Exergaming to improve balance and decrease the risk of falling in individuals with knee osteoarthritis

Background: The benefits of exercise to improve balance and reduce the risk of falls is well-recognised in the older-adult literature. However, little attention is paid to people with osteoarthritis (OA) of the knee. While there is evidence of an increasing number of falls in adults with knee OA, the contributing factors for falling has not been substantially investigated. Exergaming (exercise and gaming) is useful in improving balance in a range of health conditions, yet there is limited research regarding its application to people with knee OA. Aim: The primary aim of this thesis was to investigate the feasibility and acceptability of exergaming using Nintendo Wii Fit™ to improve balance and reduce the risk of falls in individuals with knee OA. Secondary aims were to identify the risk factors for falls in adults with knee OA and to examine the strength of relationship between falling and clinical characteristics such as dynamic balance, pain, instability, muscle strength, and physical function in adults with knee OA. Methods: The main study utilised a mixed-methods, explanatory sequential study design (quantitative followed by qualitative design) to determine the feasibility of exergaming. Nested in this thesis were two literature reviews and a cross-sectional study, all conducted to inform the design of the main study. A systematic review was conducted to identify published evidence on the risk factors for falls in adults with knee OA. The findings from the systematic review informed the risk factors for falls explored in the cross-sectional study. A narrative synthesis of exergaming literature using Nintendo Wii Fit™ was conducted to determine dosage and parameters of the exergaming intervention in the main study. Results: Findings from the systematic review included moderate evidence for impaired balance, decreased knee muscle strength, an increasing number of symptomatic joints, and the presence of comorbidities as risk factors for falls in individuals with knee OA Conflicting evidence was found for knee pain. Impaired proprioception, knee instability, and use of walking aids had limited evidence for being significantly associated with increasing risk for falls. In the cross-sectional study, 31 out of 63 (49%) participants with knee OA reported at least one fall in the previous 12 months. For participants with knee OA and history of falling, dynamic balance, knee muscle strength, and performance of physical function were significantly reduced when compared to participants with knee OA and no history of falling (p<0.05). Lower dynamic balance measured by the Composite Score (OR 0.86, 95% CI 0.73–0.98, p=0.049) and weaker quadriceps muscles strength (OR 0.70, 95% CI 0.44–0.91, p=0.028) showed positive association with an increased risk of falling. Whereas, poorer physical function measured with the Timed Up and Go test, showed increased risk of falling by almost two-fold (OR=1.65, 95% CI 1.85–4.21, p=0.006). The main study found that it is feasible and acceptable to use Nintendo Wii Fit™ as an exergaming tool to improve balance and decrease the risk of falling in adults with knee OA. The pre-defined feasibility criteria such as recruitment, retention, and compliance were successfully met. This was affirmed by the participants’ views on the procedures of the study in terms of the frequency and duration of the assessment and intervention sessions, which they reported to be acceptable. The study demonstrated that it is safe to use Nintendo Wii Fit™ as an exergaming tool as there were no adverse events reported throughout the study period. There were encouraging results in the key outcome measures such as increasing muscle strength, balance, and performance of physical function sufficient to support the conduct of a future randomised controlled trial (RCT). Participants enjoyed playing Wii Fit™ games and found exergaming motivating and interactive in spite of some barriers with the use of technology. Conclusion: This thesis highlights the risk factors for falls and the potential of exergaming to improve balance and decrease the risk of falling in individuals with knee OA. It is essential to understand the mechanism underlying the occurrence of falls in knee OA by identifying modifiable risk factors which can be mitigated. The potential use of exergaming as a balance tool and the assessment of knee OA symptoms that are critical to increasing falls risk can provide valuable information for both clinicians and fall prevention program developers. Findings coming from feasibility study are encouraging, and support the need to conduct a full-scale RCT

Arnis-based Exercise Program for Balance Control in Community-Dwelling Older Adults: Study Protocol for a Pilot Randomized Controlled Trial

