Smart±Step Exergame and Seated Computer Brain Training for Preventing Falls in Community-Dwelling Older People: A 12-Month Randomised Controlled Trial

Objectives Exergame training is a promising method for delivering evidence-based fall prevention exercise as it can facilitate exercise adherence and can be tailored to address cognitive and motor risk factors for falls. This study examined the effectiveness of two home-based computer game interventions (seated brain training and step training; smart±step) in preventing falls in community-dwelling older people, compared to a minimal-intervention control group. Design Assessor-blinded, randomised controlled trial. Setting Research institute and homes of older people living in the community of Sydney, Australia. Participants 769 people aged 65+ years living independently in the community and free of cognitive impairment, progressive neurological disease, or any other unstable or acute medical condition that precludes exercise. Interventions Participants were randomised to one of three arms: brain training using a computerised touch pad while seated; exergame step training on a computerised mat; or control. The intervention groups were provided with a home-based training system and were asked to train for at least two hours per week over the 12-month trial. Main outcome measures The primary outcome was the rate of falls reported monthly over 12 months. Results Between October 2016 and May 2019, 769 participants were randomised (seated brain training =262, exergame step training=252, control=255) and all were included in the intention-to-treat analyses. The rate of falls over 12 months was significantly reduced in the exergame step training group compared to control (IRR=0.74, 95%CI=0.56 to 0.98) and was not statistically different between the seated brain training and control groups (IRR=0.86, 95%CI=0.65 to 1.12). No serious intervention-related adverse events were reported. Conclusions A home-based exergame step training program provides a safe and effective means for preventing falls in older people living in the community. As this intervention can be conducted at home and requires only minimal equipment, it has the potential for scalability as a public health intervention to address the increasing problem of falls and fall-related injuries. Trial registration Australian and New Zealand Clinical Trial Registry ACTRN12616001325493, registered 22 September 2016.