***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Stepping impairments are associated with physical and cognitive decline in older adults and increased fall risk . Exercise interventions can reduce fall risk , but adherence is often low . A new exergame involving step training may provide an enjoyable exercise alternative for preventing falls in older people . Purpose To assess the feasibility and safety of unsupervised , home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people . Design Single-blinded two-arm r and omized controlled trial comparing step pad training with control ( no-intervention ) . Setting / Participants Thirty-seven older adults residing in independent-living units of a retirement village in Sydney , Australia . Intervention Intervention group ( IG ) participants were provided with a computerized step pad system connected to their TVs and played a step game as often as they liked ( with a recommended dose of 2–3 sessions per week for 15–20 minutes each ) for eight weeks . In addition , IG participants were asked to complete a choice stepping reaction time ( CSRT ) task once each week . Main Outcome Measures CSRT , the Physiological Profile Assessment ( PPA ) , neuropsychological and functional mobility measures were assessed at baseline and eight week follow-up . Results Thirty-two participants completed the study ( 86.5 % ) . IG participants played a median 2.75 sessions/week and no adverse events were reported . Compared to the control group , the IG significantly improved their CSRT ( F31,1 = 18.203 , p<.001 ) , PPA composite scores ( F31,1 = 12.706 , p = 0.001 ) , as well as the postural sway ( F31,1 = 4.226 , p = 0.049 ) and contrast sensitivity ( F31,1 = 4.415 , p = 0.044 ) PPA sub-component scores . In addition , the IG improved significantly in their dual-task ability as assessed by a timed up and go test/verbal fluency task ( F31,1 = 4.226 , p = 0.049 ) . Conclusions Step pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments . Trial Registration Australian New Zeal and Clinical Trials Registry ACTRN12611001081909 Loss to follow-up is often hard to avoid in r and omised trials . This article suggests a framework for intention to treat analysis that depends on making plausible assumptions about the missing data and including all participants in sensitivity Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = .041 , r = .45 ) and for single support time ( U = 24 , P = .029 , r = .48 ) during the fast walking dual task condition in favor of the dance group . No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy . Conclusions There was a significant interaction in favor of the dance video game group for improvements in step time . Significant improved fast walking performance under dual task conditions ( velocity , double support time , step length ) was observed for the dance video game group only . These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program . Trial registration This trial has been registered under IS RCT N05350123 ( http://www.controlled-trials.com BACKGROUND Older adults show increased risk of falling and major risk factors include impaired lower extremity muscle strength and postural balance . However , the potential positive effect of biofeedback-based Nintendo Wii training on muscle strength and postural balance in older adults is unknown . METHODS This r and omized controlled trial examined postural balance and muscle strength in community-dwelling older adults ( 75±6 years ) pre- and post-10 weeks of biofeedback-based Nintendo Wii training ( WII , n = 28 ) or daily use of ethylene vinyl acetate copolymer insoles ( controls [ CON ] , n = 30 ) . Primary end points were maximal muscle strength ( maximal voluntary contraction ) and center of pressure velocity moment during bilateral static stance . RESULTS Intention-to-treat analysis with adjustment for age , sex , and baseline level showed that the WII group had higher maximal voluntary contraction strength ( 18 % ) than the control group at follow up ( between-group difference = 269 N , 95 % CI = 122 ; 416 , and p = .001 ) . In contrast , the center of pressure velocity moment did not differ ( 1 % ) between WII and CON at follow-up ( between-group difference = 0.23 mm(2)/s , 95 % CI = -4.1 ; 4.6 , and p = .92 ) . For secondary end points , pre-to-post changes favoring the WII group were evident in the rate of force development ( p = .03 ) , Timed Up and Go test ( p = .01 ) , short Falls Efficacy Scale-International ( p = .03 ) , and 30-second repeated Chair St and Test ( p = .01 ) . Finally , participants rated the Wii training highly motivating at 5 and 10 weeks into the intervention . CONCLUSIONS Biofeedback-based Wii training led to marked improvements in maximal leg muscle strength ( maximal voluntary contraction ; rate of force development ) and overall functional performance in community-dwelling older adults . Unexpectedly , static bilateral postural balance remained unaltered with Wii training . The high level of participant motivation suggests that biofeedback-based Wii exercise may ensure a high degree of compliance to home- and /or community-based training in community-dwelling older adults Poor balance is considered a challenging risk factor for falls in older adults . Therefore , innovative interventions for balance improvement in this population are greatly needed . The aim of this study was to evaluate the effect of a new virtual-reality system ( the Balance Rehabilitation Unit [ BRU ] ) on balance , falls , and fear of falling in a population of community-dwelling older subjects with a known history of falls . In this study , 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic , Nepean Hospital ( Penrith , NSW , Australia ) . Subjects were r and omly assigned to either the BRU-training or control groups . Both groups received the usual falls prevention care . The BRU-training group attended balance training ( two sessions/week for 6 weeks ) using an established protocol . Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program . Both groups were assessed 9 months after their initial assessment ( month 0 ) . Adherence to the BRU-training program was 97 % . Balance parameters were significantly improved in the BRU-training group ( P < 0.01 ) . This effect was also associated with a significant reduction in falls and lower levels of fear of falling ( P < 0.01 ) . Some components of balance that were improved by BRU training showed a decline after 9 months post-training . In conclusion , BRU training is an effective and well-accepted intervention to improve balance , increase confidence , and prevent falls in the elderly Background and purpose Numerous interventions have been proposed to improve balance in older adults with varying degrees of success . A novel approach may be to use an off-the-shelf video game system utilizing real-time force feedback to train older adults . The purpose of this study is to investigate the feasibility of using Nintendo ’s Wii Fit for training to improve clinical measures of balance in older adults and to retain the improvements after a period of time . Methods Twelve healthy older adults ( aged > 70 years ) were r and omly divided into two groups . The experimental group completed training using Nintendo ’s Wii Fit game three times a week for 3 weeks while the control group continued with normal activities . Four clinical measures of balance were assessed before training , 1 week after training , and 1 month after training : Berg Balance Scale ( BBS ) , Fullerton Advanced Balance ( FAB ) scale , Functional Reach ( FR ) , and Timed Up and Go ( TUG ) . Friedman two-way analysis of variance by ranks was conducted on the control and experimental group to determine if training using the Wii Balance Board with Wii Fit had an influence on clinical measures of balance . Results Nine older adults completed the study ( experimental group n = 4 , control group n = 5 ) . The experimental group significantly increased their BBS after training while the control group did not . There was no significant change for either group with FAB , FR , and TUG . Conclusion Balance training with Nintendo ’s Wii Fit may be a novel way for older adults to improve balance as measured by the BBS OBJECTIVES To determine the long-term effects of three strength and balance exercise interventions on physical performance , fall-related psychological outcomes , and falls in older people . DESIGN A single-blinded , four-group , r and omized controlled trial . SETTING Community , Germany . PARTICIPANTS Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling . INTERVENTION After baseline assessment , 280 participants were r and omly assigned to the control group ( CG ; no intervention ; n = 80 ) or one of three strength and balance exercise interventions ( the strength and balance group ( SBG ; strength and balance only ; n = 63 ) , the fitness group ( FG ; strength and balance plus endurance training ; n = 64 ) , or the multifaceted group ( MG ; strength and balance plus fall risk education ; n = 73 ) . The interventions consisted of 32 one-hour group sessions in 16 weeks . MEASUREMENTS Data on physical performance , fall-related psychological outcomes , and falls were collected for 24 months . RESULTS Mixed-effects regression analyses showed improved short- and long-term ( 12 and 24 months , respectively ) physical performance for the SBG and FG , particularly regarding mobility , balance , and walking speed ( P < .05 ) . The improvements in physical performance outcomes were most prominent in the FG . Fall-related psychological outcomes , number of falls , and injurious falls were not significantly different from in the control group . CONCLUSION Training focusing on strength , balance , and endurance can enhance physical performance for up to 24 months in community-dwelling older adults . These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls . This demonstrates the need for a different approach ( e.g. , regarding intervention dose and components ) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults OBJECTIVE To compare the impacts of Tai Chi , a st and ard balance exercise program , and a video game balance board program on postural control and perceived falls risk . DESIGN R and omized controlled trial . SETTING Research laboratory . PARTICIPANTS Independent seniors ( N=40 ; 72.5±8.40 ) began the training , 27 completed . INTERVENTIONS Tai Chi , a st and ard balance exercise program , and a video game balance board program . MAIN OUTCOME MEASURES The following were used as measures : Timed Up & Go , One-Leg Stance , functional reach , Tinetti Performance Oriented Mobility Assessment , force plate center of pressure ( COP ) and time to boundary , dynamic posturography ( DP ) , Falls Risk for Older People-Community Setting , and Falls Efficacy Scale . RESULTS No significant differences were seen between groups for any outcome measures at baseline , nor were significant time or group × time differences for any field test or question naire . No group × time differences were seen for any COP measures ; however , significant time differences were seen for total COP , 3 of 4 anterior/posterior displacement and both velocity , and 1 displacement and 1 velocity medial/lateral measure across time for the entire sample . For DP , significant improvements in the overall score ( dynamic movement analysis score ) , and in 2 of the 3 linear and angular measures were seen for the sample . CONCLUSIONS The video game balance board program , which can be performed at home , was as effective as Tai Chi and the st and ard balance exercise program in improving postural control and balance dictated by the force plate postural sway and DP measures . This finding may have implication s for exercise adherence because the at-home nature of the intervention eliminates many obstacles to exercise training BACKGROUND physical therapy interventions that increase functional strength and balance have been shown to reduce falls in older adults . AIM this study compared a virtual reality group ( VRG ) and a control group ( CG ) . DESIGN r and omised controlled 6-week intervention with pre- and post-test evaluations . SETTING outpatient geriatric orthopaedic and balance physical therapy clinic . POPULATION forty participants were r and omised into two groups . METHOD the VRG received three different Nintendo ® Wii FIT balance interventions three times per week for 6 weeks and the CG received no intervention . RESULTS compared with the CG , post-intervention measurements showed significant improvements for the VRG in the 8-foot Up & Go test [ median decrease of 1.0 versus -0.2 s , ( P=0.038 ) and the Activities-specific 
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However , a consensus between studies is the positive motivational aspect that the use of exergames provides .