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A talk I recently gave at the Australian Seniors Computer Clubs Association talking about Games for Health.

A talk I recently gave at the Australian Seniors Computer Clubs Association talking about Games for Health.

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    • Interac(ve*digital**technologies*for*the*health* and*wellbeing*of*older*adults Stuart*Smith Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12 Some*background Background Interac(ve*digital*technologies An*example*from*our*lab Games*for*Health Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12 Background Background Ethnography not*for*profit*medical*research* ins(tute Cognitive Function Connectivity Social Falls ~200*scien(sts Technology*Research*for* focussing*on*disorders*of* Independent*Living Technology Platform brain*and*nervous*system Develop*technology*for*inJhome*monitoring*of*factors* associated*with*falls,*cogni(ve*func(on*and*social*connec(vity* Neuroscience*Research*Australia in*older*adults Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12
    • Background World Health Day, April 7 2012 Background Ageing and health Many health issues associated with ageing are non-communicable AND preventable through physical activity Source: http://www.who.int/ageing/publications/global_health/en/index.html Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12 Background however,*we*just*don’t*get*enough*PA Background We’ve used the TV to exercise for a long time. 1/3*world’s*popula(on*doesn’t* make*minimum* recommenda(ons*for*PA 6J10%*of*all*deaths*from*nonJ communicable*diseases*can*be* aOributed*to*physical*inac(vity “direct*and*indirect*economic*costs,* exerts*a*substan(al*burden*on* socie(es*and*health*systems” Source: www.jacklalanne.com Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12 Background Interac(ve*digital*technologies how*do*we*encourage* Inconvenience more*exercise Too#boring Too#painful “I#know,#I#know,#I#know#I# I#have#no#@me/ ? Expensive need#exercise” family# demands I’m#too#old Not#enough#fun Too#hot#and#sweaty I#can’t#do#it Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12
    • Interac(ve*digital*technologies Interac(ve*digital*technologies The exercise-related benefits of videogame play isn’t a new concept “Heart#rate#was#also#significantly#higher#during#play.#In#view#of#these#results,#other# Exergames for Subsyndromal Depression cardiovascular#changes#might#be#expected#to#occur#during#videoFgame#playing”. in Older Adults: A Pilot Study of a Novel Stuart*Smith Intervention www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12 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 than major depression in older adults and is associated with significant negative health outcomes. Physical activity can improve depression, but adherence is often poor. The authors assessed the feasibility, acceptability, and short-term efficacy and safety of a novel intervention using exergames (entertaining video games that combine game play with exercise) for SSD in older adults. Methods: Community-dwelling older adults (N ϭ 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-minute sessions a week. Results: Eight-six percent of enrolled participants completed the 12-week intervention. There was a significant improvement in depressive symptoms, mental health-related quality of life (QoL), and cognitive performance but not physical health-related QoL. There were no major adverse events, and improvement in depression was maintained at follow-up. Conclusions: The findings provide preliminary indication of the benefits of exergames in seniors with SSD. Randomized controlled trials of exergames for late-life SSD are warranted. (Am J Geriatr Psychiatry 2010; 18:221–226) Exergames Key Words: Physical activity, aging, videogames, depression, quality of life, cognition Interac(ve*digital*technologies A mong older people, subsyndromal depression (SSD) is several times more common than major depression and is associated with substantial suffering, 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 for Amiga/Atari*Joyboard*(1982) functional disability, increased use of costly medical improving physical health conditions and function- services, and higher mortality.1,2 There is a dearth of 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 University of California San Diego (UCSD)/San Diego State University (SDSU) (DR); Department of Psychiatry, UCSD (CAD, IVV, BWP, DVJ); Sam and Rose Stein 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, University of California, 9500 Gilman Drive (MC 0664), La Jolla, CA 92093-0664. email: djeste@ucsd.edu © 2010 American Association for Geriatric Psychiatry Am J Geriatr Psychiatry 18:3, March 2010 221 EXERGAMES Sensors*used*to*transduce*body*movements*into*control*of* video*game*play Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12 Interac(ve*digital*technologies Technologies*for* measuring*and* mo(va(ng*everyday* ac(vity Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12
