With the rapid progression of population aging worldwide, the health management of older adults is emerging as an important topic. To help prevent declines in physical and cognitive function due to aging, older adults must maintain consistent physical activity. The development of digital technology has recently allowed the optimization of exercise programs for older adults using augmented reality (AR) game technology.
Fifteen older adult females were enrolled in an AR-based exercise program. The program was conducted for 30 minutes, three times weekly, for a total of 6 weeks. To verify the effectiveness of the program and assess physical function before and after exercise, the following tests were performed: timed up-and-go test, five times sit-to-stand test, 1-minute sit-to-stand test, lung capacity test, respiratory muscle strength test, and bioelectrical impedance analysis. The Trail Making Test was used to evaluate cognitive function. For statistical analysis, a paired t-test was used to verify the effects on physical and cognitive function before and after exercise.
The study results confirmed improved overall physical and cognitive function. The timed up-and-go test, maximal inspiratory pressure, and Trail Making Test part B scores showed significant increases.
This study verified the effectiveness of AR exercise in community-dwelling older adult women. In the future, exercise programs with game elements that increase the interest and motivation of participants to engage in exercise routines should be developed and applied.
The global population is aging rapidly, with 73 million people aged 65 years or older in 2019. This figure is expected to double to 1.5 billion by 2050.
To prevent a decline in physical and cognitive function due to aging, older adults must maintain regular physical activity. Various exercise programs are used to increase physical activity in older adults. Studies have shown that older adults who participate in exercise programs have improved walking ability, lower-extremity muscle strength, grip strength, and cognitive function.
Various attempts have been made to improve physical function in older adults through strength, aerobic, and Pilates exercise programs geared towards this population.
An alternative technology in game development is augmented reality (AR), which has an advantage over VR because of its ease of use in older adult populations.
This study included 15 community-dwelling older adult women aged 65 years or older (
This study enrolled 15 older women in an exercise program using an AR exercise platform (DIDIM; Twohands Interactive, Busan, Korea) (
The dedicated space for the AR game measured 4.5 m×2.5 m. The AR equipment employs LiDAR sensors to detect and operate foot movements. The exercise program was configured for physical and cognitive function training and consisted of six routines. Tap steps, balloon pathfinding, catching bugs, speed cards, shape-stepping bridges, and random squares were performed sequentially (
To observe the effect of improving physical function in the study participants, lower extremity and respiratory functions were evaluated. In addition, bioelectrical impedance analysis was performed. The timed up-and-go test (TUG), five times sit-to-stand test (5TSTS), and 1-minute sit-to-stand test (1MSTS) were used to measure lower extremity function. TUG is an evaluation method that can identify the risk of falling in older adults by evaluating their balance ability.
Respiratory function was evaluated to assess lung capacity and respiratory muscle strength. Respiratory function was evaluated by a physiotherapist with 8 years of experience, trained according to guidelines from the American Thoracic Society/European Respiratory Society Task Force.
In addition, bioelectrical impedance analysis (BIA) (InBody S10; InBody Co. Ltd., Seoul, Korea) was used to confirm the participants’ body composition.
The data collected in this study were analyzed using IBM SPSS Statistics for Windows, version 19.0 (IBM Corp., Armonk, NY, USA). The study data satisfied normality and the effects before and after exercise were compared using the paired t-test. The significance level α was set at 0.05.
The results of applying the AR exercise program in older women are shown in
The results of this study confirmed the effects of improving physical function by applying a 6-week AR-based indoor exercise program to older adult women. The participants in this study showed significantly increased TUG and MIP scores. In addition, significant changes in SMM and BMI were observed in BIA results. However, no significant changes in the numerical values of BIA were observed. Additionally, cognitive function also improved significantly.
The community-dwelling older adult women who participated in this study had healthy physical function. Previous studies on TUG, 5TSTS, and 1MSTS have confirmed that physical health status can be predicted using physical function tests before applying an exercise program.
In this study, only TUG improved significantly among the administered lower extremity function tests such as TUG, 5TSTS, and 1MSTS. The current exercise program was composed mainly of lower-extremity agility exercises and not muscle exercises. Therefore, the TUG test score, which contains the gait ability test component, increased significantly. However, no significant changes were observed in the 5TSTS and 1MSTS, both of which focused on lower extremity muscle strength. One explanation for the lack of significant changes in lower extremity muscle strength may be the low intensity and short intervention period of the exercise program. A previous study that applied exercise programs for 20 weeks in community-dwelling older adults reported no significant change in the sit-to-stand evaluation in the first 10 weeks but observed a significant change by the 20th week.