Background: Aging causes impairment in balance and increases the prevalence of falls in older adults. Martial arts are now incorporated into exercise programs to improve balance. Arnis, a Filipino Martial Art, can improve the balance control of older adults. Objectives: This study primarily aims to determine the effects of an Arnis-based exercise program on balance control of healthy community-dwelling older adults. This study also aims to describe its effect on older adults’ concerns about falling and lower limb functional strength. Methods:This will be a single-blind, pilot randomized controlled trial. Participants will be randomly allocated to either the intervention or control group. The intervention group will perform an Arnis-based exercise program for 40-60 minutes per session thrice a week for 12 weeks. The control group will continue to do their usual activities for the duration of the study. Participants will be measured at baseline and 12 weeks after for balance, concern for falling, and lower limb strength using the Berg Balance Scale, Timed-Up and Go Test, Falls Efficacy Scale-International Filipino, and the 30-second Chair Sit-to-stand Test, respectively. Data will be analysed through independent and paired t-tests. A p-value Expected Results: Significant improvements in the balance scores in the intervention group are expected after 12 weeks of the Arnis-based exercise program, along with its effects on concerns for falling and lower extremity strength. The pilot study will provide data on the effectiveness of Arnis as a reference for future larger experimental studies

Exergaming to improve balance and decrease the risk of falling in individuals with knee osteoarthritis

Background: The benefits of exercise to improve balance and reduce the risk of falls is well-recognised in the older-adult literature. However, little attention is paid to people with osteoarthritis (OA) of the knee. While there is evidence of an increasing number of falls in adults with knee OA, the contributing factors for falling has not been substantially investigated. Exergaming (exercise and gaming) is useful in improving balance in a range of health conditions, yet there is limited research regarding its application to people with knee OA. Aim: The primary aim of this thesis was to investigate the feasibility and acceptability of exergaming using Nintendo Wii Fit™ to improve balance and reduce the risk of falls in individuals with knee OA. Secondary aims were to identify the risk factors for falls in adults with knee OA and to examine the strength of relationship between falling and clinical characteristics such as dynamic balance, pain, instability, muscle strength, and physical function in adults with knee OA. Methods: The main study utilised a mixed-methods, explanatory sequential study design (quantitative followed by qualitative design) to determine the feasibility of exergaming. Nested in this thesis were two literature reviews and a cross-sectional study, all conducted to inform the design of the main study. A systematic review was conducted to identify published evidence on the risk factors for falls in adults with knee OA. The findings from the systematic review informed the risk factors for falls explored in the cross-sectional study. A narrative synthesis of exergaming literature using Nintendo Wii Fit™ was conducted to determine dosage and parameters of the exergaming intervention in the main study. Results: Findings from the systematic review included moderate evidence for impaired balance, decreased knee muscle strength, an increasing number of symptomatic joints, and the presence of comorbidities as risk factors for falls in individuals with knee OA Conflicting evidence was found for knee pain. Impaired proprioception, knee instability, and use of walking aids had limited evidence for being significantly associated with increasing risk for falls. In the cross-sectional study, 31 out of 63 (49%) participants with knee OA reported at least one fall in the previous 12 months. For participants with knee OA and history of falling, dynamic balance, knee muscle strength, and performance of physical function were significantly reduced when compared to participants with knee OA and no history of falling (p<0.05). Lower dynamic balance measured by the Composite Score (OR 0.86, 95% CI 0.73–0.98, p=0.049) and weaker quadriceps muscles strength (OR 0.70, 95% CI 0.44–0.91, p=0.028) showed positive association with an increased risk of falling. Whereas, poorer physical function measured with the Timed Up and Go test, showed increased risk of falling by almost two-fold (OR=1.65, 95% CI 1.85–4.21, p=0.006). The main study found that it is feasible and acceptable to use Nintendo Wii Fit™ as an exergaming tool to improve balance and decrease the risk of falling in adults with knee OA. The pre-defined feasibility criteria such as recruitment, retention, and compliance were successfully met. This was affirmed by the participants’ views on the procedures of the study in terms of the frequency and duration of the assessment and intervention sessions, which they reported to be acceptable. The study demonstrated that it is safe to use Nintendo Wii Fit™ as an exergaming tool as there were no adverse events reported throughout the study period. There were encouraging results in the key outcome measures such as increasing muscle strength, balance, and performance of physical function sufficient to support the conduct of a future randomised controlled trial (RCT). Participants enjoyed playing Wii Fit™ games and found exergaming motivating and interactive in spite of some barriers with the use of technology. Conclusion: This thesis highlights the risk factors for falls and the potential of exergaming to improve balance and decrease the risk of falling in individuals with knee OA. It is essential to understand the mechanism underlying the occurrence of falls in knee OA by identifying modifiable risk factors which can be mitigated. The potential use of exergaming as a balance tool and the assessment of knee OA symptoms that are critical to increasing falls risk can provide valuable information for both clinicians and fall prevention program developers. Findings coming from feasibility study are encouraging, and support the need to conduct a full-scale RCT

