Original Study| Volume 23, ISSUE 3, P373-378.e3, March 2022

The Effect of Convergence Gamification Training in Community-Dwelling Older People: A Multicenter, Randomized Controlled Trial

  • Eun-Lee Lee
    Department of Rehabilitation Medicine, Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea

    Department of Public health, Graduate School, Inje University, Pusan, Republic of Korea
    Search for articles by this author
  • Myoung-Hwan Ko
    Department of Physical Medicine and Rehabilitation of Jeonbuk National University Medical School, Jeonju, Republic of Korea

    Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
    Search for articles by this author
  • Myung-Jun Shin
    Address correspondence to Myung-Jun Shin, PhD, Department of Rehabilitation Medicine of Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Pusan 49241, Republic of Korea.
    Department of Rehabilitation Medicine, Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
    Search for articles by this author
  • Byeong-Ju Lee
    Department of Rehabilitation Medicine, Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
    Search for articles by this author
  • Da Hwi Jung
    Department of Rehabilitation Medicine, Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
    Search for articles by this author
  • Kap-Soo Han
    Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
    Search for articles by this author
  • Jin Mi Kim
    Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
    Search for articles by this author



      It is necessary to improve the health of older adults through exercise, but there is no concrete way to implement it or an environment in which they can exercise continuously. Our objective was to confirm the safety and efficacy of information technology (IT) convergence gamification exercise equipment for older adults. We tried to demonstrate equivalence to conventional exercise by comparing the functional improvement.


      Randomized controlled trial, with 8-week-long IT convergence exercises 3 times a week vs conventional exercise.

      Setting and Participants

      40 community-dwelling participants aged 60-85 years.


      Participants were randomly divided into a conventional exercise group (group 1) and an IT convergence exercise group (group 2). Both groups were trained for 8 weeks, and functional assessment was performed before training (pre-evaluation), after training, and after 4 weeks of rest.


      There were functional improvements in both groups. A comparison of the differences in the functional assessment between pre-evaluation and after 8 weeks of training yielded the following results. In group 1, the mean Five Times Sit to Stand Test–30 seconds was scored as 3.60 ± 2.56 (P < .015); Five Times Sit to Stand Test–5 times, −1.75 ± 2.04 s (P < .015); Berg Balance Scale, 1.05 ± 1.39 (P < .015); Timed Up-and-Go test, −0.64 ± 0.64 s (P < .015); and 10-m Walking Test, −0.35 ± 0.47 s (P < .015). And in group 2, the mean Five Times Sit to Stand Test–30 seconds (s) was scored as 3.70 ± 2.62 (P < .015), Five Times Sit to Stand Test–5 times, −1.65 ± 1.59 s (P < .015); Berg Balance Scale, 1.05 ± 1.00 (P < .015); Timed Up-and-Go test, −0.93 ± 0.68 s (P < .015); 10-m Walking Test, −0.41 ± 0.489 s (P < .015); Chair Sit and Reach test, 2.23 ± 3.19 cm (P < .015); and Korean version of the Falls Efficacy Scale–International, −1.05 ± 1.43 (P < .015).

