stu ascca presentation

Interac(ve*digital**technologies*for*the*health*and*wellbeing*of*older*adults

Stuart*Smith

Wednesday, 28 November 12www.NeuRA.edu.auStuart*Smith

Wednesday, 28 November 12

www.NeuRA.edu.auStuart*Smith

Some*background

Interac(ve*digital*technologies

An*example*from*our*lab

Games*for*Health


Background



Background

Neuroscience*Research*Australia

not*for*profit*medical*research*ins(tute

~200*scien(sts

focussing*on*disorders*of*brain*and*nervous*system


Technology*Research*for*Independent*Living

Falls

Cog

nitiv

e Fu

nctio

n

Soci

al

Con

nect

ivity

Ethnography

Technology Platform

Develop*technology*for*inJhome*monitoring*of*factors*associated*with*falls,*cogni(ve*func(on*and*social*connec(vity*

in*older*adults

Background



Source: http://www.who.int/ageing/publications/global_health/en/index.html

World Health Day, April 7 2012

Ageing and health

Background


Many health issues associated with ageing are non-communicable AND preventable through physical activity

Background



6J10%*of*all*deaths*from*nonJcommunicable*diseases*can*be*aOributed*to*physical*inac(vity

“direct*and*indirect*economic*costs,*exerts*a*substan(al*burden*on*socie(es*and*health*systems”

however,*we*just*don’t*get*enough*PA

1/3*world’s*popula(on*doesn’t*make*minimum*

recommenda(ons*for*PA

Background


Source: www.jacklalanne.com

We’ve used the TV to exercise for a long time.Background



“I#know,#I#know,#I#know#I#need#exercise”

Too#boring

Not#enough#fun

I#can’t#do#it

I’m#too#old

Too#painful

Expensive

Inconvenience

I#have#no#@me/family#

demands

Too#hot#and#sweaty

Background


Interac(ve*digital*technologies how*do*we*encourage*more*exercise

?





“Heart#rate#was#also#significantly#higher#during#play.#In#view#of#these#results,#other#cardiovascular#changes#might#be#expected#to#occur#during#videoFgame#playing”.

The exercise-related benefits of videogame play isn’t a new concept




Exergames for Subsyndromal Depressionin Older Adults: A Pilot Study of a Novel

Intervention

Dori Rosenberg, M.P.H., M.S., Colin A. Depp, Ph.D.,Ipsit V. Vahia, M.D., Jennifer Reichstadt, M.S.,

Barton W. Palmer, Ph.D., Jacqueline Kerr, Ph.D.,Greg Norman, Ph.D., Dilip V. Jeste, M.D.

Objectives: Subsyndromal depression (SSD) is several times more common thanmajor depression in older adults and is associated with significant negative healthoutcomes. Physical activity can improve depression, but adherence is often poor. Theauthors assessed the feasibility, acceptability, and short-term efficacy and safety of anovel intervention using exergames (entertaining video games that combine gameplay with exercise) for SSD in older adults. Methods: Community-dwelling olderadults (N ! 19, aged 63–94 years) with SSD participated in a 12-week pilot study(with follow-up at 20–24 weeks) of Nintendo’s Wii sports, with three 35-minutesessions a week. Results: Eight-six percent of enrolled participants completed the12-week intervention. There was a significant improvement in depressive symptoms,mental health-related quality of life (QoL), and cognitive performance but notphysical health-related QoL. There were no major adverse events, and improvementin depression was maintained at follow-up. Conclusions: The findings providepreliminary indication of the benefits of exergames in seniors with SSD. Randomizedcontrolled trials of exergames for late-life SSD are warranted. (Am J Geriatr Psychiatry2010; 18:221–226)

Key Words: Physical activity, aging, videogames, depression, quality of life, cognition

Among older people, subsyndromal depression(SSD) is several times more common than major

depression and is associated with substantial suffering,functional disability, increased use of costly medicalservices, and higher mortality.1,2 There is a dearth of

safe, evidence-based interventions tailored to older per-sons with SSD that can be delivered in the home.3

