title: Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy.
abstract: BACKGROUND
  There has been a rapid increase in research on the use of virtual reality (VR) and gaming technology as a complementary tool in exercise and rehabilitation in the elderly population. Although a few recent studies have evaluated their efficacy, there is currently no in-depth description and discussion of different game technologies, physical functions targeted, and safety issues related to older adults playing exergames.
  
  
  OBJECTIVE
  This integrative review provides an overview of the technologies and games used, progression, safety measurements and associated adverse events, adherence to exergaming, outcome measures used, and their effect on physical function.
  
  
  METHODS
  We undertook systematic searches of SCOPUS and PubMed databases. Key search terms included "game", "exercise", and "aged", and were adapted to each database. To be included, studies had to involve older adults aged 65 years or above, have a pre-post training or intervention design, include ICT-implemented games with weight-bearing exercises, and have outcome measures that included physical activity variables and/or clinical tests of physical function.
  
  
  RESULTS
  Sixty studies fulfilled the inclusion criteria. The studies had a broad range of aims and intervention designs and mostly focused on community-dwelling healthy older adults. The majority of the studies used commercially available gaming technologies that targeted a number of different physical functions. Most studies reported that they had used some form of safety measure during intervention. None of the studies reported serious adverse events. However, only 21 studies (35%) reported on whether adverse events occurred. Twenty-four studies reported on adherence, but only seven studies (12%) compared adherence to exergaming with other forms of exercise. Clinical measures of balance were the most frequently used outcome measures. PEDro scores indicated that most studies had several methodological problems, with only 4 studies fulfilling 6 or more criteria out of 10. Several studies found positive effects of exergaming on balance and gait, while none reported negative effects.
  
  
  CONCLUSIONS
  Exergames show promise as an intervention to improve physical function in older adults, with few reported adverse events. As there is large variability between studies in terms of intervention protocols and outcome measures, as well as several methodological limitations, recommendations for both practice and further research are provided in order to successfully establish exergames as an exercise and rehabilitation tool for older adults.
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology PO Box 8905, 7491 Trondheim, Norway. Electronic address: nina.skjaret@ntnu.no.
authors.forename: Nina
authors.initials: N
authors.lastname: Skjæret
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology PO Box 8905, 7491 Trondheim, Norway. Electronic address: ather.nawaz@ntnu.no.
authors.forename: Ather
authors.initials: A
authors.lastname: Nawaz
authors.affiliation: Institute of Movement and Sport Gerontology, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany. Electronic address: T.Morat@dshs-koeln.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Morat
authors.affiliation: Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nuremberg, Koberger Str. 60, 90408 Nuremberg, Germany. Electronic address: daniel.schoene@fau.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schoene
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology PO Box 8905, 7491 Trondheim, Norway; Department of Clinical Services, St. Olav University Hospital, PO Box 3250 Sluppen, 7006 Trondheim, Norway. Electronic address: jorunn.helbostad@ntnu.no.
authors.forename: Jorunn Lægdheim
authors.initials: JL
authors.lastname: Helbostad
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology PO Box 8905, 7491 Trondheim, Norway. Electronic address: beatrix.vereijken@ntnu.no.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Vereijken
mesh_terms: D000368:Aged; D015444:Exercise; D006801:Humans; D012046:Rehabilitation; D012449:Safety
keywords: Aged; Computer games; Physical function; Safety; Virtual reality; Weight-bearing