Clara is 78 years old and lives in a senior residency dwelling. For most of her life, Clara was regularly physically active (e.g. fitness classes), but as she got older she experienced a noticeable decrease in her walking abilities and in her ability to perform two tasks simultaneously. Therefore, Clara joined a walking programme from her residency. Unfortunately, one day Clara fell during her walking programme because she was distracted by talking to her friend and did not focus on the walking path.
During her rehabilitation programme in a rehabilitation centre, Clara started to use the ExerG, a video game-based physical training facility, a so-called exergame. The ExerG continuously improved Clara’s walking abilities over the rehabilitation period. After successfully finishing the rehabilitation programme, Clara continued her training with the ExerG in the local physiotherapy centre, to constantly improve her physical and cognitive abilities for preventing future events of falling.
Clara is not the only person to experience a fall, according to the World Health Organisation (WHO) around 28-35% of people aged 65 years and older fall each year. Underlying reasons for falls are manifold (e.g. walking and balance disorders or physical and cognitive impairments) and are even more pronounced when older people simultaneously carry out two activities, such as walking and talking. Experiences of falls are considered as stressful events which can lead to drastic consequences in social interaction, daily activities, and quality of life. Hence, researchers strive to develop training programmes that should not only prevent the incidence of falls, but also regain the physical and cognitive functions in rehabilitation. An effective training solution needs to overcome the following challenges:
User-centred focus allowing the personalisation of the training requirements
Motivation to regularly train and exercise
Meaningfulness of the training content regarding daily life activities
Ecological validity allowing an everyday movement-based training
Accessibility in clinics and other training locations, including data transfer
An upcoming training approach that has the potential to overcome all these challenges in older adults is exergaming (a composition of the words “exercise” and “gaming”). Exergames are video games that are controlled/played via specific whole-body movements. The combination of gaming and exercising allows the concurrent training of physical and cognitive functions, which seems to generate additive positive effects. Moreover, it has been shown that feelings of flow as well as high enjoyment and motivation are experienced during exergames.
Up to now, only a few exergame approaches holistically considered the factors of attractiveness, safety, and effectiveness, and face the above-mentioned challenges of training approaches for the geriatric population. Therefore, the ExerGetic project aims to develop and examine an innovative digital solution to individually improve physical and cognitive functions using an exergame for the geriatric population – the ExerG.
For the development of the ExerG, an interdisciplinary team of all relevant disciplines (game design, industrial design, movement science and end-user institutions) together with end-users (e.g. Clara and her therapist) are involved in the design process (training concept, soft- and hardware). The design follows an end-user-centred, iterative process to produce a training facility that is specifically tailored to older adults. Such a development process is very rare in the exergame development for older adults, but mandatory to evoke positive effects on the physical, cognitive and mental health as well as on the quality of life.
The ExerGetic project is based on the integration and consideration of several innovative and interdependent elements:
Personalised (end-user-centred) re-quirements
Individual training content for physical and cognitive load adaptations. End-user-specific preferences for the look and feel are integrated into the software.
Safe training setting
A ceiling-mounted harness system is integrated into the ExerG that enables individual body-weight support and an independent training environment.
Ecological validity of the training settings
Concurrent training of physical and cognitive functions as well as multi-sensory stimulation which are close to processes of daily life activities. The ExerG offers an immersive training environment.
Cloud solution and communication
Data of the ExerG training programme and training results are able to be transferred between different end-user institutions (e.g. rehabilitation centres and physiotherapy centres) that allows a wide range of application fields.
The ExerGetic project will have several impacts on the life of Clara, her family and friends as well as her care institutions.
Social impact / improvement in quality of life
The social impact is expected to be substantial, since the main goals of the solution are to stimulate and improve older adults’ physical, cognitive and mental functions and thus enhance their daily life independence through exergaming. Independent interaction of older adults triggers a more active lifestyle, which improves the sense of social connectedness and thus the quality of life of older adults in the long-term. Besides this direct impact, this innovative solution is expected also to indirectly benefit the geriatric community in general, including healthcare pathways and family members, whose services/care will most probably not be required so frequently, as older adults will be able to more independently cope with their own life.
Effect on service models
The ExerG development will be based on the new regulations for medical devices, will include end-users in all project phases, and will evaluate feasibility and trends in its efficacy that could lead to a health care insurance-recognised training device qualifying for co-payment.