Effects of interactive video-game-based exercise on balance in older adults with mild-to-moderate Parkinson's disease

Abstract

Background: This study aimed to evaluate the effectiveness of a customized interactive video game-based (IVGB) training on balance in older adults with mild-to-moderate Parkinson's disease (PD).

Methods: In this 12-week crossover trial, PD patients ≥65 years of age were randomly divided into Group A (a 6-week intervention phase followed by a 6-week control phase) and Group B (a 6-week control phase followed by a 6-week intervention phase). Participants received IVGB exercise training during the intervention phase and no exercise during the control phase. Functional outcomes were measured using behavioral evaluation scales and questionnaires at baseline, week 6 and week 12.

Results: Twenty-four PD patients were included in this study, and were evenly divided into two groups. After Bonferroni adjustment, the changes in Modified Falls Efficacy Scale (MFES) and two subscales of Multi-Directional Reach Test were significantly different between two groups in the first 6-week period. In addition, the changes in Berg Balance Scale, MFES, and two subscales of Maximum Step Length were significantly different between two groups in the second 6-week period. Compared to controls, 6-week IVGB exercise intervention significantly improved different but overlapping functional outcomes in two groups of PD patients.

Conclusions: The customized IVGB exercise training improves balance, postural stability and confidence in preventing falls in older adults with mild-to-moderate PD. However, this IVGB exercise doesn't have a significant impact on quality of life.

Trial registration: ClinicalTrials.gov. NCT03689764 . Registered 27 September 2018, retrospectively registered.

Keywords: Balance; Crossover trial; Interactive video game-based exercise; Parkinson’s disease.

Fig. 1

Experimental design. Twenty-four participants with mild-to-moderate PD were randomly assigned to Groups A and B. Participant performance was assessed before intervention (baseline) and at weeks 6 and 12. Group A participated in the interactive video-game-based (IVGB) exercise program during the first 6 weeks, followed by a 6-week period without exercise. Group B participants did the reverse, starting with 6 weeks without exercise followed by 6 weeks of the IVGB exercise program. SF-36, 36-Item Short-Form Health Survey; MFES, Modified Falls Efficacy Scale; BBS, Berg Balance Scale; MDRT, Multi-Directional Reach Test; MSL, Maximum Step Length

Fig. 2

Schematic diagram of the multidirectional reaching task. The stepping mat was placed 60 cm in front of the monitor. a: Participants performed interactive multidirectional reaching tasks by following the target appearing on the television screen, with movements tracked by infrared photosensors in the controllers. b & c: For the antero-posterior stepping practice, participants stood 12 cm away from the mat in front/behind and stepped onto the target area according to the monitor cues. d & e: For the medial-lateral stepping practice, participants stood on the right/left side of mat (starting area) and stepped onto the target area according to the monitor cues. For forward–backward and medial–lateral stepping, the floor and mat were marked to ensure that participants started and ended in the same place

Fig. 3

Schematic diagram of the target-oriented stepping task. The stepping mat was placed 60 cm in front of the monitor. Participants stood on the marked area of the mat as the starting point. a: Participants performed the interactive target-oriented stepping task according to the cue on the television screen, with motion monitored by infrared photosensors in the controllers. b: Right foot was raised according to the cue on the monitor. c: Left foot was raised according to the cue on the monitor

Fig. 4

Outcome measures collected at three time points in Group B. The scores were presented as mean ± SD. Differences between time points were examined using repeated measures ANOVA, followed by a post hoc Bonferroni test. The alpha value was set to 0.05 for BBS and MFES; 0.0021 for subscales of SF-36; 0.0056 for subscales of MDRT; 0.0028 for subscales of MSL