***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 Purpose Interactive cognitive-motor training ( ICMT ) requires individuals to perform both gross motor movements and complex information processing . This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults . Methods A single-blinded r and omized controlled trial was conducted in community-dwelling older adults ( N = 90 , mean age 81.5±7 ) without major cognitive impairment . Participants in the intervention group ( IG ) played four stepping games that required them to divide attention , inhibit irrelevant stimuli , switch between tasks , rotate objects and make rapid decisions . The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home . Participants in the control group ( CG ) received an evidence -based brochure on fall prevention .  Measures of processing speed , attention/executive function ( EF ) , visuo-spatial ability , concerns about falling and depression were assessed before and after the intervention . Results Eighty-one participants ( 90 % ) attended re- assessment . There were no improvements with respect to the Stroop Stepping Test ( primary outcome ) in the intervention group . Compared to the CG , the IG improved significantly in measures of processing speed , visuo-spatial ability and concern about falling . Significant interactions were observed for measures of EF and divided attention , indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance . The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline . Additionally , low and high-adherer groups differed in their baseline performance and responded differently to the intervention . Compared to high adherers , low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF . Conclusions This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people . Low adherers improved in less complex functions while high-adherers improved in EF . Trial Registration Australian New Zeal and Clinical Trials Registry Background Reaction time , coordination , and cognition performance typically diminish in older adults , which may lead to gait impairments , falls , and injuries . Regular strength – balance exercises are highly recommended to reduce this problem and to improve health , well-being , and independence in old age . However , many older people face a lack of motivation in addition to other strong barriers to exercise . We developed ActiveLifestyle , an information technology (IT)-based system for active and healthy aging aim ing at improving balance and strength . ActiveLifestyle is a training app that runs on a tablet and assists , monitors , and motivates older people to follow personalized training plans autonomously at home . Objective The objectives were to ( 1 ) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people , ( 2 ) assess the impact of ActiveLifestyle on physical activity behavior change , and ( 3 ) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed . Methods A total of 44 older adults followed personalized , 12-week strength and balance training plans . All participants performed the exercises autonomously at home . Question naires were used to assess the technological familiarity and stage of behavior change , as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle . Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study . Pretests and posttests were performed to evaluate gait speed of the participants before and after the study . Results Participants were 75 years ( SD 6 ) , predominantly female ( 64 % ) , held a trade or professional diploma ( 54 % ) , and their past profession was in a sitting position ( 43 % ) . Of the 44 participants who enrolled , 33 ( 75 % ) completed the study . The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength – balance exercises ( median 6 on a 7-point Likert scale ) . Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan , as well as to change their behavior permanently toward a more physically active lifestyle . The exercises were effective to improve preferred and fast gait speed . Conclusions ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength – balance exercises over 12 weeks and had low dropout rates . The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention . The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time 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 OBJECTIVE This study investigated the effect of playing Nintendo ( ® ) " Wii Fit ™ Plus " ( Nintendo of America , Inc. , Redmond , WA ) on body balance and physical activity of nursing home residents . SUBJECTS AND METHODS In a nonr and omized controlled trial within a nursing home , two intervention groups ( both n=8 ) were exposed to the same treatment and compared with a  control group ( n=13 ) . Intervention Group 1 consisted of elderly individuals with regular Nintendo " Wii Fit " experience for at least 1 year . Elderly persons who were novices to the Nintendo " Wii Fit ( Plus ) " participated in intervention Group 2 . Control participants had no experience with the Nintendo " Wii Fit ( Plus ) "  and did not participate in the Nintendo " Wii Fit Plus " sessions . Outcome measurements were taken at baseline and after the intervention , using the Berg Balance Scale and the LASA Physical Activity Question naire . Participants