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Virtual reality treadmill training could help prevent falls

Combined virtual reality and treadmill training helps prevent falls in older adults better than treadmill training alone

Ingrid Torjesen

Friday, 12 August 2016

Combining virtual reality and treadmill training helps prevent falls in older adults better than treadmill training alone, according to a new randomised controlled trial* published in The Lancet.

The researchers say that the intervention, which combines the physical and cognitive aspects of walking, could potentially be used in gyms, rehabilitation centres or nursing homes to improve safe walking and prevent falls in older adults or people with disorders which affect movement such as Parkinson's disease.

Falls in adults aged 65 and over account for 1-2% of all healthcare expenditure in high-income countries. Three in ten older adults living in the community, and as many as 60-80% of older adults with mild cognitive impairment, dementia or Parkinson's disease, fall at least once a year.

The researchers analysed data from 282 participants from five clinical sites in Belgium, Israel, Italy, the Netherlands, and the UK between 2013 and 2015. All participants were aged 60-90, were able to walk at least 5 minutes unassisted, on stable medication, and had reported at least two falls in the six months before the start of the study. Nearly half of all participants (130) had Parkinson's disease, and some (43) had mild cognitive impairment.

Participants were assigned to treadmill training with virtual reality (146), or treadmill training alone (136). The virtual reality component consisted of a camera that captured the movement of participants' feet and projected it onto a screen in front of the treadmill, so that participants could 'see' their feet walking on the screen in real time. The game-like simulation was designed to reduce the risk of falls in older adults by including real-life challenges, such as avoiding and stepping over obstacles like puddles or hurdles, and navigating.

On average, participants in each group took part in 16 training sessions over six weeks, with each session lasting about 45 minutes. Fall rates were recorded in the six months following the end of training. Prior to training, participants in the treadmill only group had an average of 10.7 falls per six months, and participants in the treadmill plus virtual reality group averaged 11.9 falls per six months.

During the six months after training, the incidence rate of falls decreased in both groups, but the decrease was only statistically significant in the treadmill plus virtual reality group (11.9 to 6.0 falls in the virtual reality group - a 42% reduction; compared to a decrease from 10.7 to 8.3 in the treadmill only group).

Dr Anat Mirelman, Center for the study of Movement, Cognition and Mobility (CMCM), Neurology Institute, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Israel, said: "Falls in older people often occur because of tripping and poor obstacle negotiation while walking. Falls often start a vicious cycle, which has many important negative health consequences. Older people's ability to negotiate obstacles can be impaired because of age-related decline in cognitive abilities like motor planning, divided attention, executive control, and judgement, yet current interventions for falls in older adults typically focus on improving muscle strength, balance, and gait.

"Our approach combines treadmill exercise and virtual reality to help improve both physical mobility and cognitive aspects that are important for safe walking. We found that virtual reality plus treadmill training helped to reduce fall frequency and fall risk for at least six months after training."

The biggest improvement was seen in participants with Parkinson's disease, and the researchers suggest that this could be due to a number of factors, including that they had higher rates of falls at the start of the study, or that virtual reality was able to help improve cognitive and motor skills which are affected in Parkinson's disease.

Dr Mirelman said: "Treadmills are widely available, and the additional cost of treadmill training plus virtual reality is about 4,000 Euros for the set-up. Our study used personalised supervision, but this might not be necessary in everyday practice where group training might be more suitable."

* Mirelman A, et al. Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. The Lancet, published online: 11 August 2016. DOI: 10.1016/S0140-6736(16)31325-3

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