List of abbreviations:AVG (active video games), CI (confidence interval), CMA (Comprehensive Meta-Analysis), CoM (center of mass), CoP (center of pressure), GRADE (Grading of Recommendations Assessment Development and Evaluation), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses), PROSPERO (International Prospective Register of Systematic Reviews), SMD (standardized mean differences), TUG (Time-up-and-go test), US (United States), VRT (virtual reality training)
General Selection Criteria
Search Procedure and Materials
|SECTION & TOPIC||ITEM||CHECKLIST ITEM||LOCATION WHERE ITEM IS REPORTED|
|Title||1||Identify the report as a systematic review.||1|
|Abstract||2||See the PRISMA 2020 for Abstracts checklist||1|
|Rationale||3||Describe the rationale for the review in the context of existing knowledge.||4-7|
|Objectives||4||Provide an explicit statement of the objective(s) or question(s) the review addresses.||7|
|Eligibility criteria||5||Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses.||7-8|
|Information sources||6||Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted.||9-10|
|Search strategy||7||Present the full search strategies for all databases, registers and websites, including any filters and limits used.||9, Supplementary Material I|
|Selection process||8||Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.||10-12|
|Data collection process||9||Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.||10-12|
|Data items||10a||List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g. for all measures, time points, analyses), and if not, the methods used to decide which results to collect.||10-12|
|10b||List and define all other variables for which data were sought (e.g. participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information.||8-12|
|Study risk of bias assessment||11||Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.||11-12|
|Effect measures||12||Specify for each outcome the effect measure(s) (e.g. risk ratio, mean difference) used in the synthesis or presentation of results.||12-13|
|Synthesis methods||13a||Describe the processes used to decide which studies were eligible for each synthesis (e.g. tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).||10-13|
|13b||Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions.||10-13|
|13c||Describe any methods used to tabulate or visually display results of individual studies and syntheses.||10-13|
|13d||Describe any methods used to synthesise results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.||10-13|
|13e||Describe any methods used to explore possible causes of heterogeneity among study results (e.g. subgroup analysis, metaregression).||12-13|
|13f||Describe any sensitivity analyses conducted to assess robustness of the synthesised results.||10-13|
|Reporting bias assessment||14||Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).||11-12|
|Certainty assessment||15||Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome.||10-13|
|Study selection||16a||Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.||9-10, 13|
|16b||Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.||n/a|
|Study characteristics||17||Cite each included study and present its characteristics.||Supplementary Material II|
|Risk of bias in studies||18||Present assessments of risk of bias for each included study.||15-16|
|Results of individual studies||19||For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g. confidence/credible interval), ideally using structured tables or plots.||13-15, 16-18|
|Results of synthesis||20a||For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies.||15-16|
|20b||Present results of all statistical syntheses conducted. If meta-analysis was done, present for each the summary estimate and its precision (e.g. confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect.||18-24|
|20c||Present results of all investigations of possible causes of heterogeneity among study results.||18-24|
|20d||Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results.||10-13, Supplementary Material III|
|Reporting biases||21||Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed.||23-24|
|Certainty of evidence||22||Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed.||18-24|
|Discussion||23a||Provide a general interpretation of the results in the context of other evidence.||24-28|
|23b||Discuss any limitations of the evidence included in the review.||28-30|
|23c||Discuss any limitations of the review processes used.||28-30|
|23d||Discuss implications of the results for practice, policy, and future research.||30|
|Registration and protocol||24a||Provide registration information for the review, including register name and registration number, or state that the review was not registered.||1|
|24b||Indicate where the review protocol can be accessed, or state that a protocol was not prepared.||1|
|24c||Describe and explain any amendments to information provided at registration or in the protocol.||n/a|
|Support||25||Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review.||Title page|
|Competing interests||26||Declare any competing interests of review authors.||Title page|
|Availability of data, code and other materials||27||Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review.||Title page|
|PRISMA 2020 for Abstract checklist|
|SECTION & TOPIC||ITEM||CHECKLIST ITEM||REPORTED ON PAGE #|
|Title||1||Identify the report as a systematic review.||1|
|Objectives||2||Provide an explicit statement of the main objective(s) or question(s) the review addresses.||1|
|Eligibility criteria||3||Specify the inclusion and exclusion criteria for the review.||1|
|Information sources||4||Specify the information sources (e.g. databases, registers) used to identify studies and the date when each was last searched.||1|
|Risk of bias||5||Specify the methods used to assess risk of bias in the included studies.||1|
|Synthesis of results||6||Specify the methods used to present and synthesise results.||1|
|Included studies||7||Give the total number of included studies and participants and summarise relevant characteristics of studies.||1|
|Synthesis of results||8||Present results for main outcomes, preferably indicating the number of included studies and participants for each. If meta-analysis was done, report the summary estimate and confidence/credible interval. If comparing groups, indicate the direction of the effect (i.e. which group is favoured).||1|
|Limitations of evidence||9||Provide a brief summary of the limitations of the evidence included in the review (e.g. study risk of bias, inconsistency and imprecision).||1|
|Interpretation||10||Provide a general interpretation of the results and important implications.||1|
|Funding||11||Specify the primary source of funding for the review.||Title page|
|Registration||12||Provide the register name and registration number.||1|
Data Extraction and Content Coding
Evaluation of Study Quality
Samples and Settings
Risk of Bias in Individual Studies
|1||Questionnaire/Clinical Scores||Experimenter/clinician/therapist measures a range of functional behaviors using an integer score that is compared to normative data; standardized questionnaires include self-report or reports by caregivers|
|2||Functional Balance||Functional balance, including walk and turn, sit and stand, etc., measured using simple quantitative metrics, e.g., seconds, distance reached, number of repetitions|
|3||Functional Balance+||More complex functional balance involving head turns or dual cognitive tasks measured using simple quantitative metrics|
|4||Posturography||Fine-grained quantitative measures of static balance via center of pressure (CoP) or center of mass (CoM) assessed by force plates, usually with eyes open or eyes closed|
|5||Posturography+||Fine-grained quantitative measures of static balance via center of pressure (CoP) or center of mass (CoM) during dynamic balance tasks guided by videos quantified by force plates (CoP) typically provided by AVGs|
Risk of Publication Bias
Scope and impact of this meta-analysis
Benefits for different medical conditions
Comment on intervention length
Tailoring of AVGs in collaboration between scientists, healthcare providers and developers
Conclusion and Open Questions
- 1Cairns, P., et al., Future design of accessibility in games: A design vocabulary. International Journal of Human-Computer Studies, 2019. 131: p. 64-71.