Physical activity is a key modifiable behavior forimproving physical health conditions and function-ing and reducing depressive symptoms in late life.4

Received July 16, 2009; revised August 26, 2009; accepted August 31, 2009. From the Joint Doctoral Program in Clinical Psychology Universityof California San Diego (UCSD)/San Diego State University (SDSU) (DR); Department of Psychiatry, UCSD (CAD, IVV, BWP, DVJ); Sam and RoseStein Institute for Research on Aging, UCSD (CAD, IVV, JR, DVJ); and Department of Family and Preventive Medicine, UCSD (JK, GN), San Diego,CA. Send correspondence and reprint requests to Dilip V. Jeste, M.D., Stein Institute for Research on Aging, Department of Psychiatry, Universityof California, 9500 Gilman Drive (MC 0664), La Jolla, CA 92093-0664. email: [email protected]

© 2010 American Association for Geriatric Psychiatry

Am J Geriatr Psychiatry 18:3, March 2010 221


EXERGAMES


Amiga/Atari*Joyboard*(1982)

Sensors*used*to*transduce*body*movements*into*control*of*video*game*play

Exergames




Technologies*for*measuring*and*

mo(va(ng*everyday*ac(vity




So*how*are*we*using*exergames*at*NeuRA?

Falls*are*a*major*factor*for*reduced*independence*in*older*adults

1/3*community*dwelling*older*adults*(>65*yo)*fall*each*year

The Incidence and Cost of Falls Injury Among Older People

in New South Wales 2006/07.A"Report"to"NSW"Health

Total*health*cost*to*NSW*alone*in*2006/2007*$553M

$18,454*per*hospital*admission

Effective Exercise for the Prevention of Falls: A Systematic Reviewand Meta-Analysis

Catherine Sherrington, PhD,!wz Julie C. Whitney, MSc,§ Stephen R. Lord, DSc,w

Robert D. Herbert, PhD,! Robert G. Cumming, PhD,z and Jacqueline C. T. Close, MDwk

OBJECTIVES: To determine the effects of exercise on fallsprevention in older people and establish whether particulartrial characteristics or components of exercise programs areassociated with larger reductions in falls.

DESIGN: Systematic review with meta-analysis. Random-ized controlled trials that compared fall rates in older peo-ple who undertook exercise programs with fall rates inthose who did not exercise were included.

SETTING: Older people.

PARTICIPANTS: General community and residential care.

MEASUREMENTS: Fall rates.

RESULTS: The pooled estimate of the effect of exercisewas that it reduced the rate of falling by 17% (44 trials with9,603 participants, rate ratio (RR)50.83, 95% confidenceinterval (CI)5 0.75–0.91, Po.001, I2562%). The great-est relative effects of exercise on fall rates (RR5 0.58, 95%CI50.48–0.69, 68% of between-study variability ex-plained) were seen in programs that included a combina-tion of a higher total dose of exercise (450 hours over thetrial period) and challenging balance exercises (exercisesconducted while standing in which people aimed to standwith their feet closer together or on one leg, minimize use oftheir hands to assist, and practice controlled movements ofthe center of mass) and did not include a walking program.

CONCLUSION: Exercise can prevent falls in older people.Greater relative effects are seen in programs that includeexercises that challenge balance, use a higher dose of ex-ercise, and do not include a walking program. Service pro-viders can use these findings to design and implementexercise programs for falls prevention. J Am Geriatr Soc56:2234–2243, 2008.