    • Catherine Sherrington, PhD,Ã wz Julie C. Whitney, MSc,§ Stephen R. Lord, DSc,w Robert D. Herbert, PhD,Ã Robert G. Cumming, PhD, z and Jacqueline C. T. Close, MDw k OBJECTIVES: To determine the effects of exercise on falls Key words: falls; exercise; meta-analysis prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated 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 in those who did not exercise were included. SETTING: Older people. T he development and implementation of effective and cost-efficient strategies to prevent falls in older people is an urgent global health challenge. In developed countries, PARTICIPANTS: General community and residential care. life expectancy for people aged 65 years old is approxi- MEASUREMENTS: Fall rates. mately 17 years for men and 21 years for women. At least RESULTS: The pooled estimate of the effect of exercise one-third of people aged 65 and older fall at least onceSo*how*are*we*using*exergames*at*NeuRA? An*example was that it reduced the rate of falling by 17% (44 trials with annually,1 and falls account for more than half of the injury- How*do*we*encourage*exercise? 9,603 participants, rate ratio (RR) 5 0.83, 95% confidence related hospitalizations for older people.2 Fall rates in the interval (CI) 5 0.75–0.91, Po.001, I2 5 62%). The great- general older population are reported to be 1.2 falls per est relative effects of exercise on fall rates (RR 5 0.58, 95% person year.3 CI 5 0.48–0.69, 68% of between-study variability ex- Falls in older people are not purely random events but plained) were seen in programs that included a combina- tion of a higher total dose of exercise (450 hours over the Falls*are*a*major*factor*for*reduced* can be predicted by assessing a number of risk factors.4,5 Some of these risk factors (e.g., reduced muscle strength and independence*in*older*adults Dance*Dance*Revolu(on trial period) and challenging balance exercises (exercises impaired balance and gait) can be modified using exercise, conducted while standing in which people aimed to stand whereas others (e.g., poor vision, psychoactive medication with their feet closer together or on one leg, minimize use of use) require different intervention approaches. Exercise their hands to assist, and practice controlled movements of 1/3*community*dwelling*older*adults* can be used as a stand-alone falls prevention intervention or the center of mass) and did not include a walking program. as a component of a multifaceted program. Multifaceted CONCLUSION: Exercise can prevent falls in older people. interventions can prevent falls in the general community, Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of ex- (>65*yo)*fall*each*year in those at greater risk of falls, and in residential care facilities.4,6 ercise, and do not include a walking program. Service pro- Many trials have sought to establish the specific effect viders can use these findings to design and implement of exercise on fall rates, but a large proportion of these trials exercise programs for falls prevention. J Am Geriatr Soc 56:2234–2243, 2008. Total*health*cost*to*NSW*alone*in*2006/2007* have been underpowered. The best way to interpret these trials may be to pool their data in a meta-analysis, but trials The Incidence and Cost of From the ÃMusculoskeletal Among Older People $553M of the effects of exercise on fall rates vary in their quality, Falls Injury Division, The George Institute for International have been conducted on a range of populations, and employ Health and zSchool of Public Health, University of2006/07. Australia; in New South Wales Sydney, Sydney, exercise programs that differ greatly in their aims and con- w Falls and Balance Research Group, Prince of Wales Medical Research tent. Meta-analysis should therefore involve exploration of Institute, University of New South Wales, Sydney, Australia; §Clinical Age A"Report"to"NSW"Health Research Unit, Kings College Hospital, London, United Kingdom; and k Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, mates of the effect of exercise programs.7,8 $18,454*per*hospital*admission whether these factors ‘‘explain’’ (are associated with) esti- Australia. A Cochrane review of fall prevention strategies6 con- Address correspondence to Dr. Catherine Sherrington, The George Institute ducted separate meta-analyses on different forms of exer- for International Health, PO Box M201, Missenden Road, Sydney NSW cise and concluded that some exercise programs can prevent 2050, Australia. E-mail: csherrington@george.org.au of Falls: A Systematic Review Effective Exercise for the Prevention falls in community dwellers (e.g., home exercise program of balance and strength training, a Tai Chi group program) but Exercise*works*to* and Meta-Analysis DOI: 10.1111/j.1532-5415.2008.02014.x Catherine Sherrington, PhD,Ã wz Julie C. Whitney, MSc,§ Stephen R. Lord, DSc,w Robert D. Herbert, PhD,Ã Robert G. Cumming, PhD, z and Jacqueline C. T. Close, MDw k JAGS 56:2234–2243, 2008 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society reduce*fall*risk 0002-8614/08/$15.00 OBJECTIVES: To determine the effects of exercise on falls Key words: falls; exercise; meta-analysis prevention