The goal of this randomized clinical trial is to analyze the effectiveness of a physical exercise program based on exergames combined with conventional physical therapy, compared to a conventional physical exercise program alone, in improving lower limb strength, muscle quality, and physical capacity in older adults at risk of falling. The main questions it aims to answer are: Does a combined exergame and conventional exercise program improve functional capacity in older adults at risk of falling more than traditional exercise alone? Does the intervention improve lower limb strength and muscle quality more effectively than conventional exercise alone? Researchers will compare a group receiving exergame-based exercise combined with conventional therapy to a group receiving conventional physical exercise only to see if the addition of exergames enhances functional outcomes and muscle performance. Participants will: * Undergo baseline and post-intervention assessments of lower limb strength, muscle quality, and physical capacity. * Participate in a structured physical exercise program. * In the intervention group, perform exergame-based exercises using virtual reality gaming systems such as Nintendo Switch (Ring Fit Adventure). * Engage in sessions for several weeks, with consistent frequency and intensity depending on the group allocation.
Falls in older adults have been associated with a decrease in physical activity, the level of functionality and an increase in dependency. Furthermore, falls and their consequences are one of the main causes of mortality among older people. Falls are more frequent in women, in people over 75 years of age and with sensory deficits. Currently, there are promising and novel solutions to prevent and/or avoid the repetition of falls; Among them, the use of active exergames stands out. Active exergames can be developed in health, community, sports centers or in a homeroom individually or in groups using a screen through video games that involve the movement of the whole body, like the real world with or without the use of a controller that allows you to execute movements in a small space and interact with the game scenario. They have been shown to be useful for improving balance and physical condition in people of different ages and health conditions, but there is little evidence of studies that analyze the effects of this therapeutic strategy in older adults at risk of falling. Active exergames are a novel, simple, motivating, and easy-to-implement treatment option to promote healthy aging and prevent the risk of falls in older people. Therefore, it has the potential to become, in the short term, a therapeutic strategy for mass use, with high adherence and low cost in health centers. Exergames have an affordable cost, with a wide variety of games and are easy to use, therefore it is increasingly accepted by different types of patients as a therapeutic strategy. The evidence indicates that, both programs are expected to improve the primary and secondary outcomes proposed in this project. Additionally, older adults who execute an active exergame program are expected to have better performance compared to a conventional physiotherapy program in the main outcome and the secondary outcomes analyzed. It is expected to promote the use of active exergames by rehabilitation professionals in primary health care centers to prevent falls in older adults.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
52
Participants in this group will engage in a combined intervention consisting of: Multicomponent physical exercise (aerobic, strength, balance, and flexibility), delivered twice per week for 12 weeks. Exergames training using the Nintendo Switch console and Ring Fit Adventure game. Sessions include warm-up, gameplay involving full-body movements (e.g., squats, running, balance tasks), and cooldown. Sessions are adapted to individual physical capacities and supervised by a trained kinesiologist. The intensity is monitored using the Borg Scale, following ACSM guidelines.
Participants in this group will receive a standard multicomponent physical exercise program consisting of: Exercises for aerobic capacity, strength, balance, and flexibility. Delivered in-person twice per week for 12 weeks at senior care centers. Sessions include warm-up (5-10 min), main activity (30-40 min), and cooldown (5-10 min). Intensity is controlled using the Borg Scale and monitored by a supervising kinesiologist.
Universidad Católica Silva Henríquez
Santiago, Santiago Metropolitan, Chile
Risk of fall
Fall risk will be evaluated using the Downton Fall Risk Index (DFRI), a 5-item composite score based on prior falls, medication, sensory deficits, mental state, and mobility. A total score \>3 indicates high fall risk.
Time frame: Baseline and 12 weeks post-intervention
Functional Independence
Functional independence will be measured with FIM scale, it consists of 18 items that assess both motor and cognitive skills, and is scored on a 7-level scale, where 1 indicates total dependence and 7 complete independence.
Time frame: Baseline and 12 weeks post-intervention
Center of Pressure (COP)
Posturography, which records center of pressure displacement while standing on a stable platform.
Time frame: Baseline and 12 weeks post-intervention
Dynamic balance
Dynamic balance is measured with the Timed Up and Go (TUG) test, which evaluates the time in seconds that a participant takes to rise from a chair, walk 3 meters, turn, return, and sit down again.
Time frame: Baseline and 12 weeks post-intervention
Static balance
Single-Leg Stance Test (Unipedal Stance Test), where participants must maintain balance on one leg for at least 5 seconds.
Time frame: Baseline and 12 weeks post-intervention
Aerobic capacity
Aerobic capacity is assessed by the 2-Minute Walk Test, which measures the total distance (in meters) covered at a self-selected walking pace within 2 minutes on a flat surface.
Time frame: Baseline and 12 weeks post-intervention
body composition
Segmental muscle mass of the lower limbs will be assessed using a bioelectrical impedance analyzer (InBody 270). The participant stands barefoot and holds electrodes as the device estimates muscle mass.
Time frame: Baseline and 12 weeks post-intervention
Handgrip strength
handgrip strength will be assessed bilaterally in a seated position using a handheld dynamometer with the elbow at 90° flexion. The highest value from three attempts will be recorded (in kilograms).
Time frame: Baseline and 12 weeks post-intervention
Lower Limb Muscle Strength
Strength of the lower limbs will be evaluated using the Five Times Sit-to-Stand Test (FTSST). Participants are asked to sit and stand from a chair five times as quickly as possible, with arms crossed over the chest. The time taken (in seconds) will be recorded.
Time frame: Baseline and 12 weeks post-intervention
Intramuscular Fat Infiltration
Muscle echogenicity will be measured via ultrasound (transversal view of the quadriceps). Images will be analyzed using ImageJ software to calculate grayscale intensity (0-255 arbitrary units), which reflects intramuscular fat content.
Time frame: Baseline and 12 weeks post-intervention
Muscle Architecture
Muscle architecture (muscle thickness, pennation angle, fascicle length) of the quadriceps will be evaluated through ultrasound imaging. These anatomical variables will be analyzed using ImageJ software.
Time frame: Baseline and 12 weeks post-intervention
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