Effects of an Interactive Video Game (Nintendo Wii™) on Older Women with Mild Cognitive Impairment

THERAPEUTIC RECREATION JOURNAL Vol,. XLIV, No. 4 • 271-287 • 2010

Elizabeth H. Weybright, CTRS
John Dattilo
Frank R. Rusch

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Abstract
Older adults with a cognitive impairment in residential care settings are often found
to be inactive throughout the day. Participation in video games holds promise for these
individuals; however, effects of video games played by older adults have not been studied
consistently and the few studies conducted have yielded mixed results. The purpose of
this study was to examine effects of an interactive video game (Nintendo Wii'" bowling)
on attention to task and positive affect of older adult women with mild cognitive impairment. A single-subject, multiple baseline design comparing a television viewing phase
and an interactive video game phase was conducted using observational measures. Results
indicated that both participants attended to task more and demonstrated higher levels of
positive affect while engaged in the interactive video game as compared to baseline. The
low-impact activity of the Nintendo Wii" bowling program may provide the appropriate amount of physical and mental challenge and stimulation for older adults with mild
cognitive impairments.

KEYWORDS: Interactive video game, mild cognitive impairment, older adult,
recreation

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Physical and Psychosocial Effects of Wii Video Game Use among Older Women

International Journal of Emerging Technologies and Society
Vol. 8, No. 2, 2010, pp: 85 – 98

Dennis Wollersheim, Monika Merkes, Nora Shields, Pranee Liamputtong, Lara Wallis,
Fay Reynolds and Lee Koh

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Abstract

This study investigated the physical and psychosocial effect of exergaming in community
dwelling older adult women. In a pilot study consisting of a six-week baseline period and a
six-week intervention period, participants (N = 11, mean age = 73.5 years, SD = 9.0) played
Nintendo Wii Sports twice weekly. We measured full body movements using accelerometers,
and assessed psychosocial effects through end-of-study focus group meetings. There were
large self-reported psychological effects related to positive changes in self perception. The
game-play deepened social connections within the group and provided a basis for shared
experiences with younger aged family members. Physically, the game-play showed
significantly higher maximum energy expenditure (t = -4.52, p < 0.05) than baseline, but no significant difference in overall energy expenditure. Findings from the quantitative data showed that Wii-play did not have substantial physical effects; nevertheless, qualitative data revealed that the participants perceived an improved sense of physical, social and psychological wellbeing.

Keywords: Wii – Older Women – Psychosocial Benefit – Australia – Exercise – Exergames

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Wii health: a preliminary study of the health and wellness benefits of Wii Fit on university students

The British Journal of Occupational Therapy, Volume 74, Number 6, June 2011 , pp. 262-268(7)

Authors: Jacobs, Karen; Zhu, Linda; Dawes, Monique; Franco, Jessie; Huggins, Alison; Igari, Cancha; Ranta, Becky; Umez-Eronini, Amarachi

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Abstract:

Objective: The aim of this preliminary study was to determine the effectiveness of the Nintendo Wii Fit as an occupation to promote weight loss in undergraduate students.

Participants: Five first-year female students living on campus at a northeastern university in the United States were recruited to participate in this study.

Method: An A-B single subject design was created where participants were separated into three groups: a typical activity group and two Wii conditions (Wii Fit individually and Wii Fit with another participant). In all conditions, participants recorded their daily food intake and daily number of steps using a pedometer. Body mass index (BMI) and weight were recorded at baseline, at 6 weeks and at 12 weeks (the conclusion of the intervention). At baseline and 12 weeks, motivation and activity level were measured.

Results: There was a significant change in BMI, weight and motivation for participants in the singles group.

Conclusion: Although the sample size was very small, the results of this preliminary study suggest that the Wii Fit should be considered by occupational therapists as a potential occupation of weight control in undergraduate students when performed individually.

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Potential Benefits of Nintendo Wii Fit Among People with Multiple Sclerosis A Longitudinal Pilot Study

