Fall Prevention in Healthy Aging Clinical Trial
Official title:
The Effects of a Home-based Multicomponent Exergame Training on Motor Functions, Cognition, and Brain Structure of Older Adults: A Multinational Randomized Controlled Trial
This study investigates the effects of an exergame training including strength, balance, and cognitive training components on motor functions, cognition and brain structure of older adults. The primary objective is to determine the effects of the home-based multicomponent exergame training on motor and cognitive functions of older adults compared to a usual care waitlist control group. To understand the underlying mechanisms, the secondary objective is to assess the effect of the exergame training on neuronal level (brain structure). The study design is a randomized controlled trial including 40 healthy (self-reported), independently living older adults aged 65 years and older. The intervention period lasts for 16-18 weeks (no longer than two weeks of break/holiday allowed) with three training sessions per week each lasting about 40 minutes.
Age-associated degenerative changes cause gait impairments and a higher risk of falls in
elderly. Falls are a leading cause for injuries, reduced mobility, independence and general
well-being. Most of the investigator's daily life activities, including walking, are tasks
which require not only motor but also cognitive functions. Therefore, also in fall
prevention, there is a need for combined motor-cognitive interventions. Exergames - games
which require physical activity and movement to play the game - are a promising option for
motivating and engaging motor-cognitive training, especially in combination with newly
available technologies. In an international project of the Ambient Assisted Living
Association (AAL), a new exergame (Active@Home) was developed which ultimately aims for fall
prevention in elderly and incorporates theoretical background from movement sciences,
neuropsychology, cognitive sciences, and arts of game design.
During aging, age-related changes are evident not only in sensory, motor and cognitive
functions but also on (underlying) neuronal level: The aging brain is associated with
neurostructural changes and functional changes in neuronal activity pattern. Especially the
(pre)frontal lobe and medial temporal lobe (Hippocampus) are vulnerable to age-related
degeneration. However, also in higher age, experience-based neuroplasticity can be observed;
the adult brain possesses the ability to alter cortical functions and structures in response
to stimulation or training. Evidence shows that experience-dependent neural plasticity can be
enhanced by both, physical and cognitive exercise. The question arises how a combination of
both - combined motor-cognitive training - influences neuroplasticity in the aging brain.
Exergame training has been shown to improve motor as well as cognitive functions. To
understand the underlying mechanisms of these training effects, the impact on the level of
neuronal activity and brain structure has to be studied.
The primary objective of this study is to determine the effects of a home-based
multicomponent exergame training on motor and cognitive functions of older adults compared to
a usual care waitlist control group.
To understand the underlying mechanisms, the secondary objective is to assess the effect of
the exergame training on neuronal level (brain structure).
The Active@Home exergame is a multicomponent, motor-cognitive training for fall prevention in
elderly adults. It mainly consists of three components; strength training, balance training
and cognitive training. For strength training, Tai Chi-based movements are included as Tai
Chi is mainly performed in a semi-squat posture that places a large load on the muscles of
the lower extremities. For balance training, dancing is included in the Active@Home exergame
as the execution of rapid and well-directed steps has been shown to be effective in
preventing falls. Both, Tai Chi and dancing, are 'holistic' physical activities requiring
motor functions, cognition and mental involvement. Moreover, the Active@Home exergame
explicitly targets specific attentional and executive functions (selective attention, divided
attention, inhibition/interference control, mental flexibility, working memory) which are
important for walking and safe gait. To maximize benefits for participants, the Active@Home
exergame implements some basic general training principles; providing feedback, optimal load
of task demands, progression of difficulty and high variability. The Active@Home system set
up is easy and consists of an HDMI dongle (to run the application) which must be plugged into
the TV and four wearable sensors (to measure the movements).
All interested participants will be screened for eligibility for the study (cognitive
screening with MMSE, health screening with questionnaire). Then the eligible participants are
randomly allocated to either the intervention group or the waitlist control group. At the
first appointment (T1), pre-measurements are conducted (motor and cognitive functions, MRI
scans) with all participants. The participants of the intervention group will be equipped
with the Active@Home exergame kit and instructed how to set up and use the system at home.
The intervention period lasts for 16-18 weeks (no longer than two weeks of break/holiday
allowed) with three training sessions per week each lasting about 40 minutes. All
participants have to fill in an activity protocol during the whole intervention period. After
completing all training sessions (in the intervention group), post-measurements are conducted
at T2 with all participants. Measurements will take place at the CERENEO (Swiss clinic and
research institute at Vitznau, Lucerne). Participants of the waitlist control group are
instructed to continue their usual daily business and activities during the study period.
After the post-measurements, they will get the Active@Home exergame for their personal use at
home (for several months).
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