Exercise to Improve Postural Stability in Older Adults with Alzheimer&rsquo;s Disease: A Systematic Review of Randomized Control Trials

In this systematic review, we aim to synthesize published evidence on the effects of exercise in improving postural stability among older adults with Alzheimer&rsquo;s Disease (AD). A systematic electronic literature search was undertaken in Pedro, Cochrane, MEDLINE, ProQuest, Science direct and Clinical trial databases involving human participants published from year 2000&ndash;2022. This search was updated in June 2022. The studies chosen were based on predetermined criteria. Data relating to the contents and parameters of exercise in persons with AD were gathered and analyzed. A total of 8 experimental studies met the inclusion criteria. Overall, the selected studies were of a medium quality. In these studies, information and physical exercises were used to improve postural stability in older adults with AD. The findings of the review suggest that performing combined strength, balance and executive function training can improve postural stability. However, we are unable to conclude the specific dose for specific type of exercise. More high-quality studies are required pertaining to exercise prescription for older adults with AD. Mostly, information and physical exercise were delivered via face-to-face sessions conducted by health professionals. The structure of exercises summarized in this review may be beneficial for older adults with AD to improve postural stability and as a result reduce falls

The Experiences of Older Adults with Dementia of “Balance Wise”—An Individual or Group-Delivered Exercise Programme: A Qualitative Study

This study aimed to understand the experience of older adults with dementia towards, and the practicality of, the Balance Wise exercise programme. A qualitative study guided by the General Inductive Approach was employed. Ten people with dementia aged 71–87 years who completed the exercise programme and four care partners aged 69–76 years old (three of whom also participated in Balance Wise) were interviewed in dyads. The programme (individually or group delivered) was held once a week for 30 min for 10 weeks and included balance and strength exercises, cognitive training, and other enjoyable physical activities. Interviews were thematically analysed. Three overarching themes were identified (i) decision making, (ii) comprehension, and (iii) perceived benefits. Participants acknowledged their decision to participate was influenced by ‘awareness’ about their declining memory and their ‘health belief’ about the potential benefits of exercise. ‘Perceived benefits’ were influenced by the ‘support system’ and improvement in postural stability. ‘Comprehension’ was, however, an important cognitive ability to understand the purpose of the activities in the programme and facilitated motivation. This study highlighted an important message that such programmes should be developed from the end-user perspective, and this included that the programme be flexible and safely delivered, as well as be fun and pleasurable, thus promoting socialisation

Biomechanical Parameters Assessed During Running Among Running-Related Athletes with Recurrent Hamstring Strain Injury: A Scoping Review

Hamstring strain injury (HSI) is a common non-contact injury, with most cases occurring among running-related athletes and sporting events. HSI is characterized by sharp, intense pain throughout the posterior thigh, necessitating the rapid cessation of physical activity. Injury rates are predicted to be 3–4.1 per 1000 hours of competition and 0.4–0.5 per 1000 hours of training. The rate of injuries during training sessions has increased more than in competitive matches, with an average increase of 4% per year. This scoping review aims to determine the biomechanical parameters (kinematics and kinetics) associated with recurrent hamstrings injury occur among running-related athletes. Peer-reviewed papers focusing on biomechanical risk factors associated with recurrent hamstring injury among running-related athletes (sprinters, runners, basketball players, and football or soccer players) will be eligible for inclusion. Studies from inception to May 2022 written in English or English translation will be sought for this scoping review. The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews. The search strategy will aim to locate both published and unpublished studies. An initial limited search of PubMed will be undertaken to identify articles on the topic. The search strategy will be adapted for each database and information source, including all specified keywords and index terms. The reference list of all included sources of evidence will be screened for additional studies. Data will be extracted from papers included in the scoping review by two or more independent reviewers using a data extraction tool developed by the reviewers. The data will be presented in tabular form. A narrative summary will accompany the tabulated results and describe how the results relate to the review objective and question/s