- 2Oh, Y. and S. Yang. Defining exergames & exergaming. in Meaningful Play. 2010. East Lansing, MI.
- 3Hansen, L. The evolution of fitness: Exergaming defined. 2007 [cited 2022 August 15]; Available from: https://clubsolutionsmagazine.com/2007/11/the-evolution-of-fitness-exergaming-defined/.
- 4Alves, M.L.M., et al., Nintendo Wii™ Versus Xbox Kinect™ for Assisting People With Parkinson's Disease. Perceptual and Motor Skills, 2018. 125(3): p. 546-565.
- 5Skelton, D.A. and A. Mavroeidi, How do muscle and bone strengthening and balance activities (MBSBA) vary across the life course, and are there particular ages where MBSBA are most important? J Frailty Sarcopenia Falls, 2018. 3(2): p. 74-84.
- 6Ragnarsdóttir, M., The Concept of Balance. Physiotherapy, 1996. 82(6): p. 368-375.
- 7James, S.L., et al., The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Injury Prevention, 2020. 26(Suppl 2): p. i3-i11.
- 8Pelicioni, P.H.S., et al., Falls in Parkinson's Disease Subtypes: Risk Factors, Locations and Circumstances. Int J Environ Res Public Health, 2019. 16(12).
- 9Peterson, E.W., et al., Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil, 2008. 89(6): p. 1031-7.
- 10Matsuda, P.N., et al., Falls in multiple sclerosis. Pm r, 2011. 3(7): p. 624-32; quiz 632.
- 11Kerse, N., et al., Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke, 2008. 39(6): p. 1890-3.
- 12Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. 2016 [cited 2016 August 5]; Available from: http://www.cdc.gov/injury/wisqars.
- 13Wonder, C. National Vital Statistics System – Mortality data. 2020 [cited 2022 November 2]; Available from: https://wonder.cdc.gov/controller/saved/D76/D266F025.
- 14Khavinson, V., I. Popovich, and O. Mikhailova, Towards realization of longer life. Acta Biomedica Atenei Parmensis, 2020. 91(3): p. e2020054.
- 15Shubert, T.E., Evidence-based exercise prescription for balance and falls prevention: a current review of the literature. J Geriatr Phys Ther, 2011. 34(3): p. 100-8.
- 16Bond, S., et al., Exergaming and Virtual Reality for Health: Implications for Cardiac Rehabilitation. Current Problems in Cardiology, 2021. 46(3): p. 100472.
- 17Donath, L., R. Rössler, and O. Faude, Effects of Virtual Reality Training (Exergaming) Compared to Alternative Exercise Training and Passive Control on Standing Balance and Functional Mobility in Healthy Community-Dwelling Seniors: A Meta-Analytical Review. Sports Med, 2016. 46(9): p. 1293-309.
- 18Primack, B.A., et al., Role of video games in improving health-related outcomes: a systematic review. American journal of preventive medicine, 2012. 42(6): p. 630-638.
- 19Hammami, A., et al., Physical activity and coronavirus disease 2019 (COVID-19): specific recommendations for home-based physical training. Managing Sport and Leisure, 2022. 27(1-2): p. 26-31.
- 20Entertainment Software Association. 2020 Essential Facts about the Computer and Video Game Industry 2020 [cited 2022 January 2]; Available from: https://www.theesa.com/wp-content/uploads/2021/03/Final-Edited-2020-ESA_Essential_facts.pdf.
- 21Wu, J., P.D. Loprinzi, and Z. Ren, The Rehabilitative Effects of Virtual Reality Games on Balance Performance among Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health, 2019. 16(21).
