Play to prevent: Video games for preventing falls in community-dwelling older people

By Vijay Kumar MalesuReviewed by Danielle Ellis, B.Sc.Jan 18 2024

In a recent study published in Nature Medicine, a group of researchers evaluated the effectiveness of home-based cognitive and exergame step training interventions compared with a control group in preventing falls among community-dwelling older adults.

Background 

Falls in older adults, leading to disability and high mortality, are a growing public health concern due to the aging global population. This challenge strains healthcare systems and impacts communities. Effective, scalable fall prevention strategies are crucial. Exercise, particularly balance training, helps prevent falls, but issues with engagement and consistency persist. Cognitive decline, associated with increased fall risk, points to the potential benefits of cognitive training.

Combining physical and cognitive exercises, gamified training offers an engaging approach, enhancing adherence and addressing key risk factors. Further research is needed to validate findings, explore long-term effects, and optimize intervention strategies for fall prevention in older populations.

About the study 

The present study, a pragmatic assessor-blinded three-arm parallel randomized controlled trial, was designed to assess the effectiveness of the smart±step system, offered as seated cognitive training or exergame training, against a minimal-intervention control group. This assessment focused on the rate of falls in older people over a 12-month period and was conducted with the approval of the University of New South Wales Sydney Human Research Ethics Committee and registered on the Australian New Zealand Clinical Trial Registry.

Participants were recruited in Sydney, Australia, through various methods, including advertisements and health insurance company invitations. Eligible participants were over 65, English-speaking, living independently, able to walk without aid, and willing to consent. Those with unstable medical conditions, neurological disorders, acute psychiatric conditions, or significant cognitive impairment were excluded. After eligibility screening and obtaining written informed consent, participants' baseline data were collected.

Participants were allocated to one of three groups: two intervention groups receiving a smart±step mini PC with games for cognitive challenge and a control group. The exergame group used a wireless step mat for physical activities, while the cognitive group employed a touchpad for mental tasks. Both intervention groups underwent 120 minutes of weekly training for a year, monitored by research staff. The primary outcome measured was the fall rate over 12 months, alongside secondary outcomes assessing physical and cognitive performance, health, and mobility. Data were analyzed using an intention-to-treat approach with negative binomial regression to compare fall rates.

Study results

Between October 27, 2016, and May 10, 2019, a total of 1,009 individuals were screened for eligibility for a study focusing on fall prevention among older adults. Out of these, 769 participants were randomly assigned to one of three groups: cognitive training (262 participants), exergame training (252 participants), or a control group (255 participants). During the 12-month trial, 53 participants withdrew (21 from exergame training, 23 from cognitive training, and nine from the control group), and 61 participants from the intervention groups discontinued the intervention but continued to provide data on falls.

Participants who withdrew were generally 2.5 years older than those who completed the study but did not differ significantly in sex or the number of medical conditions. The baseline characteristics across the three groups were similar in terms of age, education, body mass index, sex, medical conditions, and medications, leading to no adjustments in the analyses.

In terms of the primary outcome, which was the rate of falls during the 12-month follow-up, the exergame training group reported 163 falls, the cognitive training group 197 falls, and the control group 231 falls. The exergame training group had significantly fewer falls than the control group, unlike the cognitive training group. The exergame group also reported fewer individuals experiencing at least one fall, while the cognitive group showed no significant difference from the control group. There was no substantial difference among the groups in multiple or injurious falls nor in physical and cognitive performance outcomes. 

The exergame group improved in fall efficacy, disability, and depressive symptoms, but the cognitive group did not differ significantly from the control in general or psychological health. Previous fallers in the cognitive group, however, had a reduced fall rate. No serious adverse events were reported. In terms of adherence, participants in the exergame group trained for an average of about 80 minutes per week, and those in the cognitive training group for about 95 minutes per week. System usability and enjoyment ratings were generally high for both intervention groups.