by Amanda Davis
The purpose of this study was to determine the effects of participation in Nintendo Wii activities on balance, cardiovascular endurance, and quality of life among well-elderly individuals. The Nintendo Wii is an innovative video gaming system that incorporates the use of a television, a game board which can be used in sitting or standing positions, and a handheld controller used for portraying and calculating players' body positioning and movements.
This quasi-experimental study utilized a single group, pretest-posttest design in which pretest measurements represented the participants' level of functioning at the time the study was initiated, and posttest measurements represent the participants' level of functioning following the intervention phase. Qualitative data, including researcher observations and interactions with participants, was also recorded throughout the study in participant's journals.
Balance was measured pre- and post- intervention with the Berg Balance Scale. Cardiovascular endurance was measured using Polar Heart Rate monitors. Quality of Life was measured with the RAND SF-36v2.
During the intervention phase, participants engaged in Nintendo® Wii Fit TM activities for three, 20-minute sessions per week, over a 4-week period. During each session, the participants engaged in 10-minutes of Wii Fit® balance activities, directly followed by 10-minutes of Wii Fit® aerobic activities.
At the conclusion of the study, all of the initial participants (N = 11) were still meeting the attendance requirement of attendance at 80% of sessions; however, the study's participants obtained a 98.5% attendance rate, with no participant missing more then one intervention session.
The Wilcoxon Signed-Ranks test was utilized on all dependent variables (balance, heart rate, and quality of life), with p ≤.05 and a critical value of T = 5. In this study, N=11 (N=10 for Berg Balance Scale [BBS] only). Although this study predominantly focused on the quantitative data, there was a large quantity of observable findings and verbal statements that supported the significance of the Nintendo Wii and the balance and quality of life.
All participants demonstrated improvements in balance pre- to post- intervention. All participants were found to be in either medium (50% of participants) or low fall risk (50% of participants) categories based on their BBS scores prior to intervention. Post-test scores on the BBS revealed there none of the participants needed assistive devices or further specific balance training, based on BBS criteria for the low fall risk category.
After careful review of the results from the Wilcoxon Signed-Rank Test, researchers discovered there was no statistical significance in quality of life or cardiovascular endurance, as measured pre- to post- intervention. A type II error in the calculation of these dependent variables (cardiovascular endurance and quality of life) was assumed to have occurred by researchers due to the conflicting qualitative and quantitative data gathered throughout the study.
Interpretation of Results
Results from this study revealed statistically significant improvements in balance, and no statistically significant changes in cardiovascular endurance and quality of life, as indicated by the Polar Heart Monitors and SF-36v2®, after participation in a Nintendo ® Wii Fit TM program. Although this study did not reveal a statistically significant improvement in participants' quality of life, qualitative information indicates that the participants received numerous quality of life benefits as a result of participating in the study.
Results reveal that occupational therapists working with geriatric clientele may be justified in utilizing the Nintendo ® Wii Fit TM as an evidence-based intervention to improve balance. The results also indicate a need for further research to determine cardiovascular and quality of life benefits and to further explore additional benefits of the Nintendo Wii that have not yet been tested.
Recommendations for Future Research
Therapists utilizing the Nintendo® Wii TM in occupational therapy practice must continue to examine the therapeutic benefits of Nintendo's® Wii TM activities. A variety of directions are suggested for future research. First, it is recommended that future studies that examine balance also address the association of fear of falling and the effects of participation in Nintendo's® Wii Fit TM activities. This may reveal pertinent information about the participants' self-perception of balance. Future researchers may also consider studying the different Nintendo® Wii Fit TM balance activities separately to identify if one specific game is more effective than others. Lastly, researchers should study the therapeutic benefits of using the Nintendo® Wii TM with a variety of clients to identify the numerous potential benefits of incorporating this interactive game into occupational therapy practice.
I would like to thank the residents and staff at the Communities of Solarbron for their involvement and participation in this study. I acknowledge Ellen Herlache, MA, OTRL, Research Coordinator, Master of Science in Occupational Therapy Program, Saginaw Valley State University, for editorial input. I would also like to thank and give credit to my fellow researchers: Drew Bender, Holly Mattox, Keegan Humphrey, Nicole Doherty, and Jessie Tibbs for their assistance throughout the entire research process.