Elsevier

Experimental Gerontology

Volume 138, September 2020, 110983
Experimental Gerontology

The effects of GAMotion (a giant exercising board game) on physical capacity, motivation and quality of life among nursing home residents: A pilot interventional study

https://doi.org/10.1016/j.exger.2020.110983Get rights and content

Highlights

  • A giant exercising board game has been developed and tested in nursing homes.

  • This game, the GAMotion, led to a significant increase in physical capacity.

  • The GAMotion has also led to an improved quality of life for residents.

  • Their motivation to practice physical activity has also been improved.

Abstract

Background

In 2017, our team highlighted promising results of a giant exercising board game on physical activity level and a broader array of physical and psychological outcomes among nursing home residents. However, some improvements of this game were needed to make it more suitable for nursing homes and more challenging in terms of exercises. Therefore, we decided to develop a new version of a giant exercising board game: the GAMotion.

Objectives

The primary objective of this pilot study was to assess the impact of the GAMotion on physical capacity among nursing home residents. The secondary aims were to assess the impact of the GAMotion on motivation and quality of life in this population.

Methods

A one-month pilot interventional study was performed in two comparable nursing homes. Eleven participants meeting the inclusion criteria took part in the intervention in one nursing home, whereas 10 participants were assigned to the control group in the other institution. The GAMotion required participants to perform strength, flexibility, balance and endurance activities. The assistance provided by an exercising specialist decreased gradually during the intervention in an autonomy-oriented approach based on the self-determination theory. Physical capacity (i.e. fall risk using Tinetti test; dynamic balance using Timed Up and Go test (TUG); physical abilities using SPPB test; grip strength using Jamar dynamometer; isometric lower limb muscle strength using MicroFET2 and quantitative evaluation of walking using Locometrix), motivation (i.e. using Behavioral Regulation in Exercise Questionnaire-2) and quality of life (i.e. using EQ-5D questionnaire) were assessed at baseline and at the end of the intervention. A two-way repeated-measure analysis of variance (ANOVA) was used to assess time*group (intervention vs. control group) effects. All the analyses were adjusted on age, which differed significantly between the 2 groups at baseline.

Results

During the intervention period, the experimental group displayed a greater improvement in Tinetti score (p < 0.0001), TUG (p = 0.02), SPPB (p < 0.0001), knee extensor isometric strength (p = 0.04), grip strength (p = 0.02), symmetry of steps (p = 0.04), 3 domains of the EQ-5D (i.e. mobility, self-care, usual activities: p < 0.0001) and intrinsic motivation (p = 0.02) compared to the control group. No significant improvement was demonstrated on the other parameters.

Conclusion

These promising results should be interpreted with caution because of certain limitations (e.g. small sample size, no blind assessment). Further investigation is required to confirm and evaluate the long-term effectiveness of the GAMotion in nursing homes.

Introduction

Research over past decades reports that nursing home residents spend the majority of their time inactive (Ikezoe et al., 2013) and they walk on average 1678 ± 1621 steps per day, which is far from the recommendations levels advocating a minimum of 3000 steps/day (Buckinx et al., 2017; Tudor-Locke et al., 2011). This sedentary lifestyle has detrimental effects on physical and psychological health, quality of life, and contributes to social isolation (Forster et al., 2017). Moreover, the implementation of physical activity interventions leads to positive effects on functional ability, cognition or mood (Brett et al., 2016). Barriers to practicing physical activity, in older adults, have been described in a literature review and are as follow: 1) health issues, such as limited mobility or arthritis, 2) psychological barriers such as fear of falling/being injured or low motivation, 3) medications related to chronic disease and 4) organizational and environmental barriers, such as no dedicated space for exercise equipment and or lack of time, reported by the staff, to incorporate physical activity into the residents' daily routine (Benjamin et al., 2014). Those time constraints could be at least partly overcomed with self-determination theory oriented interventions emphasing the importance of autonomous regulations in fostering physical activity (Teixeira et al., 2012).