      Conclusion and Implications

      The results of this study suggest that the IT convergence gamification exercise equipment such as balpro110 has exercise effects similar to conventional exercise and also has advantages as an alternative to exercise for older adults in the next generation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Diaz M.
        • Engelman R.
        • Klugman J.
        • et al.
        State of world population 2017. Worlds apart: Reproductive health and rights in an age of inequality.
        Population Fund, New York: United Nations2017
        • Sun W.
        • Aodeng S.
        • Tanimoto Y.
        • et al.
        Quality of life (QOL) of the community-dwelling elderly and associated factors: A population-based study in urban areas of China.
        Arch Gerontol Geriatr. 2015; 60: 311-316
        • da Silva Alexandre T.
        • de Oliveira Duarte Y.
        • Santos J.F.
        • et al.
        Prevalence and associated factors of sarcopenia among elderly in Brazil: Findings from the SABE study.
        J Nutr Health Aging. 2014; 18: 284-290
        • Boulos C.
        • Salameh P.
        • Barberger-Gateau P.
        Factors associated with poor nutritional status among community dwelling Lebanese elderly subjects living in rural areas: Results of the AMEL study.
        J Nutr Health Aging. 2014; 18: 487-494
        • Kamińska M.S.
        • Brodowski J.
        • Karakiewicz B.
        Fall risk factors in community-dwelling elderly depending on their physical function, cognitive status and symptoms of depression.
        Int J Environ Res Public Health. 2015; 12: 3406-3416
        • Noh J.W.
        • Kim K.B.
        • Lee J.H.
        • et al.
        Relationship of health, sociodemographic, and economic factors and life satisfaction in young-old and old-old elderly: A cross-sectional analysis of data from the Korean longitudinal study of aging.
        J Phys Ther Sci. 2017; 29: 1483-1489
        • Grimby G.
        • Saltin B.
        The ageing muscle.
        Clin Physiol. 1983; 3: 209-218
        • Cartee G.D.
        • Hepple R.T.
        • Bamman M.M.
        • et al.
        Exercise promotes healthy aging of skeletal muscle.
        Cell Metab. 2016; 23: 1034-1047
        • Booth F.W.
        • Roberts C.K.
        • Laye M.J.
        Lack of exercise is a major cause of chronic diseases.
        Compr Physiol. 2011; 2: 1143-1211
        • Booth F.W.
        • Chakravarthy M.V.
        • Gordon S.E.
        • et al.
        Waging war on physical inactivity: Using modern molecular ammunition against an ancient enemy.
        J Appl Physiol (1985). 2002; 93: 3-30
        • Lai C.H.
        • Peng C.W.
        • Chen Y.L.
        • et al.
        Effects of interactive video-game based system exercise on the balance of the elderly.
        Gait Posture. 2013; 37: 511-515
        • Yoo J.S.
        • Jeon M.Y.
        • Kim C.G.
        Effects of a fall prevention program on falls in frail elders living at home in rural communities.
        J Korean Acad Nurs. 2013; 43: 613-625
        • Kaviani S.
        • Dadgostar H.
        • Mazaherinezhad A.
        • et al.
        Comparing minimally supervised home-based and closely supervised gym-based exercise programs in weight reduction and insulin resistance after bariatric surgery: A randomized clinical trial.
        Med J Islam Repub Iran. 2017; 31: 34
        • Montero-Fernandez N.
        • Serra-Rexach J.
        Role of exercise on sarcopenia in the elderly.
        Eur J Phys Rehabil Med. 2013; 49: 131-143
        • Coelho F.G.d.M.
        • Vital T.M.
        • Stein A.M.
        • et al.
        Acute aerobic exercise increases brain-derived neurotrophic factor levels in elderly with Alzheimer's disease.
        J Alzheimers Dis. 2014; 39: 401-408
        • Broskey N.T.
        • Greggio C.
        • Boss A.
        • et al.
        Skeletal muscle mitochondria in the elderly: Effects of physical fitness and exercise training.
        J Clin Endocrinol Metab. 2014; 99: 1852-1861
        • Osugi T.
        • Iwamoto J.
        • Yamazaki M.
        • et al.
        Effect of a combination of whole body vibration exercise and squat training on body balance, muscle power, and walking ability in the elderly.
        Ther Clin Risk Manag. 2014; 10: 131-138
        • Halvarsson A.
        • Olsson E.
        • Farén E.
        • et al.
        Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: A randomized controlled trial.
        Clin Rehabil. 2011; 25: 1021-1031
        • Thomas S.
        • Mackintosh S.
        • Halbert J.
        Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis.
        Age Ageing. 2010; 39: 681-687
        • Taaffe D.R.
        • Irie F.
        • Masaki K.H.
        • et al.
        Physical activity, physical function, and incident dementia in elderly men: The Honolulu–Asia Aging Study.
        J Gerontol A Biol Sci Med Sci. 2008; 63: 529-535
        • Toril P.
        • Reales J.M.
        • Ballesteros S.
        Video game training enhances cognition of older adults: A meta-analytic study.
        Psychol Aging. 2014; 29: 706-716
        • Ballesteros S.
        • Prieto A.
        • Mayas J.
        • et al.
        Brain training with non-action video games enhances aspects of cognition in older adults: A randomized controlled trial.
        Front Aging Neurosci. 2014; 6: 277
        • Drew B.
        • Waters J.
        Video games: Utilization of a novel strategy to improve perceptual motor skills and cognitive functioning in the non-institutionalized elderly.
        Cogn Rehabil. 1986; 4: 26-31
        • Belchior P.
        Cognitive training with video games to improve driving skills and driving safety among older adults. PhD thesis, University of Florida.
        • Mayas J.
        • Parmentier F.B.
        • Andres P.
        • et al.
        Plasticity of attentional functions in older adults after non-action video game training: a randomized controlled trial.
        PLoS One. 2014; 9: e92269
        • Hampstead B.M.
        • Sathian K.
        • Phillips P.A.
        • et al.
        Mnemonic strategy training improves memory for object location associations in both healthy elderly and patients with amnestic mild cognitive impairment: A randomized, single-blind study.
        Neuropsychology. 2012; 26: 385
        • Erickson K.I.
        • Colcombe S.J.
        • Wadhwa R.
        • et al.
        Training-induced plasticity in older adults: effects of training on hemispheric asymmetry.
        Neurobiol Aging. 2007; 28: 272-283
        • Torres A.C.S.
        Cognitive effects of video games on old people.
        Int J Disabil Hum Devel. 2011; 10: 55-58