- 22Taylor, L.M., et al., Active Video Games for Improving Physical Performance Measures in Older People: A Meta-analysis. J Geriatr Phys Ther, 2018. 41(2): p. 108-123.
- 23Pope, Z., N. Zeng, and Z. Gao, The effects of active video games on patients' rehabilitative outcomes: a meta-analysis. Preventive medicine, 2017. 95: p. 38-46.
- 24Suleiman-Martos, N., et al., Effects of active video games on physical function in independent community-dwelling older adults: A systematic review and meta-analysis. J Adv Nurs, 2022. 78(5): p. 1228-1244.
- 25Hocking, D.R., et al., Do Active Video Games Improve Motor Function in People With Developmental Disabilities? A Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil, 2019. 100(4): p. 769-781.
- 26Pacheco, T.B.F., et al., Effectiveness of exergames for improving mobility and balance in older adults: a systematic review and meta-analysis. Syst Rev, 2020. 9(1): p. 163.
- 27Chen, Y., et al., Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis. J Neuroeng Rehabil, 2021. 18(1): p. 164.
- 28Howes, S.C., et al., Gaming for Health: Systematic Review and Meta-analysis of the Physical and Cognitive Effects of Active Computer Gaming in Older Adults. Phys Ther, 2017. 97(12): p. 1122-1137.
- 29Liberati, A., et al., The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 2009. 339: p. b2700.
- 30Podsiadlo, D. and S. Richardson, The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 1991. 39(2): p. 142-8.
- 31Higgins, J.P. and S.G. Thompson, Quantifying heterogeneity in a meta-analysis. Stat Med, 2002. 21(11): p. 1539-58.
- 32Borenstein, M., et al., Introduction to meta-analysis. 2021: John Wiley & Sons.
- 33Egger, M., et al., Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997. 315(7109): p. 629-634.
- 34Kim, J.H., et al., Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study. American Journal of physical medicine & rehabilitation, 2009. 88(9): p. 693-701.
- 35Lu, A.S., Narrative in exergames: Thoughts on procedure, mechanism, and others. Games for Health Journal, 2015. 4(1): p. 19-24.
- 36Kerber, K.A., et al., Dizziness Symptom Type Prevalence and Overlap: A US Nationally Representative Survey. The American Journal of Medicine, 2017. 130(12): p. 1465.e1-1465.e9.
- 37Li, C.M., et al., Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based Study. J Pediatr, 2016. 171: p. 240-7.e1-3.
- 38Park, S.-W., T. Dijkstra, and D. Sternad, Learning to never forget—time scales and specificity of long-term memory of a motor skill. Frontiers in Computational Neuroscience, 2013. 7.
- 39Adcock, M., et al., Effects of an In-home Multicomponent Exergame Training on Physical Functions, Cognition, and Brain Volume of Older Adults: A Randomized Controlled Trial. Frontiers in Medicine, 2020. 6: p. 321.
- 40AlSaif, A.A. and S. Alsenany, Effects of interactive games on motor performance in children with spastic cerebral palsy. J Phys Ther Sci, 2015. 27(6): p. 2001-3.
- 41Anson, E., et al., Trunk motion visual feedback during walking improves dynamic balance in older adults: Assessor blinded randomized controlled trial. Gait & posture, 2018. 62: p. 342-348.
- 42Bang, Y.S., K.H. Son, and H.J. Kim, Effects of virtual reality training using Nintendo Wii and treadmill walking exercise on balance and walking for stroke patients. J Phys Ther Sci, 2016. 28(11): p. 3112-3115.
- 43Barcala, L., et al., Visual biofeedback balance training using wii fit after stroke: a randomized controlled trial. Journal of physical therapy science, 2013. 25(8): p. 1027-1032.
- 44Barry, G., et al., Exergaming (XBOX Kinect™) versus traditional gym-based exercise for postural control, flow and technology acceptance in healthy adults: a randomised controlled trial. BMC sports science, medicine & rehabilitation, 2016. 8(1): p. 25.
- 45Cai, H., et al., Effect of Low-Intensity, Kinect™-Based Kaimai-Style Qigong Exercise in Older Adults With Type 2 Diabetes. J Gerontol Nurs, 2019. 45(2): p. 42-52.
- 46Chao, Y.-Y., et al., Physical and psychosocial effects of Wii Fit exergames use in assisted living residents: a pilot study. Clinical nursing research, 2015. 24(6): p. 589-603.
- 47Chen, C.L., et al., Muscle strength enhancement following home-based virtual cycling training in ambulatory children with cerebral palsy. Res Dev Disabil, 2012. 33(4): p. 1087-94.
- 48Cho, G.H., G. Hwangbo, and H.S. Shin, The Effects of Virtual Reality-based Balance Training on Balance of the Elderly. J Phys Ther Sci, 2014. 26(4): p. 615-7.
- 49Cho, H. and K.Y. Sohng, The effect of a virtual reality exercise program on physical fitness, body composition, and fatigue in hemodialysis patients. J Phys Ther Sci, 2014. 26(10): p. 1661-5.
- 50Cho, K.H., K.J. Lee, and C.H. Song, Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. Tohoku J Exp Med, 2012. 228(1): p. 69-74.
