title: A Narrative Synthesis of Nintendo Wii Fit Gaming Protocol in Addressing Balance Among Healthy Older Adults: What System Works?
abstract: BACKGROUND
  Balance is crucial in performing functional tasks particularly among older adults. Exergaming is gaining attention as a novel approach to enhance balance in a number of clinical populations.
  
  
  OBJECTIVE
  The aim of this review was to synthesize and present published evidence for Nintendo Wii Fit™ gaming system protocols. These include game preference, intervention setting, and exercise dosage for improving balance in healthy older adults. Commonly used outcome measures were also identified.
  
  
  METHODS
  A literature search was developed using the PICOS strategy using keywords such as "older adult," "Nintendo Wii Fit," "exergaming," and "balance" in the databases: MEDLINE, PubMed, EMBASE, CINAHL, Scopus, Science Direct, and Web of Science.
  
  
  RESULTS
  Sixteen articles were included with participants (n = 491) mostly female (69%), and mean age ranged between 71 and 85 years old. Participants were recruited mainly from the community. The most commonly used Wii Fit games were Table tilt, Soccer Heading, Ski Slalom, and Ski jump, performed three times per week, with a duration of 30 minutes per session for 6 weeks. Berg Balance Scale, Timed Up and Go Test, and Centre of Pressure were the most commonly used outcome measures.
  
  
  CONCLUSIONS
  Wii Fit exergames can be a potential alternative to improve balance if safety and technical procedures are provided. With conflicting and mechanism-based evidence on dosage presented, exergaming parameters require further research before firm recommendations can be made. Clinically, effective dosage is an important component in any type of interventions, and exergaming should not be an exception.
authors.affiliation: Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago , Dunedin, New Zealand .
authors.forename: Donald G
authors.initials: DG
authors.lastname: Manlapaz
authors.affiliation: Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago , Dunedin, New Zealand .
authors.forename: Gisela
authors.initials: G
authors.lastname: Sole
authors.affiliation: Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago , Dunedin, New Zealand .
authors.forename: Prasath
authors.initials: P
authors.lastname: Jayakaran
authors.affiliation: Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago , Dunedin, New Zealand .
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Chapple
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D000068957:Games, Recreational / Q000523:psychology*; D006801:Humans; D008297:Male; D033262:Narration; D017063:Outcome Assessment, Health Care; D004856:Postural Balance / Q000502:physiology*; D011312:Pressure; D057566:Self Report / Q000706:statistics & numerical data; D018910:Video Games / Q000592:standards*
keywords: Balance; Exergaming; Gaming protocol; Nintendo Wii Fit; Older adults