Effectiveness, enjoyment, and meaningfulness of a virtual reality gait-based fall prevention exergame in community-dwelling healthy older adults: an interdisciplinary pilot study.

INTRODUCTION

Falls are a prevalent health concern among older adults, potentially resulting in substantial physical, psychological, and social ramifications. Interventions aimed at fall prevention require effectiveness, enjoyment, and meaningfulness (EEM). As gait impairments are a key factor in fall risk, integrating natural locomotion and cognitive skills through single- and dual-task training is essential. We developed EXploVR, a fully immersive virtual reality exergame that integrates natural gait and promotes EEM. This interdisciplinary pilot study examined the EEM of EXploVR in healthy, community-dwelling older adults.

METHODS

Forty-six participants were assigned to an intervention or passive control group using a single-blinded, quasi-randomized design. Over three weeks, the intervention group completed two 60-min sessions weekly. Baseline, mid-, and post-assessments included single- and dual-task gait (instrumented normal and tandem walks, counting task), lower limb strength and transitional movement (instrumented Five Times Sit-to-Stand test, 5xSTS), and static postural control (instrumented sway tests). In-game performance (time-to-complete) was recorded. Enjoyment was assessed via the Flow Short Scale (FKS), Physical Activity Enjoyment Scale (PACES-S) and adaptations, and Exergame Enjoyment Questionnaire (EEQ). Meaningfulness was assessed via the Activities-specific Balance Confidence Scales (ABC-6, ABC-8) and custom questions on perceived safety, fear of falling, daily-life integration, emotional challenges, and perceived effectiveness for fall prevention.

RESULTS

Data from 32 participants (16 intervention, age = 70.00 ± 3.33 years; 16 control, age = 68.38 ± 5.54 years) were analyzed. Significant improvements were found in walking gait speed (p = 0.019) and tandem gait speed (p = 0.032). Under dual-task conditions, only tandem gait speed improved significantly (p = 0.022). 5xSTS showed a significant interaction for total duration (p = 0.023), while postural sway demonstrated non-significant improvement trends. In-game station completion time improved significantly in 5 of 6 sets (p < 0.05). Enjoyment remained high or increased, and meaningfulness was supported by positive trends in ABC-6 (p = 0.094) and significant gains for ABC-8 (p = 0.026). Custom questions further supported these findings.

CONCLUSION

This study suggests that EXploVR is effective and enjoyable while fostering meaningfulness. Further research with larger samples and extended interventions is needed to confirm long-term effects and daily-life transfer.