- 51Choi, D., W. Choi, and S. Lee, Influence of Nintendo Wii fit balance game on visual perception, postural balance, and walking in stroke survivors: A pilot randomized clinical trial. Games for Health, 2018. 7(6): p. 377-384.
- 52Choi, W. and S. Lee, The Effects of Virtual Kayak Paddling Exercise on Postural Balance, Muscle Performance, and Cognitive Function in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial. J Aging Phys Act, 2019. 27(4): p. 861-870.
- 53Chow, D.H. and S.K. Mann, Effect of cyber-golfing on balance amongst the elderly in Hong Kong: a pilot randomised trial. Hong Kong Journal of Occupational Therapy, 2015. 26: p. 9-13.
- 54Cikajlo, I., et al., Multi-Exergames to Set Targets and Supplement the Intensified Conventional Balance Training in Patients With Stroke: A Randomized Pilot Trial. Frontiers in psychology, 2020. 11: p. 572.
- 55Cimino, V., C. Chisari, and F. Zagari, Effects of Nintendo Wii Fit® balance exercise program on physical abilities and quality of life in Multiple Sclerosis patients. J Neurol Neurorehabil Res. 2019; 4 (2): 1-7. J Neurol Neurorehabil Res 2019 Volume 4 Issue. 2: p. 1-7.
- 56da Fonseca, E.P., N.M.R. da Silva, and E.B. Pinto, Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial. Journal of Stroke & Cerebrovascular Diseases, 2017. 26(1): p. 94-100.
- 57Ditchburn, J.-L., et al., The effects of exergaming on pain, postural control, technology acceptance and flow experience, in older people with chronic musculoskeletal pain: a randomised controlled trial. BMC Sports Science, Medicine and Rehabilitation, 2019.
- 58Duque, G., et al., Effects of balance training using a virtual-reality system in older fallers. Clinical interventions in aging, 2013. 8: p. 257-63.
- 59Eftekharsadat, B., et al., Effect of virtual reality-based balance training in multiple sclerosis. Neurol Res, 2015. 37(6): p. 539-44.
- 60Fakhro, M.A., R. Hadchiti, and B. Awad, Effects of Nintendo Wii fit game training on balance among Lebanese older adults. Aging clinical and experimental research, 2019: p. 1-8.
- 61Feng, H., et al., Virtual Reality Rehabilitation Versus Conventional Physical Therapy for Improving Balance and Gait in Parkinson's Disease Patients: A Randomized Controlled Trial. Medical science monitor: international medical journal of experimental and clinical research, 2019. 25: p. 4186-4192.
- 62Ferguson, G.D., et al., The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training. Res Dev Disabil, 2013. 34(9): p. 2449-61.
- 63Fitzgerald, D., et al., Effects of a wobble board-based therapeutic exergaming system for balance training on dynamic postural stability and intrinsic motivation levels. J Orthop Sports Phys Ther, 2010. 40(1): p. 11-9.
- 64Franco, J.R., et al., The effect of the Nintendo Wii Fit and exercise in improving balance and quality of life in community dwelling elders. Technol Health Care, 2012. 20(2): p. 95-115.
- 65Fritz, S.L., et al., Active video-gaming effects on balance and mobility in individuals with chronic stroke: a randomized controlled trial. Top Stroke Rehabil, 2013. 20(3): p. 218-25.
- 66Gandolfi, M., et al., Virtual Reality Telerehabilitation for Postural Instability in Parkinson's Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial. BioMed research international, 2017. 2017: p. 7962826.
- 67Gatica-Rojas, V., et al., Does Nintendo Wii Balance Board improve standing balance? A randomized controlled trial in children with cerebral palsy. Eur J Phys Rehabil Med, 2017. 53(4): p. 535-44.
- 68Gioftsidou, A., et al., Typical balance exercises or exergames for balance improvement? J Back Musculoskelet Rehabil, 2013. 26(3): p. 299-305.
- 69Gutierrez, R.O., et al., A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients. NeuroRehabilitation, 2013. 33(4): p. 545-54.
- 70Hamari, L., et al., The effect of an active video game intervention on physical activity, motor performance, and fatigue in children with cancer: a randomized controlled trial. BMC research notes, 2019. 12(1): p. 784.
- 71Henrique, P.P.B., E.L. Colussi, and A.C.B. De Marchi, Effects of Exergame on Patients' Balance and Upper Limb Motor Function after Stroke: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis, 2019. 28(8): p. 2351-2357.
- 72Huang, H.-C., et al., Can using exergames improve physical fitness? A 12-week randomized controlled trial. Computers in Human Behavior, 2017. 70: p. 310-316.
- 73Hung, E.S., et al., Effects of Interactive Video Game-Based Exercise on Balance in Diabetic Patients with Peripheral Neuropathy: An Open-Level, Crossover Pilot Study. Evid Based Complement Alternat Med, 2019. 2019: p. 4540709.
- 74Hung, J.-W., et al., Randomized comparison trial of balance training by using exergaming and conventional weight-shift therapy in patients with chronic stroke. Archives of physical medicine and rehabilitation, 2014. 95(9): p. 1629-1637.