Key words: falls; exercise; meta-analysis

The development and implementation of effective andcost-efficient strategies to prevent falls in older people

is an urgent global health challenge. In developed countries,life expectancy for people aged 65 years old is approxi-mately 17 years for men and 21 years for women. At leastone-third of people aged 65 and older fall at least onceannually,1 and falls account for more than half of the injury-related hospitalizations for older people.2 Fall rates in thegeneral older population are reported to be 1.2 falls perperson year.3

Falls in older people are not purely random events butcan be predicted by assessing a number of risk factors.4,5

Some of these risk factors (e.g., reduced muscle strength andimpaired balance and gait) can be modified using exercise,whereas others (e.g., poor vision, psychoactive medicationuse) require different intervention approaches. Exercisecan be used as a stand-alone falls prevention intervention oras a component of a multifaceted program. Multifacetedinterventions can prevent falls in the general community,in those at greater risk of falls, and in residential carefacilities.4,6

Many trials have sought to establish the specific effectof exercise on fall rates, but a large proportion of these trialshave been underpowered. The best way to interpret thesetrials may be to pool their data in a meta-analysis, but trialsof the effects of exercise on fall rates vary in their quality,have been conducted on a range of populations, and employexercise programs that differ greatly in their aims and con-tent. Meta-analysis should therefore involve exploration ofwhether these factors ‘‘explain’’ (are associated with) esti-mates of the effect of exercise programs.7,8

A Cochrane review of fall prevention strategies6 con-ducted separate meta-analyses on different forms of exer-cise and concluded that some exercise programs can preventfalls in community dwellers (e.g., home exercise program ofbalance and strength training, a Tai Chi group program) but

Address correspondence to Dr. Catherine Sherrington, The George Institutefor International Health, PO Box M201, Missenden Road, Sydney NSW2050, Australia. E-mail: [email protected]

DOI: 10.1111/j.1532-5415.2008.02014.x

From the !Musculoskeletal Division, The George Institute for InternationalHealth and zSchool of Public Health, University of Sydney, Sydney, Australia;wFalls and Balance Research Group, Prince of Wales Medical ResearchInstitute, University of New South Wales, Sydney, Australia; §Clinical AgeResearch Unit, Kings College Hospital, London, United Kingdom; andkDepartment of Geriatric Medicine, Prince of Wales Hospital, Sydney,Australia.

JAGS 56:2234–2243, 2008r 2008, Copyright the AuthorsJournal compilation r 2008, The American Geriatrics Society 0002-8614/08/$15.00

Effective Exercise for the Prevention of Falls: A Systematic Reviewand Meta-Analysis

Catherine Sherrington, PhD,!wz Julie C. Whitney, MSc,§ Stephen R. Lord, DSc,w

Robert D. Herbert, PhD,! Robert G. Cumming, PhD,z and Jacqueline C. T. Close, MDwk

OBJECTIVES: To determine the effects of exercise on fallsprevention in older people and establish whether particulartrial characteristics or components of exercise programs areassociated with larger reductions in falls.

DESIGN: Systematic review with meta-analysis. Random-ized controlled trials that compared fall rates in older peo-ple who undertook exercise programs with fall rates inthose who did not exercise were included.

SETTING: Older people.

PARTICIPANTS: General community and residential care.

MEASUREMENTS: Fall rates.

RESULTS: The pooled estimate of the effect of exercisewas that it reduced the rate of falling by 17% (44 trials with9,603 participants, rate ratio (RR)50.83, 95% confidenceinterval (CI)5 0.75–0.91, Po.001, I2562%). The great-est relative effects of exercise on fall rates (RR5 0.58, 95%CI50.48–0.69, 68% of between-study variability ex-plained) were seen in programs that included a combina-tion of a higher total dose of exercise (450 hours over thetrial period) and challenging balance exercises (exercisesconducted while standing in which people aimed to standwith their feet closer together or on one leg, minimize use oftheir hands to assist, and practice controlled movements ofthe center of mass) and did not include a walking program.

CONCLUSION: Exercise can prevent falls in older people.Greater relative effects are seen in programs that includeexercises that challenge balance, use a higher dose of ex-ercise, and do not include a walking program. Service pro-viders can use these findings to design and implementexercise programs for falls prevention. J Am Geriatr Soc56:2234–2243, 2008.

