***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: Abstract Background : Falls and fall-related injuries are symptomatic of an aging population . This study aim ed to design , develop , and deliver a novel method of balance training , using an interactive game-based system to promote engagement , with the inclusion of older adults at both high and low risk of experiencing a fall . Study Design : Eighty-two older adults ( 65 years of age and older ) were recruited from sheltered accommodation and local activity groups . Forty volunteers were r and omly selected and received 5 weeks of balance game training ( 5 males , 35 females ; mean , 77.18 ± 6.59 years ) , whereas the remaining control participants recorded levels of physical activity ( 20 males , 22 females ; mean , 76.62 ± 7.28 years ) . The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments . Results : Balance game training had a significant effect on levels of functional balance and balance confidence ( P < 0.05 ) . This was further demonstrated in participants who were deemed at high risk of falls . The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls . Conclusions : Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population BACKGROUND the study compares the effects of a Nintendo Wii exercise programme and a st and ard Gym-based exercise intervention on fear of falling , knee strength , physical function and falls rate in older adults . METHODS eighty community-dwelling adults aged 60 years and above with short physical performance battery score of 5 - 9 points and modified falls efficacy scale ( MFES ) score of ≤9 points participated in the parallel-group r and omised trial . Each intervention arm involved an hour of intervention per week , totalling 12 sessions over 12 weeks . Besides 1-year fall incidence , the participants were evaluated on MFES , knee extensor strength ( KES ) , timed-up- and -go test , gait speed , 6-minute walk test and narrow corridor walk test at weeks 13 and 24 . RESULTS at week 13 , between interventions , the effect of MFES changes did not reach statistical significance ( difference = -0.07 point , 95 % CI -0.56 to 0.42 , P = 0.78 ) ; at week 24 , the Wii group showed statistically significant effects over the Gym group ( difference = 0.8 point , 95 % CI 0.27 to 1.29 , P < 0.01 ) . For KES , the two groups did not differ statistically at week 13 ( difference = -2.0 % , 95 % CI -5.6 to -1.7 , P = 0.29 ) ; at week 24 , the Gym group had greater strength gains than the Wii group ( difference = -5.1 % , 95 % CI -8.7 to -1.5 , P < 0.01 ) . No between-group differences were observed for other outcome measures . CONCLUSION on completion of a 12-week Nintendo Wii exercise programme , there was no significant benefit seen on fear of falling when compared to a st and ard Gym-based exercise intervention ; however , post-intervention there was an apparent reduction in fear of falling in the group allocated to Wii training , despite knee strength apparently improving more in those allocated to the Gym . It is possible that long-term gains after using the Wii might be due to a carry-over effect . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry , ACTRN12610000576022 BACKGROUND Many issues prevent elderly individuals from exercising in daily life . There is a need for a system that allows elderly individuals to engage in exercise regularly at a low cost . We developed an exergame that uses a Kinect ( ® ) sensor ( Microsoft Corp. , Redmond , WA ) and conducted a r and omized controlled trial of the effects of using this exergame on muscle strength and balance in healthy elderly individuals . SUBJECTS AND METHODS We enrolled 57 healthy elderly individuals and r and omly divided them into an  intervention group ( n=29 ) and a  control group ( n=28 ) using a table of r and om numbers . All participants underwent gait analyses and were examined using the Berg Balance Scale ( BBS ) , Functional Reach Test ( FRT ) , and the 30-second chair-st and ( CS-30 ) test before the intervention . Participants in the intervention group played the exergame once or twice a week , up to a total of 24 times . The tests were repeated after intervention , and the scores were compared with those obtained before intervention . RESULTS Our results indicated that walking , muscle strength , and motor function improved in participants in the intervention group . Decreased double st and ing time ( P=0.03 ) , minimum foot clearance ( P=0.04 ) , BBS scores ( P<0.01 ) , CS-30 scores ( P<0.01 ) , and FRT scores ( P<0.01 ) significantly improved in the intervention group compared with values in the control group . CONCLUSIONS The Kinect-based exergame developed in this study was found to be effective in improving walking , muscular strength , and balance in elderly people Background Falls are a leading cause