- 75Hung, J.-W., et al., Feasibility of Using Tetrax Biofeedback Video Games for Balance Training in Patients With Chronic Hemiplegic Stroke. PM&R, 2016. 8(10): p. 962-970.
- 76Ibrahim, M.S., A.G. Mattar, and S.M. Elhafez, Efficacy of virtual reality-based balance training versus the Biodex balance system training on the body balance of adults. Journal of Physical Therapy Science, 2016. 28(1): p. 20-26.
- 77Jorgensen, M.G., 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 A Biol Sci Med Sci, 2013. 68(7): p. 845-52.
- 78Ju, Y.-J., et al., The effect of laboratory-developed video games on balance performance in children with developmental coordination disorder. Biomedical Engineering: Applications, Basis and Communications, 2018. 30(01): p. 1850005.
- 79Jung, J., J. Yu, and H. Kang, Effects of virtual reality treadmill training on balance and balance self-efficacy in stroke patients with a history of falling. Journal of physical therapy science, 2012. 24(11): p. 1133-1136.
- 80Kalron, A., et al., The effect of balance training on postural control in people with multiple sclerosis using the CAREN virtual reality system: a pilot randomized controlled trial. Journal of neuroengineering and rehabilitation, 2016. 13: p. 13.
- 81Kannan, L., et al., Cognitive-motor exergaming for reducing fall risk in people with chronic stroke: A randomized controlled trial. NeuroRehabilitation, 2019. 44(4): p. 493-510.
- 82Karahan, A.Y., et al., Effects of Exergames on Balance, Functional Mobility, and Quality of Life of Geriatrics Versus Home Exercise Programme: Randomized Controlled Study. Cent Eur J Public Health, 2015. 23 Suppl(Supplement): p. S14-8.
- 83Karasu, A.U., E.B. Batur, and G.K. Karataş, Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study. J Rehabil Med, 2018. 50(5): p. 406-412.
- 84Karssemeijer, E.G.A., et al., Exergaming as a Physical Exercise Strategy Reduces Frailty in People With Dementia: A Randomized Controlled Trial. Journal of the American Medical Directors Association, 2019. 20(12): p. 1502-08.
- 85Katajapuu, N., et al. Benefits of exergame exercise on physical functioning of elderly people. in 8th IEEE International Conference on Cognitive Infocommunications (CogInfoCom). 2017. IEEE.
- 86Khurana, M., S. Walia, and M.M. Noohu, Study on the Effectiveness of Virtual Reality Game-Based Training on Balance and Functional Performance in Individuals with Paraplegia. Topics in spinal cord injury rehabilitation, 2017. 23(3): p. 263-270.
- 87Khushnood, K., et al., Does Wii Fit balance training improve balance and reduce fall risk in diabetic patients as compared to balance training exercises? A randomized control trial. Rawal Medical Journal, 2019. 44(1): p. 44-48.
- 88Kim, J., et al., Unsupervised virtual reality-based exercise program improves hip muscle strength and balance control in older adults: a pilot study. Arch Phys Med Rehabil, 2013. 94(5): p. 937-43.
- 89Kliem, A. and J. Wiemeyer, Comparison of a traditional and a video game based balance training program. International Journal of Computer Science in Sport, 2010. 9(2): p. 80-91.
- 90Kramer, A., C. Dettmers, and M. Gruber, Exergaming with additional postural demands improves balance and gait in patients with multiple sclerosis as much as conventional balance training and leads to high adherence to home-based balance training. Archives of physical medicine and rehabilitation, 2014. 95(10): p. 1803-1809.
- 91Kwok, B.C. and Y.H. Pua, Effects of WiiActive exercises on fear of falling and functional outcomes in community-dwelling older adults: a randomised control trial. Age Ageing, 2016. 45(5): p. 621-7.
- 92Lai, C.H., et al., Effects of interactive video-game based system exercise on the balance of the elderly. Gait Posture, 2013. 37(4): p. 511-5.
- 93Laver, K., et al., Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial. Disability and rehabilitation, 2012. 34(21): p. 1802-1808.
- 94Lee, C.-H., Y. Kim, and B.-H. Lee, Augmented reality-based postural control training improves gait function in patients with stroke: Randomized controlled trial. Hong Kong Physiotherapy Journal, 2014. 32(2): p. 51-57.
- 95Lee, H.-C., et al., The effect of a virtual reality game intervention on balance for patients with stroke: A randomized controlled trial. Games for Health, 2017. 6(5): p. 303-311.
- 96Lee, H.Y., Y.L. Kim, and S.M. Lee, Effects of virtual reality-based training and task-oriented training on balance performance in stroke patients. J Phys Ther Sci, 2015. 27(6): p. 1883-8.
- 97Lee, I.W., Y.N. Kim, and D.K. Lee, Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients. J Phys Ther Sci, 2015. 27(7): p. 2175-7.
- 98Lee, N.Y., D.K. Lee, and H.S. Song, Effect of virtual reality dance exercise on the balance, activities of daily living, and depressive disorder status of Parkinson's disease patients. J Phys Ther Sci, 2015. 27(1): p. 145-7.