        • Guralnik J.M.
        • Ferrucci L.
        • Pieper C.F.
        • et al.
        Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M221-M231
        • Buatois S.
        • Miljkovic D.
        • Manckoundia P.
        • et al.
        Five times sit to stand test is a predictor of recurrent falls in healthy community-living subjects aged 65 and older.
        J Am Geriatr Soc. 2008; 56: 1575-1577
        • Bohannon R.W.
        Reference values for the five-repetition sit-to-stand test: A descriptive meta-analysis of data from elders.
        Percept Motor Skills. 2006; 103: 215-222
        • Alcazar J.
        • Losa-Reyna J.
        • Rodriguez-Lopez C.
        • et al.
        The sit-to-stand muscle power test: An easy, inexpensive and portable procedure to assess muscle power in older people.
        Exp Gerontol. 2018; 112: 38-43
        • Tiedemann A.
        • Shimada H.
        • Sherrington C.
        • et al.
        The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people.
        Age Ageing. 2008; 37: 430-435
        • Tsuji T.
        • Tsunoda K.
        • Mitsuishi Y.
        • et al.
        Ground reaction force in sit-to-stand movement reflects lower limb muscle strength and power in community-dwelling older adults.
        Int J Gerontol. 2015; 9: 111-118
        • Zhang Q.
        • Li Y.X.
        • Li X.L.
        • et al.
        A comparative study of the five-repetition sit-to-stand test and the 30-second sit-to-stand test to assess exercise tolerance in COPD patients.
        Int J Chron Obstruct Pulmon Dis. 2018; 13: 2833
        • Regterschot G.R.H.
        • Zhang W.
        • Baldus H.
        • et al.
        Sensor-based monitoring of sit-to-stand performance is indicative of objective and self-reported aspects of functional status in older adults.
        Gait Posture. 2015; 41: 935-940
        • Yee X.S.
        • Ng Y.S.
        • Allen J.C.
        • et al.
        Performance on sit-to-stand tests in relation to measures of functional fitness and sarcopenia diagnosis in community-dwelling older adults.
        Eur Rev Aging Phys Act. 2021; 18: 1-11
        • Jung K.S.
        • In T.S.
        • Cho H.Y.
        Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: A randomized controlled study.
        Gait Posture. 2017; 54: 183-187
        • Schlicht J.
        • Camaione D.N.
        • Owen S.V.
        Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M281-M286
        • Regterschot G.R.H.
        • Folkersma M.
        • Zhang W.
        • et al.
        Sensitivity of sensor-based sit-to-stand peak power to the effects of training leg strength, leg power and balance in older adults.
        Gait Posture. 2014; 39: 303-307
        • Langley F.A.
        • Mackintosh S.F.
        Functional balance assessment of older community dwelling adults: A systematic review of the literature.
        Internet J Allied Health Sci Pract. 2007; 5: 13
        • Blum L.
        • Korner-Bitensky N.
        Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review.
        Phys Ther. 2008; 88: 559-566
        • Berg K.O.
        • Wood-Dauphinee S.L.
        • Williams J.I.
        • et al.
        Measuring balance in the elderly: Validation of an instrument.
        Can J Public Health. 1992; 83: S7-S11
        • Lee H.J.
        • Yi C.H.
        • Yoo E.Y.
        Correlations among the Berg Balance Scale, gait parameters, and falling in the elderly.
        Phys Ther Korea. 2002; 9: 47-65
        • Steffen T.M.
        • Hacker T.A.
        • Mollinger L.
        Age- and gender-related test performance in community-dwelling elderly people: Six-minute walk test, Berg Balance Scale, Timed Up & Go Test, and gait speeds.
        Phys Ther. 2002; 82: 128
        • Podsiadlo D.
        • Richardson S.
        The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Lin M.R.
        • Hwang H.F.
        • Hu M.H.
        • et al.
        Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people.
        J Am Geriatr Soc. 2004; 52: 1343-1348
        • Balasubramanian C.K.
        The community balance and mobility scale alleviates the ceiling effects observed in the currently used gait and balance assessments for the community-dwelling older adults.
        J Geriatr Phys Ther. 2015; 38: 78-89
        • Vieira W.D.O.
        • Ostolin T.L.V.D.P.
        • Ferreira M.
        • et al.
        Test timed up and go and its correlation with age and functional exercise capacity in asymptomatic women.
