Elderly Clinical Trial
Official title:
Effects of Physical Exercise, Virtual Reality and Brain Exercise on Balance of the Elderly
The objectives of this study were to 1) compare balance of the elderly by Berg Balance Scale (BBS) and Timed Up and Go Test (TUG) among physical exercise, virtual reality, brain exercise and control groups after intervention, 2) compare cognitive function of the elderly by using Timed Up and Go Cognitive (TUGC) and Montreal Cognitive Assessment (MoCA) among physical exercise, virtual reality, brain exercise and control groups after intervention, 3) compare muscle strength of elderly by 5 Times Sit-To-Stand Test (5TSTST) and Hand Grip Strength (HG) among physical exercise, virtual reality, brain exercise and control groups after intervention, 4) compare fear of falling by using Fall Efficacy Scale-International (FES-I) among physical exercise, virtual reality, brain exercise and control groups after intervention, 5)investigate the perspective of exercise among physical exercise, virtual reality, brain exercise and control groups after intervention.
This study used healthy elderly participants with the age of 65-85 years. Eighty-four
elderly participants were recruited by announcing the study information at the elderly
homes. Sample size calculation was performed using G*Power software (G*Power version
3.1.9.2, University Kiel, Germany). To our knowledge, no study compare the effects of
physical exercise, virtual reality and brain exercise on balance of the elders. Based on
previous finding on the effects of virtual reality on balance of the elderly, a total of 84
participants were required at confidence level (α) of .05 and power (1-β) of 0.80.
Participants who were interested in participation underwent a screening process using
inclusion-exclusion criteria and receive brief information regarding the study. If they met
all inclusion criteria, the consent process was performed. To ensure they understood the
study, they were simply asked regarding the study (i.e. objectives, benefits, etc.) before
signing the consent form.
After the participants provided a written informed consent, all participants filled out the
information sheet and demographic data were collected. After that, age matching with range
of ± 5 years and random allocation to different studies groups were done. Pretest assessment
for balance by BBS and TUG, cognitive function by TUGC and MOCA, muscle strength by 5 TSTST
and Hand Grip Strength (HG) and fear of falling by FES-I and perspective of exercise by
questionnaires were done and recorded by blinded assessor. In this study, random allocation
of the participants to different study groups; physical exercise group (PE), virtual reality
group (VR), brain exercise group (BE) and control group; was done by the medical doctor and
intervention was given the physical therapist from the study area which is the elderly home.
All the assessments were done by the principal researcher. The assessor was blinded to
reduce the bias which might come from the assessor's expectation.
After that, all the participants from intervention groups were explained and demonstrated
about the respective interventions until they clearly understand about the intervention
program before commencing the intervention program. The PE, VR and BE groups got their
respective intervention for 30 minutes per sessions, 3 non-consecutive days per week for 8
weeks. The control group was reminded not to participate in any other exercise or
intervention program except their routine daily activities for 8 weeks. Participants from PE
group needed to do the 5-minute warm-up, 20-minute core content (upper and lower limb
strengthening exercises and balance challenging exercises), and 5-minute cool down exercise
programs. For the virtual reality group, the participants were reminded to play the game
according to the program and try to get as high a score as possible they can. This
intervention program included 10 games. The participants were asked to choose 6 games from
the list before each 30-minute session, and were asked to choose the games to include the
upper limbs, lower limbs, and also for both strength and balance challenges instead of
choosing the games that need to use only upper limbs or lower limbs, and were just for
strength and balance gain. For the brain exercise, participants needed to play cognitive
stimulating games; Chinese Checker, Jenga and Memory Matched pair game; in the sitting
position. The participants needed to paly 10 minutes for each game and total duration for
all 3 games was about 30 minutes. After 8-week study period, post-test assessments were done
to find out the effect of interventions.
The statistical analyses were performed by using SPSS for windows version 18.0, statistical
software package. The value of p<0.05 was considered to indicate statistical significance.
As the objective of this study was to find out the effects of PE, VR and BE on balance,
cognitive function, muscle strength and fear of falling in the elderly. Two-way mixed ANOVA
was used to test the variance differences among the four groups with post-hoc analysis as
appropriately. Prior to utilization of statistical tests, descriptive statistics were
performed and statistical assumptions were tested. Transformation will be performed if the
data were not normally distributed. Appropriate statistical tests (parametric vs.
non-parametric) were performed to determine the effects of different interventions in this
study on balance, cognitive function, muscle strength and fear of falling in the elderly.
Post-hoc power analysis was also performed.
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