- 99Lee, S. and S. Shin, Effectiveness of virtual reality using video gaming technology in elderly adults with diabetes mellitus. Diabetes technology & therapeutics, 2013. 15(6): p. 489-496.
- 100Lee, Y., et al., Virtual Reality Training With Three-Dimensional Video Games Improves Postural Balance and Lower Extremity Strength in Community-Dwelling Older Adults. Journal of Aging and Physical Activity, 2017. 25(4): p. 621-627.
- 101Leutwyler, H., et al., Impact of a Pilot Videogame-Based Physical Activity Program on Walking Speed in Adults with Schizophrenia. Community Ment Health J, 2018. 54(6): p. 735-739.
- 102Liao, Y.-Y., et al., Effects of virtual reality-based physical and cognitive training on executive function and dual-task gait performance in older adults with mild cognitive impairment: A randomized control trial. Frontiers in Aging Neuroscience, 2019. 11.
- 103Liao, Y.-Y., I.H. Chen, and R.-Y. Wang, Effects of Kinect-based exergaming on frailty status and physical performance in prefrail and frail elderly: A randomized controlled trial. Scientific reports, 2019. 9(1): p. 9353.
- 104Liao, Y.Y., et al., Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease. Neurorehabil Neural Repair, 2015. 29(7): p. 658-67.
- 105Lin, Y.T., W.C. Lee, and R.L. Hsieh, Active video games for knee osteoarthritis improve mobility but not WOMAC score: A randomized controlled trial. Ann Phys Rehabil Med, 2020. 63(6): p. 458-65.
- 106Lloréns, R., et al., Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke. Clinical rehabilitation, 2015. 29(3): p. 261-268.
- 107Martín-Martínez, J.P., et al., Effects of 24-week exergame intervention on physical function under single-and dual-task conditions in fibromyalgia: A randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 2019. 29(10): p. 1610-1617.
- 108McEwen, D., et al., Virtual reality exercise improves mobility after stroke: an inpatient randomized controlled trial. Stroke, 2014. 45(6): p. 1853-5.
- 109Mombarg, R., D. Jelsma, and E. Hartman, Effect of Wii-intervention on balance of children with poor motor performance. Res Dev Disabil, 2013. 34(9): p. 2996-3003.
- 110Montero-Alía, P., et al., Controlled trial of balance training using a video game console in community-dwelling older adults. Age Ageing, 2019. 48(4): p. 506-512.
- 111Morat, M., et al., Effects of stepping exergames under stable versus unstable conditions on balance and strength in healthy community-dwelling older adults: A three-armed randomized controlled trial. Experimental gerontology, 2019. 127: p. 110719.
- 112Morone, G., et al., Wii Fit is effective in women with bone loss condition associated with balance disorders: a randomized controlled trial. Aging clinical and experimental research, 2016. 28(6): p. 1187-1193.
- 113Morone, G., et al., The efficacy of balance training with video game-based therapy in subacute stroke patients: a randomized controlled trial. Biomed Res Int, 2014. 2014: p. 580861.
- 114Morrison, S., et al., Supervised Balance Training and Wii Fit-Based Exercises Lower Falls Risk in Older Adults With Type 2 Diabetes. J Am Med Dir Assoc, 2018. 19(2): p. 185.e7-185.e13.
- 115Mugueta-Aguinaga, I. and B. Garcia-Zapirain, FRED: Exergame to Prevent Dependence and Functional Deterioration Associated with Ageing. A Pilot Three-Week Randomized Controlled Clinical Trial. Int J Environ Res Public Health, 2017. 14(12): p. 1439.
- 116Nicholson, V.P., et al., Six weeks of unsupervised Nintendo Wii Fit gaming is effective at improving balance in independent older adults. Journal of aging and physical activity, 2015. 23(1): p. 153-158.
- 117Nilsagård, Y.E., A.S. Forsberg, and L. von Koch, Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study. Multiple Sclerosis Journal, 2013. 19(2): p. 209-216.
- 118Ordnung, M., et al., No overt effects of a 6-week exergame training on sensorimotor and cognitive function in older adults. A preliminary investigation. Frontiers in human neuroscience, 2017. 11: p. 160.
- 119Padala, K.P., et al., Home-Based Exercise Program Improves Balance and Fear of Falling in Community-Dwelling Older Adults with Mild Alzheimer's Disease: A Pilot Study. J Alzheimers Dis, 2017. 59(2): p. 565-574.
- 120Padala, K.P., et al., Wii-fit for improving gait and balance in an assisted living facility: a pilot study. J Aging Res, 2012. 2012: p. 597573.
- 121Park, E.C., S.G. Kim, and C.W. Lee, The effects of virtual reality game exercise on balance and gait of the elderly. J Phys Ther Sci, 2015. 27(4): p. 1157-9.
- 122Park, J. and J. Yim, A New Approach to Improve Cognition, Muscle Strength, and Postural Balance in Community-Dwelling Elderly with a 3-D Virtual Reality Kayak Program. The Tohoku journal of experimental medicine, 2016. 238(1): p. 1-8.
