Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

The overall goal of this research is to determine if an exergame with cognitive input and low physical impact could improve the balance, mobility and state of Depression of HIV patients suffering from frailty. This method can answer key questions in the field of frailty such as whether regular use of this exergame can improve mobility, strength and balance which are characteristics often compromised in frail HIV patients. The main advantage of this technique is that it has low physical impact and can be used by most patients.

The implications of this technique extend beyond physical improvements and may lessen Depression, likely through the cognitive features of the exergame. We first had the idea for this method when we realized that our HIV frail patients attending clinic had a low caloric expendtial during the week. Helping us film this technique will be Brad Brock who will be filling the whole of the experimental subject.

Conduct the training excercises in 30 to 60 minute sessions over a six week period. To prepare a subject for a session attach inertial sensors to the subject's shanks, thighs and lower back using self-adhering straps. At the beginning, the midpoint and end of the sessions measure the subject's balance and gait.

To measure the subject's balance track their sway while holding still. Have the subject stand for 30 seconds with their feet in a double stance, and ask them to keep their eyes fixed at one point on the wall. Next, have them repeat the task with their eyes closed.

Then have them repeat the task a third time with their eyes open and then closed. To evaluate the subject's gait, first have the subject walk 10 meters at a normal pace. Next have the subject walk 10 meters at a normal pace while performing a cognitive task such as counting backwards.

Finally, have the subject walk 10 meters at their fast pace. Assess the main gait outcomes for gait speed and variablity from the data collected by the sensors at the ankles and things. The ankle reaching task requires leaning in various directions with partial weight transfer while standing in front of the computer screen.

Rotations of the ankle joints are translated to a linear cursor on the computer screen. Have the subject move the cursor back and forth between from the middle one circle to the middle of another. This should be done accurately and quickly within one second.

To move the cursor forwards and backwards the participant must move their hips in the anterior posterior direction which will generate ankle dorsiflexion or plantar flexion. Medial lateral hip movements are used to navigate the cursor sideways. The program provides a visual and auditory explosion when the task is performed within the time limit.

When the task is performed too slowly a green circle without the noise is provided. For each session perform nine locks of 20 repetitions. Alternate between the AP direction, a diagonal direction and a visuomotor rotation task.

For the rotation task, rotate the trajectory of the cursor by 20 degrees. Between blocks have participants rest 30 to 60 seconds. In sessions 10 to 12 implement a motor cognitive exercise.

Present five labeled circles and ask the subject to move the cursor between them in a specific sequence. This challenges the subject to memorize the order as well as to perform the task. During sessions two to 12, preform a virtual obstacle crossing task designed to enhance perception lower limb position, reduce reaction time and improve single leg balance.

Have the subject face the computer screen where an avatar of the subject is presented which shows hips and lower limbs. For this task the participant crosses virtual obstacles that move on the screen from right to left. The subject's movements are translated to the stick figure avatar.

Each obstacle must be traversed using alternate legs and feedback is provided in an audio visual manner. When an object is struck the subject must return to a neutral position for two seconds. In sessions two through seven, have the computer present obstacles between 5%and 10%of the subject's height.

In sessions nine through 12 add obstacles that are 15 to 20%of the subject's height. For each session conduct two to four series of obstacle crossings with 10 repetitions each, depending on the capabilities of the subject. At the end of each session give the subject feedback about their success rate.

10 elderly adults living with HIV underwent the described training and successfully completing all of the sessions. The participants showed a significant reduction in center of mass sway during a semi-tandem balance stance with their eyes closed which is one of the more difficult positions for this population. Participants also show a significant increase in gait speed during a dual task motor cognitive assessment as measured by stride velocity which increased by over 1 meters per second.

The participants also self-reported on their pain levels their reports showed a significant reduction in pain which is an important indicator for quality of life, a more detailed discussion of these results is provided in the text protocol. After watching this video you should have a good understanding of how exergaming can improve measurable features such as mobility, balance and stregnth. Following this procedure other experiments can be performed in order to answer additional questions like how sustainable the improvements are.