In this study, the respiratory function did not change significantly based on the lung capacity; however, MIP indicated a significant increase in respiratory muscle strength. While the MEP also increased, the results were not significant. Although the AR exercise program required increased levels of activity, we believe that it did not significantly impact lung capacity because the exercise was not of high enough intensity to increase lung capacity. Previous studies on aerobic exercises in young adult women suggested that lung capacity does not increase with short-term interventions.
Increased muscle mass is a positive factor in older adults.
This study assessed cognitive function using TMT. While TMT Part A showed an improvement, the change was not statistically significant. However, Part B exhibited a significant improvement. The marked improvement in cognitive function in older adult participants who engaged in this study’s exercise program was similar to those reported previously.
Over time, exercise programs for older adults have continually been developed and applied. Existing exercise programs have proven to be effective and exert positive effects on the quality of life and physical and cognitive functions of older adults.
This study has several limitations. First, the number of participants was small, as this was a pilot study. Future studies should recruit more community-dwelling older adults. Moreover, the exercise effect should be verified not only in older adult women but also in older adult men. Furthermore, an exercise program should be designed and conducted to improve muscle strength by adding muscle strength exercises content. Moreover, the exercise intervention period should be extended to obtain new results. Finally, because there was no control group, we could not compare the effects of other exercises. Future studies should verify the effectiveness of the AR-based exercise program by using a control group.
The results of this study confirmed changes in the physical and cognitive functions of older adult women who participated in a 6-week AR-based exercise program. The exercise program was confirmed to be effective even with the short intervention period of 6 weeks. In the future, more community-based exercise programs for older adults should be conducted, based on the AR exercise equipment used in this study. It is important to keep community-dwelling older adults interested in participating in exercise programs to manage their health.
The researchers claim no conflicts of interest.
None.
Conceptualization, TSP, MJS; Data curation, TSP; Methodology, TSP; Project administration, MJS; Supervision, MJS; Writing–original draft, TSP.
The augmented reality (AR) exercise platform.
The augmented reality (AR) exercise configuration involves the following games: (A) tap step, (B) balloon pathfinding, (C) catching bugs, (D) speed cards, (E) shape-stepping bridge movement, and (F) random square.
General characteristics of the study participants
Characteristic | Value |
---|---|
Age (y) | 70.47±3.54 |
Height (cm) | 156.27±3.69 |
Weight (kg) | 58.36±6.64 |
Values are presented as mean±standard.
Exercise program application results
Pre | Post | p-value | |
---|---|---|---|
TUG (s) | 7.05±0.88 | 6.24±0.58 | 0.001 |
5TSTS (s) | 8.11±2.03 | 7.21±1.05 | 0.072 |
1MSTS | 39.60±9.24 | 42.13±8.37 | 0.270 |
FVC (L) | 2.25±0.34 | 2.28±0.30 | 0.446 |
FEV1 (L) | 1.79±0.27 | 1.83±0.25 | 0.200 |
FEV1/FVC (%) | 79.40±4.70 | 79.73±4.50 | 0.511 |
FVC% | 102.27±14.14 | 103.40±12.92 | 0.476 |
FEV1% | 99.40±14.98 | 101.33±15.72 | 0.217 |
MIP (cmH2O) | 64.87±18.97 | 68.87±16.60 | 0.016 |
MEP (cmH2O) | 79.00±18.00 | 84.53±16.54 | 0.186 |
Weight (kg) | 58.36±6.64 | 59.38±6.20 | 0.003 |
BMI (kg/m2) | 23.99±2.75 | 24.43±2.60 | 0.003 |
PBF (%) | 31.84±5.77 | 32.29±5.86 | 0.432 |
SMM (kg) | 21.21±2.49 | 21.57±2.52 | 0.040 |
SMI (kg/m2) | 7.08±0.69 | 7.09±0.71 | 0.856 |
FFM (kg) | 39.59±4.06 | 40.06±4.09 | 0.122 |
TMT_A (s) | 30.52±6.52 | 27.34±12.85 | 0.233 |
TMT_B (s) | 76.25±53.71 | 66.76±60.55 | 0.031 |
Values are presented as mean±standard.
TUG, timed up and go test; 5TSTS, five sit-to-stand test; 1MSTS, one-minute sit-to-stand test; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; MIP, maximum inspiratory pressure; MEP, maximal expiratory pressure; BMI, body mass index; PBF, percent body fat; SMM, skeletal muscle mass; SMI, skeletal muscle mass index; FFM, fat-free mass; TMT, trail making test.
p<0.05, significant difference between pre- and post-exercise.