***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: Declined balance functions have adverse effects on elderly population .  Lower limbs muscle power training is currently an emerging concept in rehabilitation on individuals with decreased balance and mobility . In this prospect i ve , controlled study , we used a human-computer interactive video-game-based rehabilitation device ( LLPR ) for training of lower limb muscle power in the elderly . Forty ( aged > 65 years ) individuals were recruited from the community . Twenty participants in the exercise group received 30-min training , twice a week , using the LLPR system . The LLPR system allows participants to perform fast speed sit-to-st and ( STS ) movements . Twenty age-matched participants in the control group performed slow speed STS movements , as well as strengthening and balance exercises , with the same frequency and duration . The results were compared after 12 sessions ( 6 weeks ) of training . The mechanical and time parameters during STS movement were measured using the LLPR system . Modified falls efficacy scale ( MFES ) , Tinetti Performance-Oriented Mobility Assessment ( POMA ) , function reach test , five times sit to st and ( FTSS ) and Timed Up and Go ( TUG ) were administered to participants as clinical assessment s. Results showed that in the exercise group , all the mechanical and time parameters showed significant improvement . In control group , only the maximal vertical ground reaction force ( MVGRF ) improved significantly . For clinical assessment s ( balance , mobility , and self-confidence ) , exercise group showed significantly better scores . The STS movements in video-game-based training mimic real life situations which may help to transfer the training effects into daily activities . The effectiveness of lower limb muscle training is worthy of further investigation 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 BACKGROUND Dementia cases may reach 100 million by 2050 . Interventions are sought to curb or prevent cognitive decline . Exercise yields cognitive benefits , but few older adults exercise .  Virtual reality-enhanced exercise or " exergames " may elicit greater participation . PURPOSE To test the following hypotheses : ( 1 ) stationary cycling with virtual reality tours ( " cybercycle " ) will enhance executive function and clinical status more than traditional exercise ; ( 2 ) exercise effort will explain improvement ; and ( 3 ) brain-derived neurotrophic growth factor ( BDNF ) will increase . DESIGN Multi-site cluster r and omized clinical trial ( RCT ) of the impact of 3 months of cybercycling versus traditional exercise , on cognitive function in older adults . Data were collected in 2008 - 2010 ; analyses were conducted in 2010 - 2011 . SETTING / PARTICIPANTS 102 older adults from eight retirement communities enrolled ; 79 were r and omized and 63 completed . INTERVENTIONS A recumbent stationary ergometer was utilized ; virtual reality tours and competitors were enabled on the cybercycle . MAIN OUTCOME MEASURES Executive function ( Color Trails Difference , Stroop C , Digits Backward ) ; clinical status ( mild cognitive impairment ; MCI ) ; exercise effort/fitness ; and plasma BDNF . RESULTS Intent-to-treat analyses , controlling for age , education , and cluster r and omization , revealed a significant group X time interaction for composite executive function ( p=0.002 ) . Cybercycling yielded a medium effect over  traditional exercise  ( d=0.50 ) . Cybercyclists had a 23 % relative risk reduction in clinical progression to MCI . Exercise effort and fitness were comparable , suggesting another underlying mechanism . A significant group X time interaction for BDNF ( p=0.05 ) indicated enhanced neuroplasticity among cybercyclists . CONCLUSIONS Cybercycling older adults achieved better cognitive function than traditional exercisers , for the same effort , suggesting that simultaneous cognitive and physical exercise has greater potential for preventing cognitive decline . TRIAL REGISTRATION This study is registered at Clinical trials.gov NCT01167400 BACKGROUND Gait and cognitive disturbances are common in Parkinson 's disease ( PD ) . These deficits exacerbate fall risk and difficulties with mobility , especially during complex or dual-task walking . Traditional gait training generally fails to fully address these complex gait activities . Virtual reality ( VR ) incorporates principles of motor learning while delivering engaging and challenging training in complex environments . We hypothesized that VR may be applied to address the multifaceted deficits associated with fall risk in PD . METHODS Twenty patients received 18 sessions ( 3 per week ) of progressive intensive treadmill training with virtual obstacles ( TT + VR ) . Outcome measures included gait under usual-walking and dual-task conditions and while negotiating physical obstacles . Cognitive function and functional performance were also assessed . RESULTS Patients were 67.1 ± 6.5 years and had a mean disease duration of 9.8 ± 5.6 years . Posttraining , gait speed significantly improved during usual walking , during dual task , and while negotiating overground obstacles . Dual-task gait variability decreased ( ie , improved ) and Trail Making Test times ( parts A and B ) improved . Gains in functional performance measures and retention effects , 1 month later , were also observed . CONCLUSIONS To our knowledge , this is the first time that TT + VR has been used for gait training in PD . The results indicate that TT + VR is viable in PD and may significantly improve physical performance , gait during complex challenging conditions , and even certain aspects of cognitive function . These findings have important implication s for underst and ing motor learning in the presence of PD and for treating fall risk in PD , aging , and others who share a heightened risk of falls The combination of active video gaming and exercise ( exergaming ) is suggested to improve elderly people 's balance , thereby decreasing fall risk . Exergaming has been shown to increase motivation during exercise therapy , due to the enjoyable and challenging nature , which could support long-term adherence for exercising balance . However , scarce evidence is available of the direct effects of exergaming on postural control . Therefore , the aim of the study was to assess the effect of a six-week videogame-based exercise program aim ed at improving balance in elderly people .  