Restricted accessResearch articleFirst published online 2023-10
Physical and Affective Physical Literacy Domains Improved After a Six-Week Exergame Exercise Program in Older Adults: A Randomized Controlled Clinical Trial
We investigated the effects of an exergames-based exercise program for older adults, and its benefits on their physical literacy (PL) domains, such as physical (mobility skills), affective (motivation and confidence), cognitive (knowledge about physical activity [PA]), and behavioral (daily exertion) when compared with a conventional exercise program and no training (NT) (control).
Material and Methods:
Forty older adults (mean age 72 years) volunteered and were randomized within three groups—exergame training (ET; n = 15), conventional training (CT; n = 14), and NT (n = 11). ET group performed training sessions based on a commercially available exergame console, while the CT group enrolled in a convention exercise program (aerobic, strength, balance, and flexibility exercises). The training program was conducted three times a week for 6 weeks. The Timed Up and Go Test (TUG), Exercise Confidence Survey (ECS), Motives for Physical Activity Measure-Revised (MPAM-R), Knowledge and Understanding Questionnaire (K&UQ), and total PA tracking (using wearable technology) were used as the study's outcomes. Outcome variables were measured at preintervention (week 0), postintervention (week 6), and at the time of final follow-up (week 9).
Results:
We observed a reduction in the ET TUG time at postintervention and follow-up. Also, a significant main effect for group and moment of measurement was observed for the Fitness-Health subscore, derived from MPAM-R. The values demonstrated by ET and CT were statistically different (P = 0.01) and a within-group comparison revealed significant differences in the ET from preintervention to both postintervention and follow-up (both, P = 0.01). We did not observe any other significant difference.
Conclusion:
Our results suggest that a 6-week exergame-based training program may have the potential in improving the physical and affective domains of PL in community-dwelling older adults. The topics related to fitness and health seem to be of interest in this population and programs can make use of them to improve the PL domains.
BriggsAM, CrossMJ, HoyDG, et al.Musculoskeletal health conditions represent a global threat to healthy aging: A report for the 2015 World Health Organization world report on ageing and health. Gerontologist, 2016; 56(suppl_2):S243–S255.
3.
RossiniPM, RossiS, BabiloniC, et al.Clinical neurophysiology of aging brain: From normal aging to neurodegeneration. Prog Neurobiol, 2007; 83(6):375–400.
4.
DemnitzN, HoganDB, DawesH, et al.Cognition and mobility show a global association in middle-and late-adulthood: Analyses from the Canadian Longitudinal Study on Aging. Gait Post, 2018; 64:238–243.
5.
SunF, NormanIJ, WhileAE. Physical activity in older people: A systematic review. BMC Public Health, 2013; 13(1):449.
6.
MichelJ-P, DreuxC, VacheronA. Healthy ageing: Evidence that improvement is possible at every age. Eur Geriatr Med, 2016; 7(4):298–305.
7.
BuchnerDM, BeresfordSA, LarsonEB, et al.Effects of physical activity on health status in older adults II: Intervention studies. Ann Rev Public Health, 1992; 13(1):469–488.
8.
LelardT, AhmaidiS. Effects of physical training on age-related balance and postural control. Neurophysiol Clin Neurophysiol, 2015; 45(4–5):357–369.
9.
JiL, PearlsonGD, ZhangX, et al.Physical exercise increases involvement of motor networks as a compensatory mechanism during a cognitively challenging task. Int J Geriatr Psychiatry, 2018; 33(8):1153–1159.
10.
HallalPC, AndersenLB, BullFC, et al.Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet, 2012; 380(9838):247–257.
11.
CheungC, TalleyK, McMahonS, et al.Knowledge of physical activity guidelines and its association with physical activity and physical function in older adults. Activ Adapt Aging, 2020; 44(2):106–118.
12.
SchutzerKA, GravesBS. Barriers and motivations to exercise in older adults. Prev Med, 2004; 39(5):1056–1061.
13.
De GrootGCL, FagerströmL. Older adults' motivating factors and barriers to exercise to prevent falls. Scand J Occup Ther, 2011; 18(2):153–160.
14.
ChaudhuryH, CampoM, MichaelY, et al.Neighbourhood environment and physical activity in older adults. Soc Sci Med, 2016; 149:104–113.