- 123Pedreira da Fonseca, E., N.M. da Silva Ribeiro, and E.B. Pinto, Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association, 2017. 26(1): p. 94-100.
- 124Pompeu, J., et al., Safety, feasibility and effectiveness of balance and gait training using Nintendo Wii Fit Plus on unstable surface in patients with Parkinson's disease: a pilot study. J Alzheimers Dis Parkinsonism, 2014. 4(136): p. 196-204.
- 125Portela, F.R., et al. Wiitherapy on seniors—Effects on physical and metal domains. in 2011 IEEE 1st International Conference on Serious Games and Applications for Health (SeGAH). 2011. IEEE.
- 126Prosperini, L., et al., Home-based balance training using the Wii balance board a randomized, crossover pilot study in multiple sclerosis. Neurorehabilitation and neural repair, 2013. 27(6): p. 516-525.
- 127Ribas, C.G., et al., Effectiveness of exergaming in improving functional balance, fatigue and quality of life in Parkinson's disease: A pilot randomized controlled trial. Parkinsonism Relat Disord, 2017. 38: p. 13-18.
- 128Rica, R.L., et al., Effects of a Kinect-based physical training program on body composition, functional fitness and depression in institutionalized older adults. Geriatr Gerontol Int, 2020. 20(3): p. 195-200.
- 129Rosiak, O., et al., Evaluation of the effectiveness of a Virtual Reality-based exercise program for Unilateral Peripheral Vestibular Deficit. Journal of vestibular research: equilibrium & orientation, 2018. 28(5-6): p. 409-415.
- 130Rutkowski, S., et al., Virtual Reality Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. International journal of chronic obstructive pulmonary disease, 2020. 15: p. 117-124.
- 131Şahin, S., et al., The Effects of Virtual Reality on Motor Functions and Daily Life Activities in Unilateral Spastic Cerebral Palsy: A Single-Blind Randomized Controlled Trial. Games for health journal, 2020. 9(1): p. 45-52.
- 132Salem, Y., et al., Effectiveness of a low-cost virtual reality system for children with developmental delay: a preliminary randomised single-blind controlled trial. Physiotherapy, 2012. 98(3): p. 189-95.
- 133Santos, P., et al., Efficacy of the Nintendo Wii combination with Conventional Exercises in the rehabilitation of individuals with Parkinson's disease: A randomized clinical trial. NeuroRehabilitation, 2019(Preprint): p. 255-631.
- 134Sato, K., et al., Improving walking, muscle strength, and balance in the elderly with an exergame using Kinect: A randomized controlled trial. Games for health journal, 2015. 4(3): p. 161-167.
- 135Schoene, D., et al., A randomized controlled pilot study of home-based step training in older people using videogame technology. PloS one, 2013. 8(3).
- 136Sheehan, D.P. and L. Katz, The effects of a daily, 6-week exergaming curriculum on balance in fourth grade children. Journal of Sport and Health Science, 2013. 2(3): p. 131-137.
- 137Shen, X. and M.K. Mak, Technology-assisted balance and gait training reduces falls in patients with Parkinson's disease: a randomized controlled trial with 12-month follow-up. Neurorehabil Neural Repair, 2015. 29(2): p. 103-11.
- 138Shih, M.-C., et al., Effects of a balance-based exergaming intervention using the Kinect sensor on posture stability in individuals with Parkinson's disease: a single-blinded randomized controlled trial. Journal of neuroengineering and rehabilitation, 2016. 13(1): p. 78.
- 139Silva, V., et al., Wii-based exercise program to improve physical fitness, motor proficiency and functional mobility in adults with Down syndrome. J Intellect Disabil Res, 2017. 61(8): p. 755-765.
- 140Singh, D.K., et al., Effects of balance-focused interactive games compared to therapeutic balance classes for older women. Climacteric, 2013. 16(1): p. 141-6.
- 141Singh, D.K.A., et al., Effects of substituting a portion of standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. BMC neurology, 2013. 13(1): p. 199.
- 142Song, J., et al., Home-based step training using videogame technology in people with Parkinson's disease: A single-blinded randomised controlled trial. Clinical Rehabilitation, 2018. 32(3): p. 299-311.
- 143Song, Y.B., et al., The effect of virtual reality and tetra-ataxiometric posturography programs on stroke patients with impaired standing balance. Ann Rehabil Med, 2014. 38(2): p. 160-6.
- 144Straker, L., et al., A crossover randomised and controlled trial of the impact of active video games on motor coordination and perceptions of physical ability in children at risk of developmental coordination disorder. Human movement science, 2015. 42: p. 146-160.
- 145Szturm, T., et al., Effects of an interactive computer game exercise regimen on balance impairment in frail community-dwelling older adults: a randomized controlled trial. Phys Ther, 2011. 91(10): p. 1449-62.
- 146Tak, S., W. Choi, and S. Lee, Game-based virtual reality training improves sitting balance after spinal cord injury: a single-blinded, randomized controlled trial. Medical Science Monitor, 2015. 56: p. 53-59.
- 147Tarakci, D., et al., Effects of Nintendo Wii-Fit((R)) video games on balance in children with mild cerebral palsy. Pediatr Int, 2016. 58(10): p. 1042-1050.