Task performance and postural control were examined using an interrupted time series design . Results of multilevel analyses showed that performance on the dot task improved within the first two weeks of training . Postural control improved during the intervention . After the intervention period task performance and balance were better than before the intervention . Results of this study show that healthy elderly can benefit from a videogame-based exercise program to improve balance and that all subjects were highly motivated to exercise balance because they found gaming challenging and enjoyable Background While many studies confirm the positive effect of cognitive and physical training on cognitive performance of older adults , only little is known about the effects of simultaneously performed cognitive and physical training . In the current study , older adults simultaneously performed a verbal working memory and a cardiovascular training to improve cognitive and motor-cognitive dual task performance . Twenty training sessions of 30 minutes each were conducted over a period of ten weeks , with a test session before , in the middle , and after the training . Training gains were tested in measures of selective attention , paired-associates learning , executive control , reasoning , memory span , information processing speed , and motor-cognitive dual task performance in the form of walking and simultaneously performing a working memory task . Results Sixty-three participants with a mean age of 71.8 ± 4.9 years ( range 65 to 84 ) either performed the simultaneous training ( N = 21 ) , performed a single working memory training ( N = 16 ) , or attended no training at all ( N = 26 ) . The results indicate similar training progress and larger improvements in the executive control task for both training groups when compared to the passive control group . In addition , the simultaneous training result ed in larger improvements compared to the single cognitive training in the paired-associates task and was able to reduce the step-to-step variability during the motor-cognitive dual task when compared to the single cognitive training and the passive control group . Conclusions The simultaneous training of cognitive and physical abilities presents a promising training concept to improve cognitive and motor-cognitive dual task performance , offering greater potential on daily life functioning , which usually involves the recruitment of multiple abilities and re sources rather than a single one BACKGROUND there are few longitudinal studies of the prognosis of falling at home . OBJECTIVE to determine outcomes in older people who fall once and more than once . DESIGN longitudinal prospect i ve cohort study . SETTING primary care in the UK . SUBJECTS 1815 subjects over 75 who had a st and ardized and vali date d health check . METHOD annual interviews over 4 years . Practice records were used to establish death and admission to institutions . RESULTS risk of death was increased at 1 year [ odds ratio ( OR ) 2.6 , 95 % confidence interval ( CI ) 1.4 - 4.7 ] and 3 years ( OR 1.9 , 95 % CI 1.2 - 3.0 ) for recurrent fallers but not single fallers ( OR 0.9 , 95 % CI 0.5 - 1.6 at 1 year ; OR 0.97 , 95 % CI 0.7 - 1.4 at 3 years ) . Risk of admission to long-term care over 1 year was markedly increased both for single fallers ( OR 3.8 , 95 % CI 1.8 - 8.3 ) and recurrent fallers ( OR 4.5 , 95 % CI 1.7 - 12 ) . Functional decline was not related to faller status , the latter being very variable from one year to the next . CONCLUSIONS the stronger relationship between falling and admission to long-term care rather than mortality supports the hypothesis that the perceived risks for those who fall only once are exaggerated 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 OBJECTIVES To evaluate the learning , retention and transfer of performance improvements after Nintendo Wii Fit ™ training in patients with Parkinson 's disease and healthy elderly people . DESIGN Longitudinal , 
    Output:
    
One pilot study found balance board training reduced falls and most studies reported training improved physical ( e.g. balance and strength ) and cognitive ( e.g. attention , executive function ) measures .
Inconsistent results were found for psychological measures related to falls-efficacy .
Very few between-group differences were evident when interactive cognitive-motor interventions were compared to traditional training programs .
Conclusions The review findings provide preliminary evidence that interactive cognitive-motor interventions can improve physical and cognitive fall risk factors in older people , but that the effect of such interventions on falls has not been definitively demonstrated .
Interactive cognitive-motor interventions appear to be of equivalent efficacy in ameliorating fall risk as traditional training programs .