15.
McGowanLJ, Devereux-FitzgeraldA, PowellR, et al.How acceptable do older adults find the concept of being physically active? A systematic review and meta-synthesis. Int Rev Sport Exer Psychol, 2018; 11(1):1–24.
16.
JacobsPL.NSCA's Essentials of Training Special Populations. Human Kinetics: Champaign, IL, USA; 2017.
17.
CaspersenCJ, PowellKE, ChristensonGM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep, 1985; 100(2):126.
18.
WhiteheadM. The definition of physical literacy. 2014. Available from: www.physical-literacy.org.uk [Last accessed: August19, 2019].
19.
LoitzC. The importance of lifelong physical literacy. Alberta Centre for Active Living—Research and Education for the Promotion of Physical Activity Well Spring: Sharing Physical Activity Knowledge, 2013; 24:50–53.
20.
JonesGR, StathokostasL, YoungBW, et al.Development of a physical literacy model for older adults–a consensus process by the collaborative working group on physical literacy for older Canadians. BMC Geriatr, 2018; 18(1):13.
21.
MandigoJ, FrancisN, LodewykK, et al.Physical literacy for educators. Phys Health Educ J, 2009; 75(3):27–30.
22.
PawMJCA, ChinA, van UffelenJG, et al.The functional effects of physical exercise training in frail older people. Sports Med, 2008; 38(9):781–793.
23.
TheouO, StathokostasL, RolandKP, et al.The effectiveness of exercise interventions for the management of frailty: A systematic review. J Aging Res, 2011; 2011:569194.
24.
GillespieLD, GillespieWJ, RobertsonMC, et al.Interventions for preventing falls in elderly people. Cochrane Database Syst Rev, 2003; 4:1–13.
25.
RobitailleY, LaforestS, FournierM, et al.Moving forward in fall prevention: An intervention to improve balance among older adults in real-world settings. Am J Public Health, 2005; 95(11):2049–2056.
26.
DograS, StathokostasL. Sedentary behavior and physical activity are independent predictors of successful aging in middle-aged and older adults. J Aging Res, 2012; 2012:190654.
27.
ChaoY-Y, SchererYK, MontgomeryCA. Effects of using Nintendo Wii™ exergames in older adults: A review of the literature. J Aging Health Promot Perspect, 2015; 27(3):379–402.
28.
HasselmannV, OeschP, Fernandez-LuqueL, et al.Are exergames promoting mobility an attractive alternative to conventional self-regulated exercises for elderly people in a rehabilitation setting? Study protocol of a randomized controlled trial. BMC Geriatr, 2015; 15(1):108.
29.
RavenekKE, WolfeDL, HitzigSL. A scoping review of video gaming in rehabilitation. Disabil Rehabil, 2016; 11(6):445–453.
30.
Gallardo-MezaC, SimonK, Bustamante-AraN, et al.Effects of 4 weeks of active exergames training on muscular fitness in elderly women. J Strength Condition Res, 2022; 36(2):427–432.
31.
BrooksAL, BrahnamS, KapralosB, et al.An Overview of Recent Advances in Technologies of Inclusive Well-Being. In: Recent Advances in Technologies for Inclusive Well-Being. Springer: Midtown Manhattan, New York City; 2017; pp. 1–11.
32.
PeetoomKK, LexisMA, JooreM, et al.Literature review on monitoring technologies and their outcomes in independently living elderly people. Disabil Rehabil, 2015; 10(4):271–294.
33.
KimK-i, GollamudiSS, SteinhublS. Digital technology to enable aging in place. Exp Gerontol, 2017; 88:25–31.
34.
YuT-C, ChiangC-H, WuP-T, et al.Effects of exergames on physical fitness in middle-aged and older adults in Taiwan. Int J Environ Res Public Health, 2020; 17(7):2565.
35.
CherniackEP. Not just fun and games: Applications of virtual reality in the identification and rehabilitation of cognitive disorders of the elderly. Disabil Rehabil, 2011; 6(4):283–289.
36.
YardleyL, Donovan-HallM, FrancisK, et al.Older people's views of advice about falls prevention: A qualitative study. Health Educ Res, 2006; 21(4):508–517.
37.