Key words: falls; exercise; meta-analysis

The development and implementation of effective andcost-efficient strategies to prevent falls in older people

is an urgent global health challenge. In developed countries,life expectancy for people aged 65 years old is approxi-mately 17 years for men and 21 years for women. At leastone-third of people aged 65 and older fall at least onceannually,1 and falls account for more than half of the injury-related hospitalizations for older people.2 Fall rates in thegeneral older population are reported to be 1.2 falls perperson year.3

Falls in older people are not purely random events butcan be predicted by assessing a number of risk factors.4,5

Some of these risk factors (e.g., reduced muscle strength andimpaired balance and gait) can be modified using exercise,whereas others (e.g., poor vision, psychoactive medicationuse) require different intervention approaches. Exercisecan be used as a stand-alone falls prevention intervention oras a component of a multifaceted program. Multifacetedinterventions can prevent falls in the general community,in those at greater risk of falls, and in residential carefacilities.4,6

Many trials have sought to establish the specific effectof exercise on fall rates, but a large proportion of these trialshave been underpowered. The best way to interpret thesetrials may be to pool their data in a meta-analysis, but trialsof the effects of exercise on fall rates vary in their quality,have been conducted on a range of populations, and employexercise programs that differ greatly in their aims and con-tent. Meta-analysis should therefore involve exploration ofwhether these factors ‘‘explain’’ (are associated with) esti-mates of the effect of exercise programs.7,8

A Cochrane review of fall prevention strategies6 con-ducted separate meta-analyses on different forms of exer-cise and concluded that some exercise programs can preventfalls in community dwellers (e.g., home exercise program ofbalance and strength training, a Tai Chi group program) but

Address correspondence to Dr. Catherine Sherrington, The George Institutefor International Health, PO Box M201, Missenden Road, Sydney NSW2050, Australia. E-mail: [email protected]

DOI: 10.1111/j.1532-5415.2008.02014.x

From the !Musculoskeletal Division, The George Institute for InternationalHealth and zSchool of Public Health, University of Sydney, Sydney, Australia;wFalls and Balance Research Group, Prince of Wales Medical ResearchInstitute, University of New South Wales, Sydney, Australia; §Clinical AgeResearch Unit, Kings College Hospital, London, United Kingdom; andkDepartment of Geriatric Medicine, Prince of Wales Hospital, Sydney,Australia.

JAGS 56:2234–2243, 2008r 2008, Copyright the AuthorsJournal compilation r 2008, The American Geriatrics Society 0002-8614/08/$15.00

Exercise*works*to*reduce*fall*risk


An*example

Dance*Dance*Revolu(on

How*do*we*encourage*exercise?



An*example 8*week*inJhome*DDR*interven(on*(somewhat*modified)


1350

1000

1050

1100

1150

1200

1250

1300

Step

ping

tim

e (m

s)

Fallers Non-fallers

What*we*measure*with*this*system



Fall

risk

Date

Mrs Smith, it looks like you have been a bit unsteady on your feet lately. Is there

anything we can do for you?

Exergames*as*a*telehealth*technology

Intriguing*possibility


Future*direc(ons*

Microsog*Xbox*Kinect*is*a*possible*technology*to*engage*older*adults*in*PA

Some*game*developers*are*interested*in*new*markets



Future*direc(ons*

Game*developers*are*partnering*with*health*insurance*companies*to*build*new*kinds*of*exergames


difficulty. Subjects were asked to rate their confidence level inperforming each of the 14 activities on a continuous scale from0 (no confidence) to 100 (completely confident). A compositescore of the average level of confidence was used for analysis.The possible range of the ABC score is 0 to 100. The ABC hasbeen shown to have a good test-retest reliability.28(p36)

