In the past three years, the Active@Home project team developed a multicomponent home-based exergame system for older adults to support healthy aging and prevent falls. Aging is accompanied by a decline in motor, sensory and cognitive functions leading to reduced daily life functioning including mobility impairments and falls.

The growing population of elderly paired with the huge costs resulting from physical and cognitive impairments lead to the strong need for effective, evidence-based interventions aiming to support healthy aging and prevent functional decline (including fall prevention). Physical activity is well known to enhance physical fitness and cognitive functions. Moreover, combining physical exercise with simultaneous cognitive training has been shown to further improve physical and cognitive functions in older adults. Exergames – games which require the player to be physically active to play the cognitively stimulating game – are a promising and motivating option for interactive motor-cognitive training. In the scope of the Active@Home project, a survey study with around 200 older adults was conducted to collect their opinion, needs and requirements regarding technology-based training. The results of the survey study guided the development and design of the Active@Home exergame.

The Active@Home exergame includes strength and balance training with Tai Chi-inspired and dance exercises. Moreover, specific cognitive functions are trained with step-based motor-cognitive games (mainly attentional and executive functions). The player virtually travels around Europe to train in different European cities in several difficulty levels. Inertial measurement units (IMUs) worn at wrists and ankles record the movements of the player. Based on complex algorithms and evaluation, the player gets a real-time performance feedback.

A usability study was conducted in laboratory setting showing high usability ratings, high adherence and low attrition and improvements in several physical and cognitive functions (gait speed, muscle strength, divided attention) after a 7-week intervention period.

After this first promising study, a feasibility study was conducted at older adults’ homes. Again, usability and affective game experience (emotions during training) were rated high and favorable. Furthermore, improvements were evident in several physical and cognitive functions (minimal toe clearance, attentional focus, information processing speed) after the 8-week intervention period. Both studies supported the conclusion that the Active@Home exergame is a usable and feasible home-based exergame training for older adults.

Afterwards, a larger randomized controlled trial was conducted. Half of the participants (training group) trained for four months three times per week at their homes with the Active@Home exergame. The other half of the participants were part of the waitlist control group and only conducted the pre- and post-measurements. Results showed improvements in higher-ordered cognitive functions after exergame training. The training group significantly improved their performance in executive functions (inhibition, working memory) compared to the control group. Moreover, MRI data showed a significant decrease in brain gray matter mainly in prefrontal brain areas in both groups. The exergame intervention in this study could not counteract the age-related loss of brain volume. Further research is needed to define the training conditions (e.g. level of physical intensity) which are required for positive brain changes.

Nevertheless, the Active@Home exergame showed to be usable and feasible for older adults in a home-based setting and might lead to improvements in several physical and cognitive functions which are important for daily life functioning. Moreover, participants reported to have enjoyed this new training approach with the main goal to support healthy aging. The business partner, Dividat, a Swiss-based company that develops sensor-based training systems for prevention and rehabilitation is now working on a seamless integration of Active@Home into their portfolio. The traction in the market for complementary home-based tele-rehab solutions is overwhelming. Together with a significant global player in the rehabilitation market, first commercial trials will start late summer 2019.

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