        Fisioter Mov. 2017; 30: 463-471
        • Zarzeczny R.
        • Nawrat-Szołtysik A.
        • Polak A.
        • et al.
        Aging effect on the instrumented Timed-Up-and-Go test variables in nursing home women aged 80–93 years.
        Biogerontology. 2017; 18: 651-663
        • Bird M.-L.
        • Hill K.
        • Ball M.
        • et al.
        Effects of resistance-and flexibility-exercise interventions on balance and related measures in older adults.
        J Aging Phys Act. 2009; 17: 444-454
        • Zhang L.
        • Weng C.
        • Liu M.
        • et al.
        Effect of whole-body vibration exercise on mobility, balance ability and general health status in frail elderly patients: A pilot randomized controlled trial.
        Clin Rehabil. 2014; 28: 59-68
        • Peters D.M.
        • Fritz S.L.
        • Krotish D.E.
        Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults.
        J Geriatr Phys Ther. 2013; 36: 24-30
        • Watson M.J.
        Refining the ten-metre walking test for use with neurologically impaired people.
        Physiotherapy. 2002; 88: 386-397
        • Bohannon R.W.
        Comfortable and maximum walking speed of adults aged 20-79 years: Reference values and determinants.
        Age Ageing. 1997; 26: 15-19
        • Chan W.L.
        • Pin T.W.
        Reliability, validity and minimal detectable change of 2-min walk test and 10-m walk test in frail older adults receiving day care and residential care.
        Aging Clin Exp Res. 2020; 32: 597-604
        • Bogaerts A.
        • Delecluse C.
        • Boonen S.
        • et al.
        Changes in balance, functional performance and fall risk following whole body vibration training and vitamin D supplementation in institutionalized elderly women. A 6 month randomized controlled trial.
        Gait Posture. 2011; 33: 466-472
        • Ferraz D.D.
        • Trippo K.V.
        • Duarte G.P.
        • et al.
        The effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly patients with Parkinson disease: A pilot randomized controlled single-blinded trial.
        Arch Phys Med Rehabil. 2018; 99: 826-833
        • Amatachaya S.
        • Kwanmongkolthong M.
        • Thongjumroon A.
        • et al.
        Influence of timing protocols and distance covered on the outcomes of the 10-meter walk test.
        Physiother Theory Pract. 2020; 36: 1348-1353
        • Jones C.J.
        • Rikli R.E.
        • Max J.
        • et al.
        The reliability and validity of a chair sit-and-reach test as a measure of hamstring flexibility in older adults.
        Res Q Exerc Sport. 1998; 69: 338-343
        • Kwak C.J.
        • Kim Y.L.
        • Lee S.M.
        Effects of elastic-band resistance exercise on balance, mobility and gait function, flexibility and fall efficacy in elderly people.
        J Phys Ther Sci. 2016; 28: 3189-3196
        • Stojanović M.D.
        • Mikić M.J.
        • Milošević Z.
        • et al.
        Effects of chair-based, low–load elastic band resistance training on functional fitness and metabolic biomarkers in older women.
        J Sports Sci Med. 2021; 20: 133-141
        • Różańska-Kirschke A.
        • Kocur P.
        • Wilk M.
        • et al.
        The Fullerton Fitness Test as an index of fitness in the elderly.
        Med Rehabil. 2006; 10: 9-16
        • IDEA Health & Fitness Association
        Program Design for Older Adults.
        IDEA Health & Fitness, San Diego, CA2001
        • Yardley L.
        • Beyer N.
        • Hauer K.
        • et al.
        Development and initial validation of the Falls Efficacy Scale-International (FES-I).
        Age Ageing. 2005; 34: 614-619
        • Park J.H.
        • Cho H.
        • Shin J.H.
        • et al.
        Relationship among fear of falling, physical performance, and physical characteristics of the rural elderly.
        Am J Phys Med Rehabil. 2014; 93: 379-386
        • Ahn B.R.
        • Kang H.J.
        • Choi E.J.
        • et al.
        Correlation of the Korean version of Falls Efficacy Scale-International with quantitative balance and gait parameters through exercise program in elderly men.
        Ann Rehabil Med. 2019; 43: 195
        • Park G.
        • Cho B.
        • Kwon I.S.
        • et al.
        Reliability and validity of Korean version of Falls Efficacy Scale-International (KFES-I).
        J Korean Acad Rehabil Med. 2010; 34: 554-559