- 148Taylor, L., et al., Exergames to improve the mobility of long-term care residents: A cluster randomized controlled trial. Games for Health, 2018. 7(1): p. 37-42.
- 149Tollar, J., F. Nagy, and T. Hortobagyi, Vastly Different Exercise Programs Similarly Improve Parkinsonian Symptoms: A Randomized Clinical Trial. Gerontology, 2019. 65(2): p. 120-127.
- 150Ürgen, M.S., et al., Investigation of the effects of the Nintendo® Wii-Fit training on balance and advanced motor performance in children with spastic hemiplegic cerebral palsy: A Randomized Controlled Trial. Int. J. Ther. Rehabil. Res, 2016. 5: p. 146.
- 151Uysal, S.A. and G. Baltaci, Effects of Nintendo Wii™ training on occupational performance, balance, and daily living activities in children with spastic hemiplegic cerebral palsy: A single-blind and randomized trial. Games for health journal, 2016. 5(5): p. 311-317.
- 152Van Biljon, A. and G. Longhurst, The influence of exergaming on the functional fitness in overweight and obese children:: physical activity, health and wellness. African Journal for Physical Health Education, Recreation and Dance, 2012. 18(Issue-4_2): p. 984-991.
- 153van den Berg, M., et al., Video and computer-based interactive exercises are safe and improve task-specific balance in geriatric and neurological rehabilitation: a randomised trial. J Physiother, 2016. 62(1): p. 20-8.
- 154van den Heuvel, M.R., et al., Effects of augmented visual feedback during balance training in Parkinson's disease: a pilot randomized clinical trial. Parkinsonism Relat Disord, 2014. 20(12): p. 1352-8.
- 155Vernadakis, N., et al., The impact of Nintendo Wii to physical education students' balance compared to the traditional approaches. Computers & Education, 2012. 59(2): p. 196-205.
- 156Vernadakis, N., et al., The effect of an exergame-based intervention on balance ability on deaf adolescents. Sport Science, 2018. 11: p. 36-41.
- 157Whyatt, C., et al., A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults. Games Health J, 2015. 4(6): p. 423-33.
- 158Wuang, Y.-P., et al., Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome. Research in developmental disabilities, 2011. 32(1): p. 312-321.
- 159Yang, W.C., et al., Home-based virtual reality balance training and conventional balance training in Parkinson's disease: A randomized controlled trial. Journal of the Formosan Medical Association, 2016. 115(9): p. 734-743.
- 160Yatar, G.I. and S.A. Yildirim, Wii Fit balance training or progressive balance training in patients with chronic stroke: a randomised controlled trial. J Phys Ther Sci, 2015. 27(4): p. 1145-51.
- 161Yazgan, Y.Z., et al., Comparison of the effects of two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis: A randomized controlled trial. Multiple Sclerosis and Related Disorders, 2020. 39: p. 101902.
- 162Yen, C.Y., et al., Effects of virtual reality-augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: a randomized controlled trial. Phys Ther, 2011. 91(6): p. 862-74.
- 163Yom, C., H.Y. Cho, and B. Lee, Effects of virtual reality-based ankle exercise on the dynamic balance, muscle tone, and gait of stroke patients. J Phys Ther Sci, 2015. 27(3): p. 845-9.
- 164Yoo, H.N., E. Chung, and B.H. Lee, The Effects of Augmented Reality-based Otago Exercise on Balance, Gait, and Falls Efficacy of Elderly Women. J Phys Ther Sci, 2013. 25(7): p. 797-801.
- 165Yu, J.H. and K.H. Cho, Effectiveness of Virtual Reality Game on Functional Movement and Activities of Daily Living in Hemiparetic Stroke Patients. Journal of Nanoelectronics and Optoelectronics, 2016. 11(1): p. 98-102.
- 166Yu, T.C., 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): p. 2565.
CRediT authorship contribution statement
Appendix. Supplementary materials
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Location where the study was performed# and the authors’ affiliation during the project:
Acknowledgment of Previous Presentation
On behalf of the authors, I would like to confirm: (i) that the content of this manuscript has not been previously presented or published; (ii) that this article is not presently under consideration by another journal, and will not be submitted to another journal before a final editorial decision from Archives of Physical Medicine and Rehabilitation is rendered; and (iii) that there are no actual or potential conflicts of interest with the National Institutes of Health or the Northeastern University, the organizations that sponsored the research.
The authors would like to thank Drs. Ann DeSmet, Julie Vermeir, Jin-Chang Hsieh and Benoît Bediou for their helpful insights in developing the coding protocol and Ms. Chloe Lee for her effort in helping with data presentation.
This study was partly funded by a grant from the National Institutes of Health (R01DK109316), Northeastern University Institute for Health Equity and Social Justice Research (IHESJR) Advancing Health Equity Pilot Project Award, and Northeastern University's Interdisciplinary Research Sabbatical, awarded to Amy S. Lu. Dagmar Sternad was partly supported by the National Science Foundation (NSF-CRCNS-1723998), the National Institutes of Health (R37-HD087089), and a Fulbright US Scholar grant.
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