Kalpana P. Padala, MD, MS

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 Wii-Fit for Activity, Balance and Gait in
Assisted Living

• Kalpana P. Padala, MD, MS
• Research Geriatrician, Assistant Professor
• Department of Family Medicine
• University of Nebraska Medical Center Omaha, NE

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Faculty Disclosures

• The presenters have disclosed that they have no
  relevant financial relationship(s).

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Funding source

• 2009 AMDA foundation / Pfizer Quality Improvement
  Award

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Learning Objectives

• By the end of the session, participants will be
  able to
• Objective 1 Appreciate the impact of balance and
  gait problems in AD
• Objective 2 Recognize barriers to exercise in
  this population
• Objective 3 Evaluate the feasibility of Wii-Fit
  to improve balance and gait in AD

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Falls in AD

• Three fold higher in AD compared to cognitively
  intact older adults
• Impact
• rate of injuries and fractures
• rate of institutionalization
• Older adults who wander and fall their life
  span by more than 3 years

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Gait in AD

• Shortened step length
• double support time
• stride length variability - proven risk factor
  for falls in AD
• gait speed

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Importance of Exercise Barriers

• Exercise is known to improve gait and balance in
  elderly
• Barriers to Exercise
• Difficulty in engaging subjects
• Lack of motivation
• Cost
• Transportation issues
• Availability of coach or physical therapist
• Lack of facilities in rural areas

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Wii-Fit

• A Nintendo gaming console
• Includes a balance board that senses weight,
  movement and balance
• Virtual trainers talk the user through the
  activity while tracking progress
• Exercise Components
• Yoga
• Strength training
• Aerobics
• Balance games

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Wii- Fit Component
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Creating Mii Calculating BMI and Wii-Fit Age
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Yoga Strength Training
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Aerobics
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Balance Games
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Balance Games
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Specific Aims

• To compare the effect of the Wii-Fit program to a
  walking program, on measures of balance, in
  subjects with mild AD residing in an assisted
  living facility
• To compare the effect of the Wii-Fit program to a
  walking program, on measures of activity, gait,
  and quality of life in the same population

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Methods

• Study design
• 8-week prospective randomized parallel-group
  study

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22 subjects (11 in each arm)
Wii-Fit arm
Walking arm
Intervention 30 minutes daily five days a week
for 8 weeks
Intervention 30 minutes daily five days a week
for 8 weeks
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Study subjects Sign consent and assent
forms Randomization
Obtain primary and secondary outcome measures
Wii-Fit intervention for 8 weeks
Walking intervention for 8 weeks
Assess primary and secondary outcome measures
Assess primary and secondary outcome measures
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Primary Outcome Measures

• Berg Balance Scale (BBS)
• 14 subsets of tasks performed in a standard order
• Each task is scored on a five-point scale (0-4)
• The maximum score for this assessment is 56
• A score of lt 45 is predictive of falls
• Good inter-rater reliability of 0.98

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Secondary Outcome Measures

• Timed Up and Go (TUG)
• Tinettis Test
• Activities of daily living (ADL)
• Instrumental Activities of daily Living (IADL)
• Quality Of Life-AD (QOL-AD)
• Mini Mental State Exam (MMSE)
• Executive Function tests (Trails A B and Exit
  -25)
• Apathy Evaluation Scale (AES)
• Actigraphs (advanced pedometers - measure
  physical function)

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95 charts screened
Study Flow diagram
46 charts found eligible
1 subject hospitalized , 1 subject on PT, 1
subject had severely limited endurance 1
subject out of the facility 5 days a week
37 subjects and/or POA approached for the study
5 subjects not pursued as the N was met
4 POA did not return phone calls 2 POA declined
2 subjects were their own POA and declined
5 subjects declined after POA agreed 2 subjects
declined before POA were contacted
22 subjects participated in the study
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Results

• 22 subjects enrolled,11 in each arm
• One subject in each arm did not complete the
  study
• The subject in Wii-Fit arm did not want to
  continue after completing 4 weeks
• The subject from Walking arm was discharged to
  his home after 4 weeks
• Data was analyzed with intent to treat analysis
• RM-ANOVA was used to analyze the continuous
  variables

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Demographics baseline variables

• Mean age 80.4 (7.8) years
• Gender 8 females in each group
• Race All subjects were Caucasians
• Mean BMI 25.4 (4.05) kg/m2
• Mean Years of education13.9 (2.1) years
• No baseline differences among the two groups with
  regards to demographics, primary and secondary
  outcome variables

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Results

• There was a significant improvement in BBS across
  the entire study subjects
• (plt0.001)
• There was also significant improvement in TUG
  (p0.036) and Tinettis (plt0.001)

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Comparison of mean change in BBS amongst the two
groups
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Results (contd)

• There was significant improvement in the balance
  and gait in both groups but within group
  differences were not statistically significant
• There was no significant improvement in the ADL,
  IADL, QOL, MMSE in both groups and within group
  differences were not statistically significant

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Conclusion

• Both Wii-Fit and walking are feasible in an
  Assisted living facility
• Balance and Gait improved significantly with both
  interventions
• Both groups had good adherence

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Limitations

• Conducted in an Assisted living, so not
  generalizeable to community dwellers
• Small sample size
• Study intervention was investigator driven than
  patients self motivation
• The study intervention was not aimed towards the
  primary outcome variable

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Acknowledgements

• William J. Burke, MD Primary Mentor
• Timothy Malloy, MD,CMD Medical Director
• Sarah Frost, PT, Physical Therapist
• Jenenne Geske, PhD Statistician
• Marie Bissell, BSN, RN Graduate assistant
• Penny Schweitzer, RN, Administrator
• Chris Stungis, RN, QMA/Director of Health care
  Services
• Facility Parsons House on Eagle Run

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Questions
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Inclusion criteria

• Age 60
• Alzheimers Dementia, mild(MMSE 18)
• Residing in assisted living facility
• Presence of legal surrogate

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Exclusion criteria

• History of myocardial infarction, TIA or stroke
  in last 6 months
• Presence of serious mental illness impacting
  memory
• Active cancer except skin cancer
• Medical conditions likely to compromise survival
  (e.g. severe CHF)
• Severe sensory and musculoskeletal impairments
• Using wheel-chair