International Journal of MS Care. 2011;13:21–3

Matthew Plow, PhD; Marcia Finlayson, PhD, OT(C), OTR/L

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Abstract

We examined the potential of Nintendo Wii Fit (Nintendo Co, Ltd, Kyoto, Japan) to increase physical activity (PA) behavior and health among people with multiple sclerosis (MS). The study consisted
of a repeated-measures design with a baseline control period and involved 30 people with MS who
had the ability to walk 25 feet with or without a cane (26 individuals were included in the analyses).
Nintendo Wii was set up in the homes of participants, who were prescribed a Wii Fit exercise program lasting 14 weeks, 3 days a week. The Physical Activity and Disability Survey, Modified Fatigue
Impact Scale, and 36-item Short Form Health Status Survey were administered three times before
participants gained access to Wii Fit (control period, at 2-week intervals), and three times after they
received Wii Fit (posttest 1: immediately after; posttest 2: 7 weeks after; posttest 3: 14 weeks after).
Mobility, balance, strength, and weight were assessed at the first pretest, immediately prior to obtaining access to Wii Fit, and 7 weeks after obtaining access to Wii Fit. Results from the questionnaires
indicated that PA significantly improved at week 7, but at week 14, PA levels declined relative to week
7 and the difference was no longer significant compared with the control period. Physical assessments
indicated that balance and strength significantly improved at week 7. One adverse event was reported
(repetitive knee injury). Physical assessments indicated that people with MS may be able to improve
their fitness levels by using Wii Fit. Future studies should incorporate behavior change strategies to
promote long-term use of Wii Fit, and explore whether individuals with more severe symptoms of MS
can safely use Wii Fit.

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Active Video Gaming to Improve Balance in the Elderly

Studies in Health Technology and Informatics 2011;167:159-64.

Claudine J.C. Lamoth, Simone R. Caljouw, Klaas Postema


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ABSTRACT
The combination of active video gaming and exercise (exergaming) is suggested to improve elderly people's balance, thereby decreasing fall risk. Exergaming has been shown to increase motivation during exercise therapy, due to the enjoyable and challenging nature, which could support long-term adherence for exercising balance. However, scarce evidence is available of the direct effects of exergaming on postural control. Therefore, the aim of the study was to assess the effect of a six-week videogame-based exercise program aimed at improving balance in elderly people. Task performance and postural control were examined using an interrupted time series design. Results of multilevel analyses showed that performance on the dot task improved within the first two weeks of training. Postural control improved during the intervention. After the intervention period task performance and balance were better than before the intervention. Results of this study show that healthy elderly can benefit from a videogame-based exercise program to improve balance and that all subjects were highly motivated to exercise balance because they found gaming challenging and enjoyable.

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Energy expenditure in chronic stroke patients playing Wii Sports: a pilot study

Journal of Neuroengineering and Rehabililtation. 2011; 8: 38.
Published online 2011 July 14

Henri L Hurkmans, Gerard M Ribbers, Marjolein F Streur-Kranenburg, Henk J Stam, and Rita J van den Berg-Emons

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ABSTRACT:

BACKGROUND:

Stroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing.

METHODS:

Ten chronic (≥ 6 months) stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2) during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs), calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs) or vigorous (> 6 METs) according to the American College of Sports Medicine and the American Heart Association Guidelines.

RESULTS:

Among the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean (± SD) energy expenditure during Wii Sports game play was 3.7 (± 0.6) METs for tennis and 4.1 (± 0.7) METs for boxing. All 8 participants who played boxing and 6 of the 7 who played tennis attained energy expenditures > 3 METs.

CONCLUSIONS:

With the exception of one patient in the tennis group, chronic stroke patients played Wii Sports tennis and boxing at moderate-intensity, sufficient for maintaining and improving health in this population.

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Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: A pilot study

Lupus. 2011 Jun 23

Yuen H, Holthaus K, Kamen DL, Sword D, Breland HL.

University of Alabama at Birmingham, USA.

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Abstract

Fatigue and physical deconditioning are common, difficult to treat conditions among patients with systemic lupus erythematosus (SLE). The aim of this pilot study was to evaluate the effectiveness of a home-based exercise program using the Wii Fit system in patients with SLE. Fifteen sedentary African American women with SLE experiencing moderate to severe fatigue participated in a home exercise program using the Wii Fit 3 days a week for 30 minutes each for 10 weeks. A one-group pretest-post test design was used to evaluate the effectiveness of this program. Primary outcome measure was severity of fatigue. Secondary outcome measures were body weight, waist circumference, fatigue-related symptoms of distress, activity level, and physical fitness. At the completion of the 10-week Wii Fit exercise program, participants perceived fatigue severity as measured by the Fatigue Severity Scale to be significantly decreased (p= 0.002), and body weight and waist circumference were significantly reduced (pp= 0.01). In addition, anxiety level, as measured by Hospital Anxiety and Depression Scale, and overall intensity of total pain experience, as measured by Short-form of the McGill Pain Questionnaire, were also significantly reduced (p < 0.05). Findings provide preliminary evidence that the Wii Fit motivates this population to exercise, which leads to alleviation of fatigue and reduced body weight, waist circumference, anxiety level, and overall intensity of total pain experience.

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Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial

Trials. 2011; 12: 155.
Published online 2011 June 18

Boon Chong Kwok, Kaysar Mamun, Manju Chandran and Chek Hooi Wong

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Abstract

Background
Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo® Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo® Wii™ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline.

Methods
This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and non-fallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments.

Discussions
The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme.


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