Healthy Elderly
Conditions
Keywords
Virtual Reality Exergame, Older Adult, Physical Activity
Brief summary
Virtual Reality exergame is a video games that combine body motion control with physical activity in a safe virtual environment. In the elderly, VR exergames like the Nintendo Switch RingFit Adventure aid rehabilitation, improving physical function, cognition, balance and mental well-being. These games overcome the boredom of traditional exercise with a multisensory and interactive environment that engages the whole body. The general objective of the present research is to evaluate the effectiveness of virtual reality exergames on physical activity and fitness in the elderly. Design : This study is an experimental study with a randomized controlled trial - double blind design. This experimental study was conducted with blinding, specifically a single blinding where the researcher and data analyst (statistician) did not know the allocation of samples to the intervention and control groups.
Detailed description
Aging is associated with a decline in biological, physiological, and functional capacities, impacting muscle strength, flexibility, balance, and the ability to perform daily activities. This decline adversely affects the quality of life in the elderly, measurable through the concept of healthy adjusted life expectancy (HALE). In Indonesia, the average HALE is 62.25 years, indicating a loss of approximately 8.85 years due to chronic diseases and disabilities. One effective strategy to address chronic diseases and disabilities is the implementation of physical activities or exercises, including aerobic, strength, flexibility, and balance training, as recommended by the World Health Organization (WHO). Aerobic exercise not only enhances cardiovascular and pulmonary function but also provides broader benefits to both physical and mental health. However, adherence and motivation in elderly populations are often low due to external factors such as limited mobility and unsupportive environments. To overcome these challenges, exergames have emerged as an innovative intervention combining active video gaming with physical exercise. Virtual Reality (VR) exergames, such as the Nintendo Switch RingFit Adventure, offer immersive, multisensory, and interactive environments that enhance motivation for exercise among older adults. Evidence suggests that VR exergame interventions can improve physical function, reduce symptoms of depression and anxiety, and enhance health-related quality of life, although research on fitness outcomes in the elderly remains limited and warrants further investigation. The general objective : to evaluate the effectiveness of virtual reality exergames on physical activity and fitness in the elderly. Specific objectives: * To determine the difference in effectiveness between virtual reality exergame and aerobic exercise training on physical activity in the older adult. * To determine the difference in effectiveness between virtual reality exergame and aerobic exercise training on body composition parameters in the older adult. * To determine the difference in effectiveness between virtual reality exergame and aerobic exercise training on hand muscle strength parameters in the older adult. * To determine the difference in effectiveness between virtual reality exergame and aerobic exercise training on muscle endurance in the older adult. * To determine the difference in effectiveness between virtual reality exergame and aerobic exercise training on flexibility in the older adult. Methods : This study is an experimental study with a randomized controlled trial - double blind design. The study sample consisted of 40 patients assigned to the intervention group (n=20) or control group (n=20). The study will be conducted from February 2024 to June 2024, targeting the elderly population in Makassar City, South Sulawesi, Indonesia. The accessible population consists of elderly individuals in the Zaitun Elderly Community. Researcher will compare the intervention group, which participates in virtual reality exergame-based aerobic exercise, with the control group, which engages in video-based aerobic exercise provided by the Ministry of Health, focusing on physical activity and physical fitness outcomes. * Participants will undergo interviews, physical examinations (vital signs, nutritional status, weight, height, and BMI), and additional assessments before and after 6 weeks of exercise, including : 1. IPAQ (International Physical Activity Questionnaire) for daily activity, muscle endurance (30-second sit-to-stand test), hand strength (dynamometer), flexibility (chair-sit-and-reach test), and body composition (bioimpedance analysis). 2. Cognitive function (MOCA-Ina), exercise intensity (Borg Scale), and pre-exercise protocols (risk screening, 6-minute walking test) on the first day, followed by an introduction to equipment and exercise clothing. * Both groups will follow a warm-up and cool-down routine for 10 minutes before and after exercise. The treatment group will perform VR exergame exercises using Nintendo Switch Ring Fit Adventure 3 times per week for 6 weeks, while the control group will perform conventional aerobic exercises supervised by a doctor. * Exercise adherence and intensity will be monitored and recorded in a logbook, along with any complaints before, during, and after each session. The estimated time required for each meeting (training session) will increase every week by 40 - 60 minutes. * At the end of the study, data will be collected again, and any adverse event (AE) experienced by participants will be addressed. Researcher will pause exercises and treat them if symptoms such as cybersickness occur. Ethical Approval and Sample Criteria This study has obtained ethical approval from the Ethics Committee of the Faculty of Medicine, Hasanuddin University, Makassar, Indonesia, to ensure the quality and compliance of the research. The data collected will undergo descriptive analysis to outline the characteristics of the participants. For hypothesis testing, chi-square or McNemar tests will be used for categorical dependent variables, while t-tests will analyze numerical dependent variables. The effects of VR exergame compared to aerobic exercise will be assessed using independent t-tests for normally distributed data and Mann-Whitney tests for non-normal data. Normality and homogeneity of numerical dependent variables will be evaluated using the Kolmogorov-Smirnov test, with p-values greater than 0.05 indicating normal distribution. Results will be comprehensively discussed by the research team and experts to draw appropriate conclusions. Correlation between variables will be measured using Pearson's correlation for normally distributed numerical data, Spearman's test for ordinal categorical data, or contingency coefficients for nominal categorical data. All analyses will be conducted using SPSS version 23.