of injury and death for old adults , with one risk factor for falls being balance deficits . The low cost ( < 400 USD ) , wide availability , and ability to incorporate multiple training paradigms make gaming systems appealing as possible balance intervention tools . Aims To investigate the feasibility of using the Xbox Kinect for training to improve clinical measures of balance in old adults and retain improvements after a period of time . Methods Thirteen healthy old adults ( aged 70 + years ) were r and omly divided into two groups . The experimental group completed Kinect training 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 and 1 month after training : Berg balance scale ( BBS ) , Fullerton advanced balance ( FAB ) scale , functional reach ( FR ) , and timed up and go ( TUG ) . Results The ability to implement the training program was successful . The experimental group significantly increased their BBS and FAB after training while the control group did not . There was no significant change for either groups with FR and TUG . Conclusion A training program using the Kinect with commercially available games was feasible with old adults . Kinect training may be an inexpensive way for old adults to receive helpful feedback encouraging them to continue with balance training program in their home [ Purpose ] The aim of this study was to examine the effects of ball exercise as a general exercise on the balance abilities of elderly individuals by comparing ball exercise with virtual reality exercise . [ Subjects and Methods ] Thirty elderly individuals residing in communities were r and omly divided into a virtual reality game group and a ball exercise group and conducted exercise for 30 min 3 times a week for 8 weeks . [ Results ] Step length increased significantly , and the average sway speed and Timed Up and Go time significantly decreased in both groups . A comparison of sway length after the intervention between the two groups revealed that the virtual reality game exercise result ed in a reduction than the ball exercise . [ Conclusion ] The results of this study indicated that the virtual reality game exercise may improve balance and gait of elderly individuals in communities Frequent or recurrent fallers are more likely to have chronic medical conditions and physiological impairments , exhibit functional decline and have poor outcomes , than single fallers [ 1 ] . Fractures are also more common in recurrent fallers than single fallers [ 2 ] . Modern surgery for hip fracture can no longer improve on its outcomes [ 3 ] and therefore , effective prevention of falls [ 4 , 5 ] is the key to preventing disability and death . There is still no published evidence that a single intervention ( tailored group exercise ) can prevent falls or injuries in a high risk group of frequent fallers . This r and omised controlled trial ( RCT ) aim ed to investigate the impact of a 36 week individualised and tailored group and home exercise intervention , compared with a control intervention , in reducing falls and injuries in communitydwelling , independent-living , frequent falling women aged 65 years and over . Preliminary results have been published in abstract form [ 6 ] . The primary outcome was falls and fallrelated injuries . The secondary outcome was the number of frequent fallers who had died , had moved into residential care or were in hospital compared with the group they were in Background The use of exergaming is a potential alternative to traditional methods of balance training , which can be repetitive and somewhat monotonous . The purpose of this study was to assess the effects of exergaming using XBOX Kinect ™ versus traditional gym-based exercise with no virtual stimuli ( TGB ) on postural control , technology acceptance , flow experience and exercise intensity , in young healthy adults . Methods Fifty healthy active adults ( age : 33.8 ± 12.7 years , height : 172.9 ± 11.9 cm , weight : 75 ± 15.8 kg ) were recruited ; 44 completed both baseline and post-intervention data collection . Participants were r and omised ( blind card ) allocation to one of two groups : ( 1 ) received balance training using the XBOX Kinect ™ and ( 2 ) performed traditional gym-based exercise . Exercises were matched for intensity , duration and movement patterns across groups . All participants completed three , 30-minute , exercise sessions a week for four weeks . Postural sway was measured using a Kistler ™ Force platform during unipedal st and ing . Mean heart rate ( HR ) and rate of perceived exertion ( RPE ) were collected during each exercise session to determine and verify that intensity of exercise was matched between groups . Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology ( UTAUT ) and flow experience with the Flow State Scale ( FSS ) . Results Heart rate was matched between groups and BORG RPE was significantly lower in the Kinect ™ group . There were significant between-group differences in postural sway in the medial-lateral direction and CoP. There were also significant differences in technology acceptance between groups for performance expectancy , social influence and behavioral intention , with higher values in the Kinect exercise group . The flow state scale showed significant differences between the groups on several dimensions , with higher values in the Kinect exercise group . Conclusion Objective physiological dem and of exercise ( HR ) was matched across groups , but the exergaming group perceived it as being less dem and ing and of lower intensity . This suggests that exergaming may offer an alternative method of rehabilitation exercise through improved concordance . Balance training in healthy adults using the Kinect is both accepted and intrinsically motivating . Trial registration Retrospectively registered on 27th July 2016 . Trial number NCT02851017 Background / Objectives . Balance problems are well-established modifiable risk factors for falls , which are common in older adults . The objective of this study was to establish the efficacy of a Wii-Fit interactive video-game-led physical exercise program to improve balance  in older Veterans . Methods . A prospect i ve r and omized controlled parallel-group trial was conducted at Veterans Affairs Medical Center . Thirty community dwelling Veterans aged 68 ( ±6.7 ) years were r and omized to either the exercise or control groups . The exercise group performed Wii-Fit program while the control group performed a computer-based cognitive program for 45 minutes , three days per week for 8-weeks . The primary ( Berg Balance Scale ( BBS ) ) and secondary outcomes ( fear of falling , physical activity enjoyment , and quality of life ) were measured at baseline , 4 weeks , and 8 weeks . Results . Of 30 r and omized subjects , 27 completed all aspects of the study protocol . There were no study -related adverse events . Intent-to-treat analysis showed a significantly greater improvement in BBS in the exercise group ( 6.0 ; 95 % CI , 5.1–6.9 ) compared to the control group ( 0.5 ; 95 % CI , −0.3–1.3 ) at 8 weeks ( average intergroup difference ( 95 % CI ) , 5.5 ( 4.3–6.7 ) , p < 0.001 ) after adjusting for baseline . Conclusion . This study establishes that the Wii-Fit exercise program is efficacious in improving balance  in community dwelling older Veterans . This trial is registered with Clinical Trials.gov Identifier NCT02190045 Objective : To compare the effectiveness of three protocol s ( Adapted Physical Activities , Wii Fit ® , Adapted Physical Activities + Wii Fit ® ) on the balance of independent senior subjects . Design : Case comparison study . Setting s : Healthy elderly subjects living in independent community dwellings . Subjects : Thirty-six subjects , average age 75.09 ± 10.26 years , took part in this study , and were r and omly assigned to one of the four experimental groups : G1 followed an Adapted Physical Activities training programme , while the second group ( G2 ) participated in Wii Fit ® training and the third one ( G3 ) combined both methods . There was no training for the fourth group ( G4 ) . All subjects trained once a week ( 1 hour ) for 20 weeks and were assessed before and after treatment . Main measures : The Tinetti test , unipedal tests and the Wii Fit ® tests . Results : After training , the scores in the Tinetti test decreased significantly ( P < 0.05 ) for G1 , G2 and G3 respectively in static conditions and for G1 and G3 in dynamic conditions . After training , the performance in the unipedal tests decreased significantly ( P < 0.05 ) for G1 and G3 . The position of the centre of gravity was modified significantly ( P < 0.05 ) for G2 and G3 . Conclusion : After 20 training sessions , G1 ( Adapted Physical Activities ) , G2 ( Wii Fit ® ) and G3 ( Adapted Physical Activities and Wii Fit ® ) improved their balance . In addition , G1 and G3 increased their dynamic balance . The findings suggest that Adapted Physical Activities training limits the decline in sensorial functions in the elder 
    Output:
    
Exergaming does encourage individuals to st and up ( 3 ) , lean while st and ing ( 4 ) , move upper limbs and turn heads ( 6 ) and dual-task while st and ing ( 9 ) , to some extent move the body forwards , backwards and sideways ( 1 ) , and coordinate movements ( 2 ) but hardly at all to kick , hop , jump or walk ( 7 ) , or to force a postural reaction from a physical force to the individual ( 5 ) and it does not mimic actual changes in sensory context ( 8) .
Some elements of PC are too unsafe to be trained using exergames , such as restricting sensory inputs or applying physical perturbations to an individual to elicit postural responses