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Randomized Controlled Trial
. 2013;8(3):e57734.
doi: 10.1371/journal.pone.0057734. Epub 2013 Mar 5.

A Randomized Controlled Pilot Study of Home-Based Step Training in Older People Using Videogame Technology

Free PMC article
Randomized Controlled Trial

A Randomized Controlled Pilot Study of Home-Based Step Training in Older People Using Videogame Technology

Daniel Schoene et al. PLoS One. .
Free PMC article


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.

Conflict of interest statement

Competing Interests: SRL declares that the FallScreen fall risk assessment tool is commercially available through Neuroscience Research Australia (NeuRA); any profits from sales of the assessments are shared between the inventor (SRL), the falls and balance research group at NeuRA, and the NeuRA central fund. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.


Figure 1
Figure 1. Step pad and intervention tasks used in this study.
a) DDR example screen with updrifting arrow. The participant has to step when the red arrow (moving up) is directly over the target arrow (blue arrows). The round object on the bottom right side is a ‘bomb’ for which the participant has to inhibit his step. b) CSRT example screen. One of four arrows on the screen changes its color to blue and the participant is asked to step as quickly as possible onto the same location of the pad (front left).
Figure 2
Figure 2. Flow chart of study.

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Grant support

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