The effect of exergames on balance and falls in frail older adult.


To systematically review trials that examine whether exergames training is effective in improving balance and falls in frail elderly population.


Three databases were searched: Scopus, Web of science, PubMed, and MEDLINE.

The searches were limited to the period from 2007 to 2019. Frail adults, aged 65 and older, with no specific disorders.

Interventions were exergames intervention with the aim of improving balance and falls and were compared to no intervention, traditional exercises, or standard care. The focus was on studies that used Nintendo Wii as a training device because of the wide variety of exergames it provides compare to other devices and it is the common device being used in the last decade in elderly rehabilitation.

The outcome measures were balance and falls as measured by any validated outcome measure.

The Physiotherapy Evidence Database (PEDro) quality assessment tool and The Cochrane Collaboration tool for assessing risk of bias (CCTARB) were used by two independent authors (HA and MA) to appraise the included studies.


The database search resulted in 1540 articles, of which eleven papers were included.

Exergame was compared to no intervention, standard care and traditional exercise. The total number of participants in all the five included studies was 388, with a mean age of 79±5.7 years.

255 were included in the Wii group, while 181 were placed in the control group. A total of 15 games were used in all Wii studies, with number of games per study ranging from 3 to 6 with a mean of 3.7 (SD 1.5). The duration of exergames sessions ranged from 3 to 15 weeks with mean of 8.8 (SD 3.8) weeks.

The total number of treatments ranged from 6 to 45 with mean of 20 (SD 11.1) session. The length of treatment ranged from 15 to 60 minutes with mean of 44 (SD 15.7) minutes.

Four studies were rated as high-quality studies, three were rated as poor quality and the remaining four had fair quality. the effects of exergames on balance and falls could not be pooled for a meta-analysis, due to methodological variability and the different control intervention used across studies

Exergames was found to have positive effect on falls and postural balance among frail elderly. However, definitive judgment could not be obtained due to variation in training, outcomes and methodology.

Future studies should focus on designing a standard protocol and include multicomponent exercise rather than just balance exercises.


Using exergames in elderly rehabilitation is promising and could serve as an alternative for traditional exercise. To achieve optimal outcomes future studies should focus on designing a standard protocol for exergames and include multicomponent exercise rather than balance exercises only.

Funding acknowledgements


Additional notes

This work was presented at Physiotherapy UK 2019