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The ability to make well-timed, appropriately directed steps underpins our ability to maintain our balance and move unaided through our environment. 1 There is evidence to suggest that the timing of volitional stepping 2 3 and execution of successful steps for recovery of balance following an induced slip 4 can be significantly improved in older adults following repetitive training of stepping responses. Randomised control trials that include muscle strengthening and balance training also show that the risk of falls can be significantly reduced; 5 however, compliance with fall prevention interventions is often disappointing, 6 7 suggesting some reluctance on the part of older adults to take part in such programs.
One possible method by which compliance with exercise programs could be improved involves the use of interactive exercise videogames (exergames) that combine player movement, engaging recreation, immediate performance feedback and social connectivity via competition. 8 - 13 Dance Dance Revolution (DDR; Konami) is an example of an exergame that involves participants making rapid step responses from either leg to a target location in response to a randomly presented visual stimulus. Such games involve controlled body weight transfers that are similar to the step responses required to avoid many falls. We have developed a novel step training system for use by older adults based on DDR and present here a series of studies that establish parameters of system use in adults aged ≥70.
Methods
Study participants
Participants were recruited from a pool of 44 older adults aged >70 (mean age 78.9) who were living independently in the community and were participating in ongoing studies at the Prince of Wales Medical Research Institute or were volunteers from local older adult community groups. All participants were without cognitive impairment (ie, mini-mental state examination scores of ≥24) or visual impairment not correctable with glasses and were capable of stepping unaided.
DDR step training system
The system consists of a modified Universal Serial Bus (USB) video game dance mat ( fig 1A ), which measures approximately 1 m2 and has four step-sensitive target panels, two leftward and two rightward pointing. Each step panel measured 30 cm and was positioned 20 cm away from the nearest foot.Players stand at the centre of the mat at all times and make...