in older people and establish whether particular trial characteristics or components of exercise programs are Stuart*Smith associated with larger reductions in falls. www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.au DESIGN: Systematic review with meta-analysis. Random- ized controlled trials that compared fall rates in older peo-Wednesday, 28 November 12 ple who undertook exercise programs with fall rates in Wednesday, 28 November 12 those who did not exercise were included. SETTING: Older people. T he development and implementation of effective and cost-efficient strategies to prevent falls in older people is an urgent global health challenge. In developed countries, PARTICIPANTS: General community and residential care. life expectancy for people aged 65 years old is approxi- MEASUREMENTS: Fall rates. mately 17 years for men and 21 years for women. At least RESULTS: The pooled estimate of the effect of exercise one-third of people aged 65 and older fall at least once was that it reduced the rate of falling by 17% (44 trials with annually,1 and falls account for more than half of the injury- 9,603 participants, rate ratio (RR) 5 0.83, 95% confidence related hospitalizations for older people.2 Fall rates in the interval (CI) 5 0.75–0.91, Po.001, I2 5 62%). The great- general older population are reported to be 1.2 falls per est relative effects of exercise on fall rates (RR 5 0.58, 95% person year.3 CI 5 0.48–0.69, 68% of between-study variability ex- Falls in older people are not purely random events but plained) were seen in programs that included a combina- can be predicted by assessing a number of risk factors.4,5 tion of a higher total dose of exercise (450 hours over the Some of these risk factors (e.g., reduced muscle strength and trial period) and challenging balance exercises (exercises impaired balance and gait) can be modified using exercise, conducted while standing in which people aimed to stand whereas others (e.g., poor vision, psychoactive medication with their feet closer together or on one leg, minimize use of use) require different intervention approaches. Exercise their hands to assist, and practice controlled movements of can be used as a stand-alone falls prevention intervention or the center of mass) and did not include a walking program. as a component of a multifaceted program. Multifaceted CONCLUSION: Exercise can prevent falls in older people. interventions can prevent falls in the general community, Greater relative effects are seen in programs that include in those at greater risk of falls, and in residential care exercises that challenge balance, use a higher dose of ex- facilities.4,6 ercise, and do not include a walking program. Service pro- Many trials have sought to establish the specific effect viders can use these findings to design and implement of exercise on fall rates, but a large proportion of these trials exercise programs for falls prevention. J Am Geriatr Soc have been underpowered. The best way to interpret these 56:2234–2243, 2008. trials may be to pool their data in a meta-analysis, but trials of the effects of exercise on fall rates vary in their quality, From the ÃMusculoskeletal Division, The George Institute for International have been conducted on a range of populations, and employ Health and zSchool of Public Health, University of Sydney, Sydney, Australia; exercise programs that differ greatly in their aims and con- w Falls and Balance Research Group, Prince of Wales Medical Research tent. Meta-analysis should therefore involve exploration of Institute, University of New South Wales, Sydney, Australia; §Clinical Age whether these factors ‘‘explain’’ (are associated with) esti- Research Unit, Kings College Hospital, London, United Kingdom; and k Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, mates of the effect of exercise programs.7,8 Australia. A Cochrane review of fall prevention strategies6 con- Address correspondence to Dr. Catherine Sherrington, The George Institute ducted separate meta-analyses on different forms of exer- for International Health, PO Box M201, Missenden Road, Sydney NSW cise and concluded that some exercise programs can prevent 2050, Australia. E-mail: csherrington@george.org.au falls in community dwellers (e.g., home exercise program of DOI: 10.1111/j.1532-5415.2008.02014.x balance and strength training, a Tai Chi group program) but JAGS 56:2234–2243, 2008 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614/08/$15.00 An*example 8*week*inJhome*DDR*interven(on*(somewhat*modified) What*we*measure*with*this*system 1350 1300 Stepping time (ms) 1250 1200 1150 1100 1050 1000 Fallers Non-fallers Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12 Intriguing*possibility Future*direc(ons* Mrs Smith, it looks like you have been a bit unsteady on your feet lately. Is there anything we can do for you? Microsog*Xbox*Kinect*is*a*possible* technology*to*engage*older*adults*in*PA Fall risk Date Some*game*developers*are* interested*in*new*markets Exergames*as*a*telehealth*technology Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12