CampeloAM, KatzL. Older adults' perceptions of the usefulness of technologies for engaging in physical activity: Using focus groups to explore physical literacy. Int J Environ Res Public Health, 2020; 17(4):1144.
38.
Van DiestM, LamothCJ, StegengaJ, et al.Exergaming for balance training of elderly: State of the art and future developments. J Neuroeng Rehabil, 2013; 10(1):101.
39.
BierylaKA, DoldNM. Feasibility of Wii Fit training to improve clinical measures of balance in older adults. Clin Interven Aging, 2013; 8:775.
40.
JorgensenMG, LaessoeU, HendriksenC, et al.Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: A randomized controlled trial. J Gerontol Series A, 2012; 68(7):845–852.
41.
LarsenLH, SchouL, LundHH, et al.The physical effect of exergames in healthy elderly—A systematic review. Games Health, 2013; 2(4):205–212.
42.
MaillotP, PerrotA, HartleyA. Effects of interactive physical-activity video-game training on physical and cognitive function in older adults. Psychol Aging, 2012; 27(3):589.
43.
SkjæretN, NawazA, MoratT, et al.Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy. Int J Med Inform, 2016; 85(1):1–16.
44.
ACSM ACoSM. Guidelines for Exercise Testing and Prescription. Williams & Wilkins: Philadelphia, USA; 2013.
45.
BorsonS, ScanlanJM, ChenP, et al.The Mini-Cog as a screen for dementia: Validation in a population-based sample. J Am Geriatr Soc, 2003; 51(10):1451–1454.
46.
Shumway-CookA, BrauerS, WoollacottM. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther, 2000; 80(9):896.
47.
MedleyA, ThompsonM. Usefulness of variations of the Timed Up and Go in apparently healthy individuals. Phys Occup Ther Geriatr, 2005; 23(4):1–23.
48.
SallisJF, PinskiRB, GrossmanRM, et al.The development of self-efficacy scales for healthrelated diet and exercise behaviors. Health Educ Res, 1988; 3(3):283–292.
49.
ResnickB, JenkinsLS. Testing the reliability and validity of the self-efficacy for exercise scale. Nurs Res, 2000; 49(3):154–159.
50.
MorrowJR, Krzewinski-MaloneJA, JacksonAW, et al.American adults' knowledge of exercise recommendations. Res Quarter Exer Sports Med, 2004; 75(3):231–237.
51.
HuiSSC, MorrowJR. Level of participation and knowledge of physical activity in Hong Kong Chinese adults and their association with age. J Aging Phys Act, 2001; 9(4):372–385.
52.
RyanRM, FrederickCM, LepesD, et al.Intrinsic motivation and exercise adherence. Int J Sport Psychol, 1997; 28(4):335–354.
53.
WeisbergA, CampeloAM, BhaidaniT, et al.Physical activity tracking wristbands for use in research with seniors: An overview and recommendations. J Measure Phys Behav, 2020; 3(4):265–273.
54.
RedeniusN, KimY, ByunW. Concurrent validity of the Fitbit for assessing sedentary behavior and moderate-to-vigorous physical activity. BMC Med Res Methodol, 2019; 19(1):29.
55.
KisnerC, ColbyLA, BorstadJ. Therapeutic Exercise: Foundations and Techniques. Fa Davis: Philadelphia, Pennsylvania, USA; 2017.
56.
CookTD, CampbellDT. Quasi-Experimentation: Design and Analysis Issues for Field Settings. Houghton Mifflin: Boston, Massachusetts, USA; 1979.
57.
SinghDKA, SanNE, PingNC, et al.Mobility and fear of falls measuring tools to predict falls risk among malaysian community dwelling older adults. J Sains Kesihatan Malaysia, 2018; 16:101.
58.
KwokBC, PuaYHJA, ageing. Effects of WiiActive exercises on fear of falling and functional outcomes in community-dwelling older adults: A randomised Control Trial. 2016; 45(5):621–627.
59.
Orsega-SmithEM, KalksmaPJ, HarrisW, et al.Older adults and exergames olympics: Feasibility and fun. Activities Adapt Aging, 2021; 45:1–17.
60.
HwangM-Y, HongJ-C, JongJ-T, et al.From Fingers to Embodiment: A Study on the Relations of the Usability, Dependability of the Embodied Interactive Video Games and the Elders' Flow Experience. Springer: Champaign, IL, USA; 2009.
