A randomized controlled pilot study of home-based step training in older people using videogame technology

PLoS One. 2013;8(3):e57734. doi: 10.1371/journal.pone.0057734. Epub 2013 Mar 5.


Background: Stepping impairments are associated with physical and cognitive decline in older adults and increased fall risk. Exercise interventions can reduce fall risk, but adherence is often low. A new exergame involving step training may provide an enjoyable exercise alternative for preventing falls in older people.

Purpose: To assess the feasibility and safety of unsupervised, home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people.

Design: Single-blinded two-arm randomized controlled trial comparing step pad training with control (no-intervention).

Setting/participants: Thirty-seven older adults residing in independent-living units of a retirement village in Sydney, Australia.

Intervention: Intervention group (IG) participants were provided with a computerized step pad system connected to their TVs and played a step game as often as they liked (with a recommended dose of 2-3 sessions per week for 15-20 minutes each) for eight weeks. In addition, IG participants were asked to complete a choice stepping reaction time (CSRT) task once each week.

Main outcome measures: CSRT, the Physiological Profile Assessment (PPA), neuropsychological and functional mobility measures were assessed at baseline and eight week follow-up.

Results: Thirty-two participants completed the study (86.5%). IG participants played a median 2.75 sessions/week and no adverse events were reported. Compared to the control group, the IG significantly improved their CSRT (F31,1 = 18.203, p<.001), PPA composite scores (F31,1 = 12.706, p = 0.001), as well as the postural sway (F31,1 = 4.226, p = 0.049) and contrast sensitivity (F31,1 = 4.415, p = 0.044) PPA sub-component scores. In addition, the IG improved significantly in their dual-task ability as assessed by a timed up and go test/verbal fluency task (F31,1 = 4.226, p = 0.049).

Conclusions: Step pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611001081909.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control*
  • Aged
  • Aged, 80 and over
  • Australia
  • Cognition Disorders / complications
  • Exercise Therapy / methods*
  • Geriatrics / methods*
  • Humans
  • Patient Compliance
  • Pilot Projects
  • Postural Balance
  • Sensitivity and Specificity
  • Single-Blind Method
  • Treatment Outcome
  • Video Games*

Grants and funding

This study was financially supported by a National Health and Medical Research Council (NHMRC) project grant (grant number 568724) (http://www.nhmrc.gov.au). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.