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Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial

Nature Medicine volume 30, pages 98–105 (2024)Cite this article

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Abstract

Exergame training, in which video games are used to promote exercise, can be tailored to address cognitive and physical risk factors for falls and is a promising method for fall prevention in older people. Here, we performed a randomized clinical trial using the smart±step gaming system to examine the effectiveness of two home-based computer game interventions, seated cognitive training and step exergame training, for fall prevention in community-dwelling older people, as compared with a minimal-intervention control group. Participants aged 65 years or older (n = 769, 71% female) living independently in the community were randomized to one of three arms: (1) cognitive training using a computerized touchpad while seated, (2) exergame step training on a computerized mat or (3) control (provided with an education booklet on healthy ageing and fall prevention). The rate of falls reported monthly over 12 months—the primary outcome of the trial—was significantly reduced in the exergame training group compared with the control group (incidence rate ratio = 0.74, 95% confidence interval = 0.56–0.98), but was not statistically different between the cognitive training and control groups (incidence rate ratio = 0.86, 95% confidence interval = 0.65–1.12). No beneficial effects of the interventions were found for secondary outcomes of physical and cognitive function, and no serious intervention-related adverse events were reported. The results of this trial support the use of exergame step training for preventing falls in community-dwelling older people. As this intervention can be conducted at home and requires only minimal equipment, it has the potential for scalability as a public health intervention to address the increasing problem of falls and fall-related injuries. Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616001325493.

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Fig. 1: The smart±step gaming system.
Fig. 2: Trial profile.

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Data availability

The data that support the findings of this study are not openly available due to reasons of confidentiality. Upon reasonable request, individual deidentified participant data (including data dictionaries) will be made available via a RedCap web-based database, after review and approval of a methodologically sound proposal, with a signed data access agreement, in line with Ethics Committee requirements. Please contact corresponding author, D.L.S. (d.sturnieks@neura.edu.au). These files will be available from the date of publication until the date stated in the approved request. The study protocol is available as an open access publication34 and the statistical analysis plan is available on OpenScience Framework (https://osf.io/uqk5s/).

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Acknowledgements

We appreciate the considerable time and energy contributed by the participants and project staff involved in this study. This work is supported by the National Health and Medical Research Council of Australia Project Grant (ID: 1086804) awarded to D.L.S., J.M. and K.D. and Program Grant (ID: 1055084) awarded to S.R.L. and R.D.H. M.J.V., K.D., C.S., R.D.H. and S.R.L. also received salary funding (fellowships) from the National Health and Medical Research Council of Australia. D.L.S. was supported by a Bushell Foundation Rising Star Fellowship. These funders had no role in study design, data collection, data analysis, data interpretation or writing of the report. This study was approved by the Human Research Ethics Committee, UNSW Sydney (HC15203) on 8 September 2015.

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Authors and Affiliations

  1. Neuroscience Research Australia, Randwick, New South Wales, Australia

    Daina L. Sturnieks, Cameron Hicks, Natassia Smith, Mayna Ratanapongleka, Jasmine Menant, Jessica Turner, Joanne Lo, Carly Chaplin, Kim Delbaere, Robert D. Herbert & Stephen R. Lord

  2. School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia

    Daina L. Sturnieks & Robert D. Herbert

  3. UNSW Ageing Futures Institute, Sydney, New South Wales, Australia

    Daina L. Sturnieks, Jasmine Menant, Kim Delbaere & Stephen R. Lord

  4. School of Population Health, University of New South Wales, Sydney, New South Wales, Australia

    Cameron Hicks, Jasmine Menant, Kim Delbaere & Stephen R. Lord

  5. UTS Games Studio, Faculty of Engineering and IT, University of Technology Sydney, Sydney, New South Wales, Australia

    Jaime Garcia

  6. Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia

    Michael J. Valenzuela

  7. Skin2Neuron Pty Ltd, Sydney, New South Wales, Australia

    Michael J. Valenzuela

  8. Sydney Musculoskeletal Health, Sydney School of Public Health, Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia

    Catherine Sherrington

  9. College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

    Barbara Toson

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  1. Daina L. Sturnieks
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Contributions

D.L.S., S.R.L., K.D., J.M. and M.J.V. conceived and designed the trial. Additional advice about design and statistical analyses was given by C.S. and R.D.H. Funding was obtained by D.L.S., J.M., K.D. and M.J.V. with substantial input by S.R.L. J.G. led software development with input from D.L.S., S.R.L. and K.D. J.T., C.H., N.S., M.R., J.L. and C.C. established databases and study manuals, and contributed to recruitment, data collection and processing. C.H., S.R.L., D.L.S. and B.T. undertook the statistical analyses, and directly accessed and verified the underlying data reported in the manuscript. All authors contributed intellectual input into and approved the manuscript. The authors agree to be accountable for the work.

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Correspondence to Daina L. Sturnieks.

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Nature Medicine thanks Joaquin Anguera, Kenneth Rockwood, Emma Stanmore and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Michael Basson, in collaboration with the Nature Medicine team.

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Extended data

Extended Data Table 1 Planned analyses on the effects of exergame step and cognitive training on the rate of falls over 12 months, compared to control, for subgroups of: faller status; physical status; and cognitive status
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Supplementary Information

Statistical analysis plan and published protocol related to Extended Data Table 1.

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Sturnieks, D.L., Hicks, C., Smith, N. et al. Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial. Nat Med 30, 98–105 (2024). https://doi.org/10.1038/s41591-023-02739-0

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