Taking into consideration the encouraging evidence about the implementation of physical activity interventions in nursing homes (Jansen et al., 2015), and in order to overcome the barriers to physical activity, we previously investigated the effects of a giant exercising board game intervention on ambulatory physical activity and a broader array of physical and psychological outcomes among nursing home residents (Mouton et al., 2017). As explained in our previous publication (Mouton et al., 2017), we decided to use a giant board game since interventions combining physical exercise and behavioral components could lead to an autonomous form of motivation for physical activity through different strategies, including the satisfaction of exercise-related basic psychological needs for autonomy, competence, and relatedness (Teixeira et al., 2012). Indeed, making physical activity more enjoyable and sociable could encourage residents to participate in physical activity more regularly and to move beyond the relatively monotonous lifestyle in nursing homes (Chen and Li, 2014). Moreover, literature indicates that exergaming approaches for physical activity promotion, such as interactive video games, lead to increased enjoyment and motivation in addition to positive cognitive and physical outcomes (Bleakley et al., 2015). Nevertheless, active video game are difficult to implement in nursing home since they mostly involve one-on-one supervision, required technology, and are not as effective as traditional intervention (Bleakley et al., 2015; Molina et al., 2014). In the sense, the GAMotion could be an interesting alternative.

The study, published in 2017, highlighted promising results. Indeed, after a 3-month follow-up period, results showed that a giant board game intervention led to a significant increase in physical activity level (number of steps per day), daily energy expenditure, quality of life (EQ-5D), balance and gait (Tinetti), and strength of the ankle, whereas these improvements were not observed in the control group (Mouton et al., 2017). However, some improvements of this game were needed to make it more suitable in nursing homes and more challenging in terms of exercises. Effectively, some institutions have reported that the board game was too bulky (i.e. 4∗3 m) and that the playing time was too long (i.e. 24 games squares and ~1 h) for the residents. Some residents also reported that the exercises were sometimes too simple. Taking into account the critics mentioned above, a new version of a giant exercising board game, the GAMotion (i.e. contraction of the words “Game” and “Motion”), was developed. In this new version, we decided to reduce the dimensions of the mat (i.e. 4.20 ∗ 1.70 m) and the number of game squares (i.e. 16 squares) and therefore to reduce playing time (i.e. ~30 min). Then, focus groups bringing together public health professionals, sports sciences specialists, physiotherapists and nursing home staff were organized to modify or adapt the exercises.

The aim of the present study was to develop the GAMotion and evaluate its impact on physical capacity. The secondary objectives of this investigation were to assess the impact of the GAMotion on motivation and quality of life in this population.

Section snippets

Study design and participants

A one-month pilot interventional study was performed in two comparable nursing homes (i.e. number of beds >90, semi-rural area and similar services, such as nursing care, physiotherapy, physical and social activities) in the Province of Liège: “Val Mosan” and “Saint Joseph”. These two nursing homes were randomized in one intervention group and one control group.

Before intervention initiation, investigators met the director and staff of the nursing homes to inform them about the inclusion and

Participants

The selection of participants for the present study is summarized in Fig. 3. Medical staff of the nursing homes was asked to pre-screen between 15 and 30 eligible participants. Respectively, 9.5% and 8.5% of the population of the intervention and control nursing homes were pre-screened. Among these eligible residents, 5 refused to participate in the intervention group (26%) and 3 did not reach the required MMSE score. In the control group, 14 residents declined to participate (50%), and 4 had

Discussion

The positive effects of GAMotion on physical capacity, motivation and quality of life among nursing home residents observed in the present pilot study go in the same direction than the results obtained with the previous version of the giant exercising board game.

More specifically, the experimental group displayed a greater improvement in Tinetti score (p < 0.0001), Timed Up and Go (p = 0.02), SPPB (p < 0.0001), knee extensor isometric strength (p = 0.04), grip strength (p = 0.02) and symmetry

Acknowledgments

The authors are grateful to all the volunteers for their participation in this study.

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