61.
WilliamsMA, SoizaRL, JenkinsonAM, et al.EXercising with C omputers in L ater L ife (EXCELL)-pilot and feasibility study of the acceptability of the Nintendo® WiiFit in community-dwelling fallers. BMC Res Notes, 2010; 3(1):238.
62.
DerakhshanradSA, PivenE, GhoochaniBZ. A cross-sectional study to investigate motivation for physical activity in a sample of Iranian community-dwelling older adults. Health Promot Perspect, 2020; 10(2):135.
63.
LoosE.Exergaming: Meaningful Play for Older Adults? Springer: Champaign, IL, USA; 2017.
64.
FitzgeraldD, TrakarnratanakulN, SmythB, et al.Effects of a wobble board-based therapeutic exergaming system for balance training on dynamic postural stability and intrinsic motivation levels. J Orthopaed Sports Phys Ther, 2010; 40(1):11–19.
65.
TaylorLM, KerseN, FrakkingT, et al.Active video games for improving physical performance measures in older people: A meta-analysis. J Geriatr Phys Ther, 2018; 41(2):108.
66.
SmithST, SchoeneD. The use of exercise-based videogames for training and rehabilitation of physical function in older adults: Current practice and guidelines for future research. Aging Health, 2012; 8(3):243–252.
67.
ChatzisarantisNL, HaggerMS, BiddleSJ, et al.The cognitive processes by which perceived locus of causality predicts participation in physical activity. J Health Psychol, 2002; 7(6):685–699.
68.
HaggerMS, ArmitageCJ. The influence of perceived loci of control and causality in the theory of planned behavior in a leisure-time exercise context. J Appl Biobehav Res, 2004; 9(1):45–64.
69.
HaggerMS, ChatzisarantisNL, CulverhouseT, et al.The processes by which perceived autonomy support in physical education promotes leisure-time physical activity intentions and behavior: A trans-contextual model. J Educ Psychol, 2003; 95(4):784.
70.
HaggerMS, ChatzisarantisNL, HarrisJ. From psychological need satisfaction to intentional behavior: Testing a motivational sequence in two behavioral contexts. Personal Soc Psychol Bullet, 2006; 32(2):131–148.
71.
LiJ, LiC, ChiaBX, et al.Exergaming as a community program for older adults: The effects of social interaction and competitive information. J Aging Phys Act, 2020; 29(3):466–474.
72.
McPhateL, SimekEM, HainesTP. Program-related factors are associated with adherence to group exercise interventions for the prevention of falls: A systematic review. J Physiother, 2013; 59(2):81–92.
73.
SimekEM, McPhateL, HainesTP. Adherence to and efficacy of home exercise programs to prevent falls: A systematic review and meta-analysis of the impact of exercise program characteristics. Prev Med, 2012; 55(4):262–275.
74.
NymanSR, VictorCR. Older people's participation in and engagement with falls prevention interventions in community settings: An augment to the Cochrane systematic review. Age Ageing, 2012; 41(1):16–23.
75.
RosenbergD, DeppCA, VahiaIV, et al.Exergames for subsyndromal depression in older adults: A pilot study of a novel intervention. Am J Geriatr Psychiatry, 2010; 18(3):221–226.
76.
KonstantinidisEI, BillisAS, MouzakidisCA, et al.Design, implementation, and wide pilot deployment of FitForAll: An easy to use exergaming platform improving physical fitness and life quality of senior citizens. IEEE J Biomed Health Inform, 2014; 20(1):189–200.
77.
WhiteheadM.Physical Literacy: Throughout the Lifecourse. Routledge: Abingdon, England, UK; 2010.
78.
SumK-WR, LiM-H, ChoiS-M, et al.In/visible physical education and the public health agenda of physical literacy development in Hong Kong. Int J Environ Res Public Health, 2020; 17(9):3304.
79.
EdwardsLC, BryantAS, KeeganRJ, et al.Definitions, foundations and associations of physical literacy: A systematic review. Sports Med, 2017; 47(1):113–126.
80.
BabakM, MajidB, RashidH, et al.The factors in older adults' health literacy in the field of physical activity: A qualitative study. BMC Geriatr, 2022; 22(1):630.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
