Move Well: Design Deficits in Postural Based Exergames. What are We Missing?

One in three older adults in the UK over the age of sixty experience a fall. Exergaming (exercise-gaming) interventions are an alternate method of training postural control (PC) to prevent future falls, yet the movements trained in exergaming interventions are not fully understood with respect to established theory, the Systems Framework for Postural Control (SFPC). We systematically reviewed articles from six databases using search terms pertaining to older adults, PC, exergaming and falls. Full-text articles were screened for outcome measures, movement characteristics and were rated in conjunction with the SFPC. We assessed quality using the PEDro scale. Eighteen trials were included in the review with a mean PEDro score of 5.6 (1.5). A third of publications reported movement characteristics where commercial apparatus were used. Overall, 4.99 (1.27) of 9 possible areas of PC are currently trained with some not practical to train in an exergaming environment (sensory integration, reactive PC). Other areas of the SFPC are lacking due to restrictions in console apparatus and in game design due to a lack of movement ranges necessary to drive gameplay. Future game designs should consider the individual components of the SFPC and within each element the range of movement and speed of movement capabilities of an older adult. Designing for the needs of older adults and considering this framework may help train balance deficits within this population.