% when compared to a control group. The results of the trial were published in Nature Medicine.

“Regular balance-challenging exercise is effective at preventing falls, so we tried to make exercise fun and easy to do,” said Dr Daina Sturnieks, lead author of the study and Senior Research Scientist at NeuRA and UNSW Sydney.

What were the findings of the study?

769 people over 65 — all living in the community — participated in Sturnieks’ study. They were asked to do smart±step exercise games for 120 minutes per week over the course of 12 months. Participants reported their falls over this period and this data was compared to a control group, who only received a public health pamphlet about preventing falls.

Over the 12 month-study period, participants who received the exercise intervention showed significantly fewer falls compared to the control group: 36% of the exercise group had a fall in the study period, whereas 48.2% of the pamphlet group had a fall.

While these results are encouraging, the researchers said one limitation of the research was that the sample primarily consisted of well-educated and high-functioning older people.

“The findings cannot be generalised to frailer older people,” the researchers said.

“Furthermore, participants were not blinded to their intervention, therefore the level of expectancy for preventing falls may have differed between the groups, which may contribute to a placebo effect that might impact the findings.”

What are the benefits of gamified exercise?

One in three people over the age of 65 living independently will experience a fall every year. Falls are a significant public health issue, contributing to mobility-related disability and loss of independence, and they are also the second leading cause of unintentional injury deaths worldwide.

The best evidence for fall prevention in the community is balance-challenging exercise, according to Sturnieks.

“We’ve known for a long time that, if done correctly and consistently, balance-challenging exercises can prevent falls. But the problem is that often people don’t keep up with their exercises because they can get boring very quickly,” she said.

This led Sturnieks and the team at the Falls, Balance and Injury Research Centre at NeuRA to explore the idea of gamifying the balance exercises.

“People get addicted to games because they are fun and they become motivated to beat their high score and just get lost in the game,” she said.

Gamified exercise also provides cognitive benefits

The advantages of smart±step exercise games — or exergames — go beyond physical exercise benefits: people are also undertaking cognitive training, which is easily incorporated into these games.

“These exergames require people to think quickly, unlike traditional exercise programs where you often just go through the movements,” Sturnieks said. The smart±step exergames involve stepping on a mat, which acts as a controller.

The exergames vary in content and range, from collecting treasures to stomping on moving cockroaches or avoiding obstacles. Overall, the games require timely movements and quick thinking to keep up.

“Exergames are like a two-in-one: you get physical benefits but also you are keeping yourself cognitively challenged, which is good for the brain and healthy aging. Plus, it’s fun!”

Image caption: smart±step is connected to a television screen and once a game of choice is selected it requires the person to step on target panels on a step mat, just like one would with a game controller. Photo credit: NeuRA.