A custom-built step exergame training programme to prevent falls in people with multiple sclerosis: A multicentre randomised controlled trial.

BACKGROUND: Cognitive-motor step training can improve stepping, balance and mobility in people with multiple sclerosis (MS), but effectiveness in preventing falls has not been demonstrated. OBJECTIVES: This multisite randomised controlled trial aimed to determine whether 6 months of home-based step exergame training could reduce falls and improve associated risk factors compared with usual care in people with MS. METHODS: In total, 461 people with MS aged 22-81 years were randomly allocated to usual care (control) or unsupervised home-based step exergame training (120 minutes/week) for 6 months. The primary outcome was rate of falls over 6 months from randomisation. Secondary outcomes included physical, cognitive and psychosocial function at 6 months and falls over 12 months. RESULTS: Mean (standard deviation (SD)) weekly training duration was 70 (51) minutes over 6 months. Fall rates did not differ between intervention and control groups (incidence rates (95% confidence interval (CI)): 2.13 (1.57-2.69) versus 2.24 (1.35-3.13), respectively, incidence rate ratio: 0.96 (95% CI: 0.69-1.34, p = 0.816)). Intervention participants performed faster in tests of choice-stepping reaction time at 6 months. No serious training-related adverse events were reported. CONCLUSION: The step exergame training programme did not reduce falls among people with MS. However, it significantly improved choice-stepping reaction time which is critical to ambulate safely in daily life environment.

Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial.

Exergame training, in which video games are used to promote exercise, can be tailored to address cognitive and physical risk factors for falls and is a promising method for fall prevention in older people. Here, we performed a randomized clinical trial using the smart±step gaming system to examine the effectiveness of two home-based computer game interventions, seated cognitive training and step exergame training, for fall prevention in community-dwelling older people, as compared with a minimal-intervention control group. Participants aged 65 years or older (n = 769, 71% female) living independently in the community were randomized to one of three arms: (1) cognitive training using a computerized touchpad while seated, (2) exergame step training on a computerized mat or (3) control (provided with an education booklet on healthy ageing and fall prevention). The rate of falls reported monthly over 12 months-the primary outcome of the trial-was significantly reduced in the exergame training group compared with the control group (incidence rate ratio = 0.74, 95% confidence interval = 0.56-0.98), but was not statistically different between the cognitive training and control groups (incidence rate ratio = 0.86, 95% confidence interval = 0.65-1.12). No beneficial effects of the interventions were found for secondary outcomes of physical and cognitive function, and no serious intervention-related adverse events were reported. The results of this trial support the use of exergame step training for preventing falls in community-dwelling older people. As this intervention can be conducted at home and requires only minimal equipment, it has the potential for scalability as a public health intervention to address the increasing problem of falls and fall-related injuries. Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616001325493 .

Cognitive functioning and falls in older people: A systematic review and meta-analysis.

OBJECTIVE: To identify which cognitive functions and specific neuropsychological assessments predict falls in older people living in the community. METHODS: Five electronic databases were searched until 30/08/2022 for studies assessing the association between specific cognitive functions and faller status (prospective and retrospective), in community-dwelling older people. Risk of bias was assessed with the Newcastle-Ottawa Scale. Meta-analyses synthesised the evidence regarding the associations between different neurocognitive subdomains and faller status. RESULTS: Thirty-eight studies (20 retrospective, 18 prospective) involving 37,101 participants were included. All but one study was rated high or medium quality. Meta-analyses were performed with data from 28 studies across 11 neurocognitive subdomains and four specific neuropsychological tests. Poor cognitive flexibility, processing speed, free recall, working memory and sustained attention were significantly associated with faller status, but poor verbal fluency, visual perception, recognition memory, visuo-constructional reasoning and language were not. The Trail Making Test B was found to have the strongest association with faller status. CONCLUSION: Poor performance in neurocognitive subdomains spanning processing speed, attention, executive function and aspects of memory are associated with falls in older people, albeit with small effect sizes. The Trail Making Test, a free-to-use, simple assessment of processing speed and mental flexibility, is recommended as the cognitive screening test for fall risk in older people.