of both intervention groups played the Nintendo " Wii Fit Plus " for 10 minutes twice a week during 12 weeks . RESULTS Although balance improved for all three groups , there was no effect of playing " Wii Fit Plus " ( P=0.89 ) . On physical activity , the intervention did have a positive effect ( P=0.005 ) ; physical activity levels increased with a median of 54.3 ( interquartile range , 63.1 ) minutes/day for intervention Group 1 and a median of 60.7 ( interquartile range , 56.8 ) minutes/day for intervention Group 2 . CONCLUSIONS This study showed an effect of Nintendo " Wii Fit Plus " gaming on physical activity of nursing home residents , but not on their balance . The effect of physical activity should be consoli date d in a r and omized controlled trial in a broader population Abstract Background Falls and fall-related injuries are a serious public health issue . Exercise programs can effectively reduce fall risk in older people . The iStoppFalls project developed an Information and Communication Technology-based system to deliver an unsupervised exercise program in older people ’s homes . The primary aims of the iStoppFalls r and omized controlled trial were to assess the feasibility ( exercise adherence , acceptability and safety ) of the intervention program and its effectiveness on common fall risk factors . Methods A total of 153 community-dwelling people aged 65 + years took part in this international , multicentre , r and omized controlled trial . Intervention group participants conducted the exercise program for 16 weeks , with a recommended duration of 120 min/week for balance exergames and 60 min/week for strength exercises . All intervention and control participants received educational material including advice on a healthy lifestyle and fall prevention . Assessment s included physical and cognitive tests , and question naires for health , fear of falling , number of falls , quality of life and psychosocial outcomes . Results The median total exercise duration was 11.7 h ( IQR = 22.0 ) over the 16-week intervention period . There were no adverse events . Physiological fall risk ( Physiological Profile Assessment , PPA ) reduced significantly more in the intervention group compared to the control group ( F1,127 = 4.54 , p = 0.035 ) . There was a significant three-way interaction for fall risk assessed by the PPA between the high-adherence ( > 90 min/week ; n = 18 , 25.4 % ) , low-adherence ( < 90 min/week ; n = 53 , 74.6 % ) and control group ( F2,125 = 3.12 , n = 75 , p = 0.044 ) . Post hoc analysis revealed a significantly larger effect in favour of the high-adherence group compared to the control group for fall risk ( p = 0.031 ) , postural sway ( p = 0.046 ) , stepping reaction time ( p = 0.041 ) , executive functioning ( p = 0.044 ) , and quality of life ( p for trend = 0.052 ) . Conclusions The iStoppFalls exercise program reduced physiological fall risk in the study sample . Additional subgroup analyses revealed that intervention participants with better adherence also improved in postural sway , stepping reaction , and executive function . Trial registration Australian New Zeal and Clinical Trials Registry Trial ID : ACTRN12614000096651 International St and ard R and omised Controlled Trial Number : IS RCT Background This r and omized controlled pilot study aim ed to explore whether a cognitive-motor exercise program that combines traditional physical exercise with dance video gaming can improve the voluntary stepping responses of older adults under attention dem and ing dual task conditions . Methods Elderly subjects received twice weekly cognitive-motor exercise that included progressive strength and balance training supplemented by dance video gaming for 12 weeks ( intervention group ) . The control group received no specific intervention . Voluntary step execution under single and dual task conditions was recorded at baseline and post intervention ( Week 12 ) . Results After intervention between-group comparison revealed significant differences for initiation time of forward steps under dual task conditions ( U = 9 , P = 0.034 , r = 0.55 ) and backward steps under dual task conditions ( U = 10 , P = 0.045 , r = 0.52 ) in favor 
    Output:
    
Adherence was higher for technology-based interventions than traditional interventions independent of study site , level of supervision , and delivery mode .
Discussion : This systematic review provides evidence that technology offers a well-accepted method to provide older adults with engaging exercise opportunities , and adherence rates remain high in both supervised and unsupervised setting s at least throughout the first 12 weeks of intervention .
The higher adherence rates to technology-based interventions can be largely explained by the high reported levels of enjoyment when using these programs .
However , the small sample sizes , short follow-up periods , inclusion of mostly healthy older people , and problems related to the methods used to report exercise adherence limit the generalizability of our findings .
Conclusion : This systematic review indicates that technology-based exercise interventions have good adherence and may provide a sustainable means of promoting physical activity and preventing falls in older people .