Interventions
BEHAVIORALvirtual reality exergame
virtual reality exergame using Nintendo RingFit
BEHAVIORALConventional
Conventional-based aerobic exercise using video aerobic exercise of the Ministry of Health (KEMENKES) protocol
Sponsors
Hasanuddin University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
In this study, masking is applied to both the investigators and the outcomes assessors to minimize bias during data collection and analysis. The investigators who analyze the data are blinded to the participants' group assignments to ensure objective interpretation of the results. The outcomes assessors, responsible for evaluating physical activity and fitness, are also blinded to which intervention each participant received, preventing subjective influence on outcome measurement.
Intervention model description
The interventional study model in this research employs a parallel design, where participants are randomly assigned into two groups. One group receives the intervention in the form of Virtual Reality Exergame, while the other group serves as a control group receiving conventional aerobic exercise following the Ministry of Health. Both groups proceed simultaneously throughout the study period to compare the effects of the intervention on physical activity and fitness in older adults. This parallel model allows for a direct evaluation of the effectiveness of Virtual Reality Exergame by comparing outcomes between groups at the same time, resulting in more valid and reliable findings. Randomization is used to minimize bias and ensure equivalence between groups.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Willing to participate in the study 2. Aged above 60 years 3. Able to watch television with or without glasses from a distance of 2 meters (visual acuity between 20/20 and 20/80) 4. No cognitive impairment (MOCA-Ina score: 26-30)
Exclusion criteria
1. Congestive heart failure 2. Uncontrolled hypertension 3. History of fracture or surgery within the last 6 months 4. Currently on the waiting list for orthopedic surgery 5. Myocardial infarction or stroke within the last 6 months 6. Dependence on a wheelchair 7. Severe hearing and vision impairments 8. Other neuromusculoskeletal disorders that interfere with the ability to perform exercises (pain with VAS \> 4)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| body composition (muscle mass) | Body composition (muscle mass) was assessed at week 0 (before the intervention) and week 6 (after the intervention) to evaluate changes in participants' body composition during the intervention period. | The body composition (muscle mass) parameter is integratedly measured using Bioelectrical Impedance Analysis (BIA) with the Tanita BC 730 device. interpretation : Muscle mass, also presented as a percentage, reflects lean body mass important for function, with males aged 60-79 years ranging from 70-84% and females from 60-72.5%. |
| Hand muscle strength | Hand muscle strength was assessed at week 0 (before the intervention) and week 6 (after the intervention) to evaluate changes in participants' hand muscle strength during the intervention period. | Hand muscle strength was measured using an electronic hand dynamometer, CAMRY ISO 9001 model EH101. |
| physical activity | Physical activity was assessed at week 0 (before the intervention) and week 6 (after the intervention) to evaluate changes in participants' physical activity levels during the intervention period. | Physical activity was measured using the Indonesian version of the International Physical Activity Questionnaire (IPAQ) - Short Form. The International Physical Activity Questionnaire (IPAQ) score is calculated by assessing the duration and frequency of physical activities across three categories: walking, moderate-intensity, and vigorous-intensity activities. Each category is assigned a standard Metabolic Equivalent of Task (MET) value, namely 3.3 METs for walking, 4.0 METs for moderate activities, and 8.0 METs for vigorous activities. The weekly total MET-minutes are obtained by multiplying the MET value by the minutes per day and the number of days per week for each activity type, then summing these values across all categories. Based on the total MET-minutes per week, physical activity levels are interpreted : * Sedentary (\<600 MET-minutes/week) * Intermediate (600-3,000 MET-minutes/week) * Active (\>3,000 MET-minutes/week) |
| Muscle endurance | Muscle endurance was assessed at week 0 (prior to the intervention) and week 6 (post-intervention) to evaluate changes in participants' muscle endurance throughout the intervention period. | Muscle endurance was measured using the 30-second sit-to-stand test with a stopwatch |
| Flexibility | Flexibility was assessed at week 0 (prior to the intervention) and week 6 (post-intervention) to evaluate changes in participants' flexibility throughout the intervention period. | Flexibility was assessed using the Chair Sit-and-Reach Test. |
| body composition (fat mass) | Body composition (fat mass) was assessed at week 0 (before the intervention) and week 6 (after the intervention) to evaluate changes in participants' body composition during the intervention period. | The body composition (fat mass) parameter is integratedly measured using Bioelectrical Impedance Analysis (BIA) with the Tanita BC 730 device. Interpretation : Fat mass is expressed as a percentage of total body weight, varying by age and sex; for instance, males over 40 years typically range from 11-24%, while females range from 23-35%. |
| Body composition (Bone mass) | Body composition (bone mass) was assessed at week 0 (before the intervention) and week 6 (after the intervention) to evaluate changes in participants' body composition during the intervention period. | The body composition (bone mass) parameter is integratedly measured using Bioelectrical Impedance Analysis (BIA) with the Tanita BC 730 device. interpretation : Bone mass is reported in kilograms and stratified by weight and sex, such as 2.65-3.29 kg for males weighing 65-95 kg and about 2.40 kg for females weighing between 50-75 kg. |
Countries
Indonesia
Outcome results
None listed