Perceptions of academic staff and students of senior high school in implementing game-based exercises in physical education classes—a research protocol for a qualitative descriptive study

Background The COVID-19 pandemic has taken a toll on both physical activity and fitness as several pursuits and activities have been restricted. Coupled with this, increased food intake and sedentary lifestyles have produced poor physical health outcomes. Online physical education classes have been more difficult to conduct given the limitations of the setup. As such, exergaming has been identified as a possible educational tool that could improve students’ motivation, participation and fitness levels and reduce negative behaviours in class while contributing to the current curriculum.Objectives The study explores the perspectives of both the physical education academic staff and senior high school students from the University of Santo Tomas on the implementation of exergaming to determine the feasibility of exergaming as an educational tool in the Philippines’ physical education curriculum.Methodology A descriptive qualitative design will be used and participants will be selected through criterion sampling. The authors will conduct a process of question development and pilot FGDs beforehand to ensure smooth proceedings. Once done, they will undergo FGDs conducted through Google Meet. Data will be coded and analysed via thematic analysis using manual coding and NVivo V.12 software to summarise central themes and perceptions.Ethics and dissemination This study will abide by the Nuremberg Code, Declaration of Helsinki, Belmont Report, Data Privacy Act of 2012 and National Ethical Guidelines (for health-related research) of 2017. The study has received approval from the University of Santo Tomas (UST)-College of Rehabilitation Sciences (CRS) Ethics Review Committee. All participant data will be labelled according to random two-digit computer generated codes to preserve anonymity and stored in password-protected laptops and Google Drive folders to preserve confidentiality. Results will be made available to individual UST physical education academic staff and senior high school students prior to publication in peer-reviewed journal

Level of self-efficacy among skill-based allied health students in the University of Santo Tomas-Enriched Virtual Mode of learning: A cross-sectional study

Background: Self-efficacy expresses a learner’s perception of how well they can do in the online academic setting. Although students’ academic successes can be measured by online learning self-efficacy, there is a scarcity of evidence targeted toward allied health students. Objective: The primary aim of this study is to determine the level of online self-efficacy among students from skill-based allied health programs. The secondary aim is to correlate online self-efficacy with age, sex, year level, and program of the students. Methods: This cross-sectional analytic study utilized the Online Learning Self-Efficacy Scale (OLSE) to determine students’ level of self-efficacy via a survey conducted with students who underwent the Enriched Virtual Mode of learning. Descriptive statistics was used to characterize the study participants, describe the level of self-efficacy, and compare the subscales of OLSE. Inferential statistics using Spearman’s rho was performed to determine the correlation. Results: A total of 117 respondents with a mean age ± SD of 20.59 ± 0.11 years old, predominantly female (71%) were included in the study. The students from allied health programs had an online self-efficacy overall mean score of 3.83 ([Formula: see text]; range 2.64–5.00) with the use of technology subscales weighted the highest mean score (4.24). Females have a higher average OLSE score ([Formula: see text], [Formula: see text]) compared to males. Significant correlation was found between OLSE scores to sex ([Formula: see text], [Formula: see text]) and year level ([Formula: see text], [Formula: see text]) while nonsignificant correlation was found between OLSE scores to the program ([Formula: see text], [Formula: see text]) and age ([Formula: see text], [Formula: see text]). Conclusion: Students of allied health programs generally have a very good level of online self-efficacy. This study assists educators in developing proactive strategies and approaches to promote students’ self-confidence across all domains and encourage them to adopt a dynamic remote learning-based approach. Educational institutions should use this opportunity to assess how well they have implemented remote learning to ensure educational continuity, especially in times of crisis