title: 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.
abstract: BACKGROUND
  Balance training is considered an important means to decrease fall rates in seniors. Whether virtual reality training (VRT) might serve as an appropriate treatment strategy to improve neuromuscular fall risk parameters in comparison to alternative balance training programs (AT) is as yet unclear.
  
  
  OBJECTIVE
  To examine and classify the effects of VRT on fall-risk relevant balance performance and functional mobility compared to AT and an inactive control condition (CON) in healthy seniors.
  
  
  METHODS
  The literature search was conducted in five databases (CINAHL, EMBASE, ISI Web of Knowledge, PubMed, SPORTDiscus). The following search terms were used with Boolean conjunction: (exergam* OR exer-gam* OR videogam* OR video-gam* OR video-based OR computer-based OR Wii OR Nintendo OR X-box OR Kinect OR play-station OR playstation OR virtua* realit* OR dance dance revolution) AND (sport* OR train* OR exercis* OR intervent* OR balanc* OR strength OR coordina* OR motor control OR postur* OR power OR physical* OR activit* OR health* OR fall* risk OR prevent*) AND (old* OR elder* OR senior*).
  
  
  METHODS
  Randomized and non-randomized controlled trials applying VRT as interventions focusing on improving standing balance performance (single and double leg stance with closed and open eyes, functional reach test) and functional mobility (Berg balance scale, Timed-up and go test, Tinetti test) in healthy community-dwelling seniors of at least 60 years of age were screened for eligibility.
  
  
  METHODS
  Eligibility and study quality (PEDro scale) were independently assessed by two researchers. Standardized mean differences (SMDs) served as main outcomes for the comparisons of VRT versus CON and VRT versus AT on balance performance and functional mobility indices. Statistical analyses were conducted using a random effects inverse-variance model.
  
  
  RESULTS
  Eighteen trials (mean PEDro score: 6 ± 2) with 619 healthy community dwellers were included. The mean age of participants was 76 ± 5 years. Meaningful effects in favor of VRT compared to CON were found for balance performance [p < 0.001, SMD: 0.77 (95 % CI 0.45-1.09)] and functional mobility [p = 0.004, SMD: 0.56 (95 % CI 0.25-0.78)]. Small overall effects in favor of AT compared to VRT were found for standing balance performance [p = 0.31, SMD: -0.35 (95 % CI -1.03 to 0.32)] and functional mobility [p = 0.05, SMD: -0.44 (95 % CI: -0.87 to 0.00)]. Sensitivity analyses between "weaker" (n = 9, PEDro ≤5) and "stronger" (n = 9, PEDro ≥6) studies indicated that weaker studies showed larger effects in favor of VRT compared to CON regarding balance performance (p < 0.001).
  
  
  CONCLUSIONS
  Although slightly less effective than AT, VRT-based balance training is an acceptable method for improving balance performance as well as functional mobility outcomes in healthy community dwellers. VRT might serve as an attractive complementary training approach for the elderly. However, more high-quality research is needed in order to derive valid VRT recommendations compared to both AT and CON.
authors.affiliation: Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, 4052, Basel, Switzerland. lars.donath@unibas.ch.
authors.forename: Lars
authors.initials: L
authors.lastname: Donath
authors.affiliation: Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, 4052, Basel, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Rössler
authors.affiliation: Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, 4052, Basel, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Faude
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D004856:Postural Balance / Q000502:physiology*; D012307:Risk Factors; D063367:Virtual Reality Exposure Therapy