Wii Fit Helps Reduce Risk for Falls in Alzheimer's Patients?

Jenni Laidman

July 06, 2012

July 6, 2012 — Regular Wii Fit (Nintendo) workouts proved as effective as a robust walking routine in reducing the risk for falling in elderly people with mild Alzheimer's disease (AD), a small study published online June 13 in the Journal of Aging Research showed.

Kalpana P. Padala, MD, assistant professor, Donald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, and colleagues assessed fall risk with 3 tests of balance and gait in 22 elderly people enrolled in 1 of 2 exercise interventions. Eleven participants were assigned to a supervised walking program, and 11 used the Wii Fit yoga, strength-training, and balance games. Each group exercised 5 times weekly for 30 minutes over 8 weeks.

The participants were tested with the Berg Balance Scale (BBS), the Tinetti Test (TT), and Timed Up and Go (TUG) test before they began exercising, at the 4-week point, and after 8 weeks. Research participants lived in an assisted-living facility.

Both groups showed improvements on all 3 tests, with no statistically significant difference between the groups. Both groups began with a BBS score of less than 45, indicating a high risk for falls, and significantly improved those scores over time (P = .0001). But group-by-time interactions failed to reach significance for any measure: TT (P = .97), TUG (P = .52), and BBS (P = .56).

In an intragroup analysis, at 8 weeks the Wii Fit group showed statistically significant improvements in BBS (average improvement, 6.27 ± 5.27; P = .003) and TT (average improvement, 1.82 ± 2.04; P = .013) scores. Wii Fit TUG scores did not reach significance (average improvement, -0.82 ± 2.56; P = .31).

In the walking group, an intragroup analysis showed a significant improvement in TT scores (average improvement, 2.0 ± 1.89; P = .006); however, although BBS and TUG scores trended toward improvement, they failed to reach statistical significance (average improvements, respectively, of 5.27 ± 7.36 [P = .06] and -2.1 ± 3.45 [P = .07]).

In terms of group-by-time interactions, neither walking nor Wii Fit was superior for the trial's secondary endpoints, which measured activities of daily living (P = .11), instrumental activities of daily living (P = .11), quality of life (P = .61), and cognition per the Mini-Mental State Examination (P = .7).

However, intragroup analysis showed significant improvements in quality of life for the walking group (P = .03).

Interpretation of Data Limited

"This is really a relatively limited observation about the influence of these interventions on walking and balance," said Robert P. Friedland, MD, chair and professor of neurology, University of Louisville, Kentucky, who was not involved in the study. "I wouldn't say [the study] added much."

Dr. Friedland told Medscape Medical News that although balance is typically not a problem in mild AD, it was probably the mean age of the study cohort — 79.3 ± 9.8 (standard deviation) years for the Wii Fit group and 81.6 ± 5.2 years for the walking group — that led to the balance issues.

The study authors write, “This study shows that the use of Wii Fit is feasible in an assisted living environment in elderly patients with mild dementia."

Several previous small studies have reached similar conclusions and showed improvements in balance and walking speed, as well as a decreased risk for falling, the researchers report.

"Our study is different from the above-mentioned studies in that we had a robust arm of a monitored walking program," the authors write.

In addition, they continue, this study had people walk with research personnel, ensuring greater exercise compliance than previously seen.

The study limitations include the small sample size and use of BBS as the primary outcome measure. The latter is a limitation because the scale is "prone to a ceiling effect," the authors explain. In addition, the assessors were not blinded, there was no usual-care control group, and there was a high level of staff involvement.

"This pilot study demonstrates the safety and efficacy of using Wii Fit in an assisted living facility in subjects with mild AD," the authors conclude. "Use of Wii Fit resulted in significant improvements in balance and gait, and these benefits were comparable to those experienced by the subjects who participated in the robust monitored walking program. These results need to be confirmed in a larger, methodologically sound study."

The study was funded by the 2009 AMDA Foundation/Pfizer Quality Improvement Award and Alzheimer’s Association New Investigator Award. The authors and Dr. Friedland have disclosed no relevant financial relationships.

Aging Res. Published online June 13. Abstract

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