Quality of life was assessed by the SF-36 Questionnaire, acondition-generic tool composed of 36 questions measuringfunctional health and well being in 8 domains including Phys-ical Functioning, Role Functioning, Bodily Pain, GeneralHealth, Vitality, Social Functioning, Mental Health, and RoleEmotional.29 This instrument has been extensively studied, hasbeen validated in healthy adult outpatients and elderly patients,and has shown minimal floor or ceiling effects.30

SLS measures the amount of time a person can maintain SLSwithout support. Subjects were asked to stand on 2 forceplates,c1 under each foot, and to lift 1 foot whenever ready, with EO,unsupported, for up to 30 seconds. They were asked to repeatthis 3 times with each leg, and the repetition with the longesttime for each leg was chosen for analysis. The stance time wasdetermined by the vertical force from the corresponding forceplatebeing 0, with a timing resolution of .02 seconds. The SLS time isshown to correlate strongly with falls.31

Timed Up and Go measures the amount of time a personneeds to complete a well defined task. Subjects were asked tostand up from a chair, walk a 3-m distance, turn around, return,and sit down again.32 The time to complete this task wasrecorded by a digital timer with a resolution of .02 seconds.Each subject was asked to repeat this 3 times, and the repetitionwith the shortest time was used for analysis. This test has highinterrater and intrarater reliability (99%).32

Body sway in the medial-lateral direction during quiet stance isdefined as the displacement of the COP under the feet (normalizedby the width of the base of support) and is shown to be asignificant predictor for future falls in elders.33 Subjects wereasked to stand on a force platform, as still as possible, for 1 minutewith feet touching and EO, and then EC. The data from the forceplatform were collected by a personal computer with a samplingfrequency of 50Hz and were used to compute the COP in themedial-lateral and anterior-posterior directions, respectively.

Data AnalysisOutcome measures were examined to detect outliers and

other data anomalies. Group effect was tested for baseline andfor the change between pretest and posttest using 1-wayANOVA. If a significant group effect was found, pairwisecomparisons of the 3 groups were performed using the Tukeytest to adjust for multiple comparisons. Training effect wastested for each group using the paired t test. A significantdifference was set at a P value of .05. All analysis was doneusing intention to treat. Analyses were conducted using theSPSSd and SASe statistical programs.

RESULTS

Subject InformationA total of 112 subjects responded to the calls for recruitment,

94 were screened, and 64 enrolled in the study on a first-come,first-served basis. Main reasons for exclusion were health prob-lems and unwillingness to be randomized (including preferenceto one type of exercise over another, conflict with the class

Fig 1. A schematic illustra-tion of the Tele-ex set-up forthe exercise instructor andsubjects. The DocBox is alsoshown. Abbreviation: TV,television; MCU, multipointcontrol unit.

851TELE BASED TAI CHI FOR ELDERS, Wu

Arch Phys Med Rehabil Vol 91, June 2010

Instructor

Future*direc(ons*



Future*direc(ons Social*connec(vity*to*close*the*loop


Health researchersGame developers and

technologists

Where to from here

\We’d like to

reduce risk of falls

Games for Health Australasia



Finally, why videogames?Older adults like to play exergames

Game consoles are relatively inexpensive

with existing distribution networks for both hardware and software

Australian games industry is forecast to reach $2.5B by 2015


Future*direc(ons:* A*challenge

It’s*all*too*easy*to*find*excuses*to*not*engage*in*physical*

ac(vity

Withings FitbitWednesday, 28 November 12


Future*direc(ons:*

A*challenge

hOp://www.wcaa2012challenge.com


Future*direc(ons:* A*challenge

http://www.wcaa2012challenge.com/



Future*direc(ons:*



Future*direc(ons:*




Future*direc(ons:*


We’d REALLY appreciate some help

here


Thank*[email protected]

NB: This is a group NOT a page


stu ascca presentation

Health & Medicine

adults stuart

novel stuart

videofg older adults

exercise family

painful i

subsyndromal depression

major depression

healthmany health issues