Playing active computer games (ACGs) may increase older adults’ physical activity, but authors of a recent article published in Physical Therapy (PTJ) say that current data provide "little confidence" that such activity improves physical health or cognition. And it’s not yet clear whether it is safe for older adults to play ACGs unsupervised.

Active computer gaming such as Nintendo Wii or Microsoft’s Xbox is being used in rehabilitation based in part on an assumption that sounds reasonable enough: because the games are fun and motivating, adherence to physical therapist interventions will improve, which will in turn have an impact on health outcomes such as falls. Authors of the PTJ review wanted to know if that assumption was supported by data.

Authors analyzed 35 randomized controlled trials with 1,838 total participants to determine whether ACG improved balance, functional exercise capacity, functional mobility, fear of falling, and cognition. They also examined participant adherence to interventions and factors such as dose, frequency, setting, and whether interventions were supervised.

What they found: playing ACGs had a "significant moderate effect" on cognition and balance, and on functional exercise capacity when participants played more than 120 minutes per week. But ACG had no effect on functional mobility or fear of falling. Researchers interpret the findings with caution, as all of the studies were low or very low quality.

The fact that ACG had a moderate effect "on one outcome associated with falls risk yet no effect on another…highlights the importance of tailoring ACG interventions to older adults’ specific needs for daily function," authors write. The ACG interventions employed a variety of mechanisms to improve function, they explain, and facing forward while standing in one spot may have helped participants improve balance but not functional mobility.

Authors also raise safety as an issue for ACGs, which they say hold "promise for self-led exercise interventions for even the most frail." But determining which ACGs are safe to use unsupervised was impossible to determine, as only 3 studies used unsupervised interventions. Further, only 9 studies included individuals with balance impairments—making them less likely to be unable to engage in traditional exercise. This makes it difficult to evaluate effects of ACG for this population, authors say.

"Findings of this review suggest that ACG may provide positive physical and cognitive health benefits greater than those observed following no treatment, traditional exercise, or rehabilitation interventions for balance, functional exercise capacity, and cognitive function," authors conclude, but higher-quality, "robust" randomized controlled trials are needed "in order to state with confidence" that ACG is effective.

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