Exergaming und Sturzprävention

Transkript

1 Exergaming und Sturzprävention Eling D. de Bruin Wer viel erkennen will, muss viel spielen Gottfried Benn.

2 [1] Theoretischer Hintergrund [2] Genereller Überblick Ausgewählte Studien [3] Beispiele

3 Exergaming: Bild dividat:

4 Adapted from Hausdorff et al. J Appl Physiol. 90: , 2001

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6 The rather low speed in comfortable walking (men 1.0 m.s-1, women 0.9 m.s-1) and the reduced capacity for step climbing diminish the possibility of using public transport and pedestrian street intersections in relatively healthy old people. Danneskiold-Samsøe et al. Eur J Appl Physiol Occup Physiol A speed of 1.22 m.s-1 is required in crossing signaled intersections. Rantanen et al., Am Journal Phys Med & Rehabil

7 <0.6 m/s = ernsthaft abnormal 0.6 to 1.0 m/s = leicht abnormal 1.0 to 1.4 = normal 1.4 oder höher = überlegen

8 Schwelle der Unabhängigkeit Oberschenkelkraft: Benötigtes Minimum Knie-extension für Gehen (1.22 m/s) = 4 W/kg

9 Muskel-Kraft & Sensorische Beeinträchtigung American Geriatrics Society (2001) JAGS 49:

10 Recommendation 7. Strength training may be included in addition to balance training, the inclusion of strength training does not seem to be crucial for an effect of exercise on falls,.

11 Tolea MI, Galvin JE. Sarcopenia and impairment in cognitive and physical performance. Clin Interv Aging Mar 30;10:663-71

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13 Survival curves illustrating the percent of subjects who did not fall as a function of time and executive function (EF). Mirelman A, Herman T, Brozgol M, Dorfman M, et al. (2012) Executive Function and Falls in Older Adults: New Findings from a FiveYear Prospective Study Link Fall Risk to Cognition. PLoS ONE 7(6): e doi: /journal.pone

14 Proposed biologic mechanisms contributing to dynapenia (the age-associated loss of strength). It shows the influence of multiple factors that may lead to muscle weakness in the elderly. Adapted from J Gerontol A Biol Sci Med Sci :

15 Conceptual model of how nervous and muscle system impairments lead to dynapenia Brian C. Clark, Todd M. Manini. What is dynapenia? Nutrition Volume 28, Issue

16 Neurophysiologische mechanismen (dynapenia): Cortex Aging motor cortex excitability/cortical plasticity muscle performance Spinal Cord Aging General excitability spinal reflexes Δ motor unit discharge muscle functional properties Muscle Maximal motor unit firing rates Scott. Nature Reviews Neuroscience 5, ; 2004 Clark & Manini. Nutrition 28(5), 2012:

17 Motorisches Lernen: Video Games Spielen There is evidence to suggest that certain types of video games positively affect physical functioning postural control walking abilities and general functions of the upper and lower extremities (Pichierri et al. BMC Geriatrics 2011, 11:29) 16

18 Martin G. Jorgensen et al. J Gerontol A Biol Sci Med Sci 2013;68: Pre-to-post intervention changes in maximal leg extension strength (maximal voluntary contraction [MVC]; left panel) and postural balance (center of pressure velocity moment [CoP-VM], right panel) adjusted for gender, age, and baseline level in the Nintendo Wii group (dark grey bars) and the control group (light grey bars). The Author Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please journals.permissions@oup.com.

19 Molecular Psychiatry (2014) 19, ; doi: /mp

20 Weighted mean differences (95% CI) of the effect immediately after intervention of substituting some or all of standard rehabilitation (SR) with virtual reality based rehabilitation (VRBR) on walking speed, pooling data from seven trials (n = 138). Weighted mean differences (95% CI) of the effect beyond the end of the intervention period of substituting some or all of standard rehabilitation (SR) with virtual reality based rehabilitation (VRBR) on walking speed, pooling data from three trials.

21 Weighted mean differences (95% CI) of the effect of substituting some or all of standard rehabilitation (SR) with virtual reality based rehabilitation (VRBR) on the Berg Balance Scale score (0 to 56 points), pooling data from five trials (n = 130). Weighted mean differences (95% CI) of the effect of substituting some or all of standard rehabilitation (SR) with virtual reality based rehabilitation (VRBR) on the Timed Up and Go test, pooling data from five trials (n = 114).

22 Weighted mean differences (95% CI) of the effect of adding extra virtual reality based rehabilitation (VRBR) to standard rehabilitation (SR) on the Timed Up and Go test, pooling data from two trials (n = 42).

23 Zusammenfassung In der Rehabilitation und bei Senioren müssen nicht nur Körperfunktionen/-strukturen beurteilt und trainiert werden, sondern auch die Kognition

24 Exergaming und Sturzprävention Die Spiele der Jugend sind kein müßiger Zeitvertreib, sondern sie gehören zu den wichtigsten Erziehungsmitteln, bei deren Auswahl und Wechsel der Zweck der harmonischen Ausbildung des Körpers und Geistes im Vordergrund stehen sollte. Wilhelm Max Wundt ( ).