    • TELE BASED TAI CHI FOR ELDERS, Wu 851Future*direc(ons* Future*direc(ons* Game*developers*are*partnering*with*health*insurance* companies*to*build*new*kinds*of*exergames Instructor Fig 1. A schematic illustra- tion of the Tele-ex set-up for the exercise instructor and subjects. The DocBox is also shown. Abbreviation: TV, television; MCU, multipoint control unit. difficulty. Subjects were asked to rate their confidence level in Body sway in the medial-lateral direction during quiet stance is performing each of the 14 activities on a continuous scale from defined as the displacement of the COP under the feet (normalized 0 (no confidence) to 100 (completely confident). A composite by the width of the base of support) and is shown to be a score of the average level of confidence was used for analysis. significant predictor for future falls in elders.33 Subjects were The possible range of the ABC score is 0 to 100. The ABC has asked to stand on a force platform, as still as possible, for 1 minute been shown to have a good test-retest reliability.28(p36) with feet touching and EO, and then EC. The data from the force Quality of life was assessed by the SF-36 Questionnaire, a platform were collected by a personal computer with a sampling condition-generic tool composed of 36 questions measuring frequency of 50Hz and were used to compute the COP in the functional health and well being in 8 domains including Phys- medial-lateral and anterior-posterior directions, respectively. ical Functioning, Role Functioning, Bodily Pain, General Health, Vitality, Social Functioning, Mental Health, and Role Data Analysis Emotional.29 This instrument has been extensively studied, has Outcome measures were examined to detect outliers and been validated in healthy adult outpatients and elderly patients, other data anomalies. Group effect was tested for baseline and and has shown minimal floor or ceiling effects.30 for the change between pretest and posttest using 1-way SLS measures the amount of time a person can maintain SLS ANOVA. If a significant group effect was found, pairwise without support. Subjects were asked to stand on 2 forceplates,c comparisons of the 3 groups were performed using the Tukey 1 under each foot, and to lift 1 foot whenever ready, with EO, test to adjust for multiple comparisons. Training effect was unsupported, for up to 30 seconds. They were asked to repeat tested for each group using the paired t test. A significant this 3 times with each leg, and the repetition with the longest difference was set at a P value of .05. All analysis was done Stuart*Smith time for each leg was chosen forwww.NeuRA.edu.au time was analysis. The stance using intention to treat. Analyses were conducted using the Stuart*Smith www.NeuRA.edu.au determined by the vertical force from the corresponding forceplate SPSSd and SASe statistical programs. being 0, with a timing resolution of .02 seconds. The SLS time isWednesday, 28 November 12 shown to correlate strongly with falls.31 Wednesday, 28 November 12 RESULTS Timed Up and Go measures the amount of time a person needs to complete a well defined task. Subjects were asked to stand up from a chair, walk a 3-m distance, turn around, return, Subject Information and sit down again.32 The time to complete this task was A total of 112 subjects responded to the calls for recruitment, recorded by a digital timer with a resolution of .02 seconds. 94 were screened, and 64 enrolled in the study on a first-come, Each subject was asked to repeat this 3 times, and the repetition first-served basis. Main reasons for exclusion were health prob- with the shortest time was used for analysis. This test has high lems and unwillingness to be randomized (including preference interrater and intrarater reliability (99%).32 to one type of exercise over another, conflict with the class Arch Phys Med Rehabil Vol 91, June 2010Future*direc(ons Social*connec(vity*to*close*the*loop Where to from here We’d like to reduce risk of falls Game developers and Games for Health technologists Health researchers Australasia Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12 Finally, why videogames? Future*direc(ons:* A*challenge Older adults like to play exergames It’s*all*too*easy*to*find*excuses* to*not*engage*in*physical* Game consoles are relatively inexpensive ac(vity with existing distribution networks for both hardware and software Australian games industry is forecast to reach $2.5B by 2015 Withings Fitbit Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12
    • Future*direc(ons:* Future*direc(ons:* A*challenge A*challenge hOp://www.wcaa2012challenge.com http://www.wcaa2012challenge.com/ Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12Future*direc(ons:* Future*direc(ons:*http://www.wcaa2012challenge.com/ http://www.wcaa2012challenge.com/ Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12Future*direc(ons:* We’d REALLY appreciate some help NB: This is a group NOT a page here Thank*you s.smith@neura.edu.auhttp://www.wcaa2012challenge.com/ Stuart*Smith www.NeuRA.edu.au Stuart*Smith www.NeuRA.edu.auWednesday, 28 November 12 Wednesday, 28 November 12