Older adults’ experience of falls prevention exercise delivered using active gaming and virtual reality

Purpose: Active gaming and virtual reality (AVR) may provide a novel way to deliver falls prevention exercise to older people. “Otago World” is an AVR system designed specifically to deliver strength and balance exercises based on the Otago Exercise Programme (OEP). The aim of the study was to assess the safety, usability and acceptability of this system to deliver falls prevention exercises via AVR using two viewing mediums in older adults. Methods: The planned study design was a cross-sectional study conducted in urban day centres for older adults. Individuals were eligible for inclusion if they were aged over 65 years, were independently mobile with or without a walking aid, such that they were living at home or in supported living for older people, and had stable health. The “Otago World” system included the Kinect sensor for tracking users’ movements whilst playing a series on mini-games based on the OEP, and was suitable for display using two viewing mediums, a 21inch monitor and the Oculus Rift head-mounted display. Participants were invited to test both viewing mediums. Sessions were video-recorded to supplement hand-written notes on the ability of participants to use the system including level of assistance required and any safety concerns. Participants completed two questionnaires and a semi-structured interview, following use of the system, to explore their experience using the system and how acceptable they found it. Results: Nine participants (5 female/4 male) were included in this study; their mean (SD) age was 82.2 (6.3) years. The overall rate of completion of the “Otago World” mini-games displayed on-screen was 82.9%. The overall rate of completion of the “Otago World” mini-games using the Oculus Rift head-mounted display was 62.5%. During play viewed on-screen, hand support was frequently used (23/29 = 79%) and additional instruction was required by participants frequently (21/29 = 72%). Whilst using the Oculus Rift head-mounted display, hand support was required by participants for all games, participants were provided with additional verbal instruction frequently (4/5 = 80%) and physical assistance was required on three occasions. Questionnaire responses indicated that older adults had positive attitudes to the system and found it fairly easy to use, with a preference for AVR displayed on-screen. This was also reflected in semi-structured interviews. Users’ acceptance of the system was based on three broad themes: User experience; motivation; and, ability to participate. Participants also reported willingness to use the system in the future, confidence in their ability to do so and a preference for use within the day care setting rather than at home. Conclusion(s): Overall results from the semi-structured interviews and comments recorded during use of the system suggested that the participants viewed the VR game, particularly when displayed on screen, as an acceptable mode of exercise; they found the game enjoyable and useful. Implications: This study provides valuable insight into older adults’ experience of a specifically developed AVR system. Future research should focus on enabling autonomous use of such systems and the impact of repeated use on acceptability. Findings have been used to inform another stage of the study. Funding acknowledgements: This study was supported by the Department of Employment and Learning Northern Ireland, the Trauma and Rehabilitation RRG and the MRC via funding for the UKCRC Centre of Excellence for Public Health Northern Ireland.