Effects of Physical Exercise, Virtual Reality and Brain Exercise on Balance of the Elderly
Condition: Elderly
Study type: Interventional

Summary: 
      The objectives of this study were to 1) compare balance of the elderly by Berg Balance Scale
      (BBS) and Timed Up and Go Test (TUG) among physical exercise, virtual reality, brain exercise
      and control groups after intervention, 2) compare cognitive function of the elderly by using
      Timed Up and Go Cognitive (TUGC) and Montreal Cognitive Assessment (MoCA) among physical
      exercise, virtual reality, brain exercise and control groups after intervention, 3) compare
      muscle strength of elderly by 5 Times Sit-To-Stand Test (5TSTST) and Hand Grip Strength (HG)
      among physical exercise, virtual reality, brain exercise and control groups after
      intervention, 4) compare fear of falling by using Fall Efficacy Scale-International (FES-I)
      among physical exercise, virtual reality, brain exercise and control groups after
      intervention, 5)investigate the perspective of exercise among physical exercise, virtual
      reality, brain exercise and control groups after intervention.
    

Detailed description: 
      This study used healthy elderly participants with the age of 65-85 years. Eighty-four elderly
      participants were recruited by announcing the study information at the elderly homes. Sample
      size calculation was performed using G*Power software (G*Power version 3.1.9.2, University
      Kiel, Germany). To our knowledge, no study compare the effects of physical exercise, virtual
      reality and brain exercise on balance of the elders. Based on previous finding on the effects
      of virtual reality on balance of the elderly, a total of 84 participants were required at
      confidence level (α) of .05 and power (1-β) of 0.80. Participants who were interested in
      participation underwent a screening process using inclusion-exclusion criteria and receive
      brief information regarding the study. If they met all inclusion criteria, the consent
      process was performed. To ensure they understood the study, they were simply asked regarding
      the study (i.e. objectives, benefits, etc.) before signing the consent form.

      After the participants provided a written informed consent, all participants filled out the
      information sheet and demographic data were collected. After that, age matching with range of
      ± 5 years and random allocation to different studies groups were done. Pretest assessment for
      balance by BBS and TUG, cognitive function by TUGC and MOCA, muscle strength by 5 TSTST and
      Hand Grip Strength (HG) and fear of falling by FES-I and perspective of exercise by
      questionnaires were done and recorded by blinded assessor. In this study, random allocation
      of the participants to different study groups; physical exercise group (PE), virtual reality
      group (VR), brain exercise group (BE) and control group; was done by the medical doctor and
      intervention was given the physical therapist from the study area which is the elderly home.
      All the assessments were done by the principal researcher. The assessor was blinded to reduce
      the bias which might come from the assessor's expectation.

      After that, all the participants from intervention groups were explained and demonstrated
      about the respective interventions until they clearly understand about the intervention
      program before commencing the intervention program. The PE, VR and BE groups got their
      respective intervention for 30 minutes per sessions, 3 non-consecutive days per week for 8
      weeks. The control group was reminded not to participate in any other exercise or
      intervention program except their routine daily activities for 8 weeks. Participants from PE
      group needed to do the 5-minute warm-up, 20-minute core content (upper and lower limb
      strengthening exercises and balance challenging exercises), and 5-minute cool down exercise
      programs. For the virtual reality group, the participants were reminded to play the game
      according to the program and try to get as high a score as possible they can. This
      intervention program included 10 games. The participants were asked to choose 6 games from
      the list before each 30-minute session, and were asked to choose the games to include the
      upper limbs, lower limbs, and also for both strength and balance challenges instead of
      choosing the games that need to use only upper limbs or lower limbs, and were just for
      strength and balance gain. For the brain exercise, participants needed to play cognitive
      stimulating games; Chinese Checker, Jenga and Memory Matched pair game; in the sitting
      position. The participants needed to paly 10 minutes for each game and total duration for all
      3 games was about 30 minutes. After 8-week study period, post-test assessments were done to
      find out the effect of interventions.

      The statistical analyses were performed by using SPSS for windows version 18.0, statistical
      software package. The value of p<0.05 was considered to indicate statistical significance. As
      the objective of this study was to find out the effects of PE, VR and BE on balance,
      cognitive function, muscle strength and fear of falling in the elderly. Two-way mixed ANOVA
      was used to test the variance differences among the four groups with post-hoc analysis as
      appropriately. Prior to utilization of statistical tests, descriptive statistics were
      performed and statistical assumptions were tested. Transformation will be performed if the
      data were not normally distributed. Appropriate statistical tests (parametric vs.
      non-parametric) were performed to determine the effects of different interventions in this
      study on balance, cognitive function, muscle strength and fear of falling in the elderly.
      Post-hoc power analysis was also performed.
    

Intervention name(s): Physical Exercise; Virtual Reality; Brain Exercise
Intervention type(s): Other; Other; Other
Intervention description(s): Participants were trained by exercise program based on their initial muscle strength and balance condition.
They received a 30-minute exercise for 3sessions per week for 8 weeks in this study.; Participants were trained with the guidance of VR system.The participants will be asked to choose 6 games from the list before each 30-minute session, and were asked to choose the games to include the upper limbs, lower limbs, and also for both strength and balance challenges instead of choosing the games that need to use only upper limbs or lower limbs, and only for strength or balance gain.
They received a 30-minute exercise for 3sessions per week for 8 weeks in this study.; Brain Exercise (BE) BE stimulates the executive function, planning, concentration, visual memory and eye-hand co-ordination of the participants throughout the training.For the brain exercise, participants needed to play cognitive stimulating games; Chinese Checker, Janga and Memory Matched pair game; in the sitting position. The participants needed to paly 10 minutes for each gamed and total duration of all 3 games was about 30 minutes in each session for 3sessions per week for 8 weeks in this study.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Balance; Cognition; Exercise