Image_1_Exergaming in a Moving Virtual World to Train Vestibular Functions and Gait; a Proof-of-Concept-Study With Older Adults.pdf

<p>Background: The use of Exergames designed to improve physical and cognitive functioning is relatively new in rehabilitation. Exergaming allows the training of skills, the handling of tools, and procedures; however, often, the potential of these aspects are not assessed before they are adopted in clinical settings. This study aimed at exploring the effects of exergaming on vestibular functions and gait in healthy community dwelling older adults using a proof-of-concept study design registered under ClinicalTrials.gov NCT03160352.</p><p>Methods: A pre-test-post-test one-group study design comprising 10 older adults (mean age of 73.5 ± 7.6 years, four males) investigated the feasibility of eight exergaming training sessions (for 160 min) and the effects on dynamic visual acuity (DVA), functional gait assessment (FGA), and extended timed get-up-and-go (ETGUG). The simulator sickness questionnaire (SSQ) and the game scores were evaluated for the feasibility of the intervention. Wilcoxon test and Cohen’s d (d) were chosen to test for differences and for effect size estimation.</p><p>Results: Exergaming led to a significantly improved DVA (z = −2.50, p = 0.01, d = 1.35) with improvements in 9 out of 10 participants. In addition, the FGA significantly improved with a large effect size (z = −2.25, p = 0.02, d = 1.17). Specifically, component tasks such as walking with horizontal head turns (p = 0.03), gait with a narrow base of support (p = 0.03), ambulating backward (p = 0.05) significantly improved. The ETGUG component task Gait initiation significantly improved (p = 0.04). No change was found in gait speed and SSQ. The game scores of the participants improved continuously during the course of the intervention for every game.</p><p>Discussion: This proof-of-concept study suggests that the use of exergaming that requires active stepping movements and that contains moving game projection is feasible and facilitates gaze stability during head movements in healthy community dwelling older adults. Aspects of functional gait and gait initiation also improved. Future research aimed at testing this exergaming intervention in patients suffering from vestibular impairments is warranted.</p

Older adults must hurry at pedestrian lights! A cross-sectional analysis of preferred and fast walking speed under single- and dual-task conditions

<div><p>Slow walking speed is strongly associated with adverse health outcomes, including cognitive impairment, in the older population. Moreover, adequate walking speed is crucial to maintain older pedestrians’ mobility and safety in urban areas. This study aimed to identify the proportion of Swiss older adults that didn’t reach 1.2 m/s, which reflects the requirements to cross streets within the green–yellow phase of pedestrian lights, when walking fast under cognitive challenge. A convenience sample, including 120 older women (65%) and men, was recruited from the community (88%) and from senior residences and divided into groups of 70–79 years (<i>n</i> = 59, 74.8 ± 0.4 y; mean ± SD) and ≥80 years (<i>n</i> = 61, 85.5 ± 0.5 y). Steady state walking speed was assessed under single- and dual-task conditions at preferred and fast walking speed. Additionally, functional lower extremity strength (5-chair-rises test), subjective health rating, and retrospective estimates of fall frequency were recorded. Results showed that 35.6% of the younger and 73.8% of the older participants were not able to walk faster than 1.2 m/s under the fast dual-task walking condition. Fast dual-task walking speed was higher compared to the preferred speed single- and dual-task conditions (all <i>p</i> < .05, <i>r</i> = .31 to .48). Average preferred single-task walking speed was 1.19 ± 0.24 m/s (70–79 y) and 0.94 ± 0.27 m/s (≥80 y), respectively, and correlated with performance in the 5-chair-rises test (<i>r</i>_<i>s</i> = −.49, <i>p</i> < .001), subjective health (τ = .27, <i>p</i> < .001), and fall frequency (τ = −.23, <i>p</i> = .002). We conclude that the fitness status of many older people is inadequate to safely cross streets at pedestrian lights and maintain mobility in the community’s daily life in urban areas. Consequently, training measures to improve the older population’s cognitive and physical fitness should be promoted to enhance walking speed and safety of older pedestrians.</p></div

Socio-demographic characteristics of the two age groups.

<p>Socio-demographic characteristics of the two age groups.</p

Total weekly time spent per setting.

<p>Total time (in hours) spent in each activity setting during the measurement week. Since boys and girls did not show any significant differences in total time spent in a setting, data is presented for the whole study sample using median and interquartile range (IQR).</p

Walking speed, dual-task costs, and 5-chair-rises-test performance.

<p>Walking speed, dual-task costs, and 5-chair-rises-test performance.</p

Association between fast single-task walking speed and performance in the 5-chair-rises test.

<p>The gray line represents the regression line (y = 20.53 − 6.09 × x, R² linear = 0.310).</p

Percentage of women and men walking slower than 1.2 m/s.

<p>The graphs represent each of the four walking conditions (A–D). DT, dual-task; ST, single-task.</p

Walking speed under the four walking conditions.

<p>Mean walking speed was higher in the younger age group in all four respective walking conditions (all <i>p</i> < .001). Mean values of adjacent boxplots in the respective age group are significantly different (all <i>p</i> < .05). The dashed green line represents the required 1.2 m/s walking speed to cross streets safely within the green–yellow phase of pedestrian lights. DT, dual-task; ST, single-task.</p

Weekly minutes of MVPA by gender.

<p>Bold: significant difference <i>p</i> < 0.05.</p><p>IQR, Interquartile Range; Mdn, Median; MVPA, Moderate-Vigorous Physical Activity</p><p>Weekly minutes of MVPA by gender.</p

Definitions and methods of generating the seven activity settings.

<p>Definitions of the seven activity settings and overview of their construction in a geographic information system (GIS). Land use data and points-of-interest (POI) were provided by the Land Surveying Office of Winterthur. The assignment of participant’s data points to one of the seven activity settings was carried out in a hierarchical top-down order.</p