Effects of Nintendo Wii fit game training on balance among Lebanese older adults

  • Mohammed Ali FakhroEmail author
  • Rodrigue Hadchiti
  • Baraa Awad
Original Article



Falls are the second leading cause of accidental death, with persons older than 65 years being the most affected. Moreover, gait- and balance-related problems represent the most consistent predictors of future falls.


The aim was to determine the effects of Wii fit game training on dynamic and static balance among Lebanese older adults.


A randomized-controlled trial was conducted over a period of 8 weeks, where institutionalized older adults with no history of falls were randomized into two groups. The participants of each group were carefully followed up during the intervention and data collection periods. The intervention group was trained for standing balance during a 40-min session, starting with the “Soccer Heading” game during the first 4 weeks, followed by the “Table Tilt” game for the remaining 4 weeks. Timed up-and-go (TUG) test and the Nintendo Wii Balance Board were used to measure the dynamic and static balance, respectively, both at baseline and post-intervention.


Sixty-four participants recruited from both, the Tyre and Saida districts were enrolled in the study. Within-group comparison of TUG test values between baseline and post-intervention; both groups showed an extremely significant difference (P = 0.000). Similarly, the between-group comparison showed a significant difference (P = 0.013). Concerning the center of pressure measures, only the intervention group showed a very significant improvement between baseline and post-intervention measures (P = 0.002).


Wii fit balance training is a valid method for improving both dynamic and static balance among Lebanese older adults.


Dynamic balance Static balance Wii fit Older adults Falls 



The authors declare that they have not received any funding.

Compliance with ethical standards

Conflict of interest

The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee [Ethical approval was obtained from the Lebanese German University Institutional Review Board ( NCT03983642)] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Fakhro MA (2018) What’s really happening among the elderly population? Gerontol Geriatric Stud 3(3):GGS.000563.
  2. 2.
    Battaglia G, Bellafiore M, Bianco A et al (2010) Effects of a dynamic balance training protocol on podalic support in older women. Pilot Study. Aging Clin Exp Res 22:406. CrossRefPubMedGoogle Scholar
  3. 3.
    Cordeiro HIP, de Mello Alves Rodrigues AC, Alves MR et al (2019) Exercise with active video game or strength/balance training? Case reports comparing postural balance of older women. Aging Clin Exp Res. CrossRefPubMedGoogle Scholar
  4. 4.
    Ganz DA, Bao Y, Shekelle PG et al (2007) Will my patient fall? JAMA 297:77–86CrossRefGoogle Scholar
  5. 5.
    Heiden E, Lajoie Y (2010) Games-based biofeedback training and the attentional demands of balance in older adults. Aging Clin Exp Res 22:367. CrossRefPubMedGoogle Scholar
  6. 6.
    Jehu DA, Paquet N, Lajoie Y (2017) Balance and mobility training with or without concurrent cognitive training improves the timed up and go (TUG), TUG cognitive, and TUG manual in healthy older adults: an exploratory study. Aging Clin Exp Res 29:711. CrossRefPubMedGoogle Scholar
  7. 7.
    Rao SS (2005) Prevention of falls in older patients. Am Fam Phys 72:81–88Google Scholar
  8. 8.
    Ting LH (2007) Dimensional reduction in sensorimotor systems: a framework for understanding muscle coordination of posture. Prog Brain Res 165:299–321. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dunsky A, Zeev A, Netz Y (2017) Balance performance is task specific in older adults. Biomed Res Int 4:1–7. CrossRefGoogle Scholar
  10. 10.
    Starr JM, Leaper SA, Murray AD et al (2003) Brain white matter lesions detected by magnetic resonance [correction of resonance] imaging are associated with balance and gait speed. J Neurol Neurosurg Psychiatry 74:94–98CrossRefGoogle Scholar
  11. 11.
    Blahak C, Baezner H, Pantoni L (2009) Deep frontal and peri ventricular age-related white matter changes but not basal ganglia and infra tentorial hyper intensities are associated with falls: cross sectional results from the LADIS study. J Neuro Neurosci Psychol 80:608–613CrossRefGoogle Scholar
  12. 12.
    Lesinski M, Hortobágyi T, Gollhofer A et al (2015) Effects of balance training on balance performance in healthy older adults: a systematic review and meta-analysis. Sports Med 45:1721–1738. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Howe TE, Rochester L, Neil F et al (2011) Exercise for improving balance in older people. Cochrane Database Syst Rev. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Laufer G, Dar EK (2014) Does a Wii-based exercise program enhance balance control of independently functioning older adults? Systematic review. Clin Interv Aging 9:1803–1813CrossRefGoogle Scholar
  15. 15.
    Sherrington A, Tiedemann N, Fairhall JC et al (2011) Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull 22:78–83CrossRefGoogle Scholar
  16. 16.
    Padala KP, Padala PR, Lensing SY et al (2017) Efficacy of Wii-Fit on static and dynamic balance in community dwelling older veterans: a randomized controlled pilot trial. J Aging Res 2017:4653635. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nitz J, Choy N (2004) The efficacy of a specific balance-strategy training programme for preventing falls among older people: a pilot randomized controlled trial. Age Ageing 33:52–58CrossRefGoogle Scholar
  18. 18.
    Kirk B, Blasius T, Cortright T et al (2008) Comparison of efficacy between traditional and video game-based balance programs. Clin Kinesiol. 62:26–31Google Scholar
  19. 19.
    Bainbridge E, Bevans S, Keeley B et al (2011) The effects of the Nintendo Wii Fit on community-dwelling older adults with perceived balance deficits: a pilot study. Phys Occup Ther Geriatr. 29:126–135. CrossRefGoogle Scholar
  20. 20.
    Williams B, Doherty NL, Bender A et al (2011) The effect of Nintendo Wii on balance: a pilot study supporting the use of the Wii in occupational therapy for the well elderly. Occup Ther Health Care. 25:131–139. CrossRefPubMedGoogle Scholar
  21. 21.
    Agmon M, Perry CK, Phelan E et al (2011) A pilot study of Wii Fit 370 exergames to improve balance in older adults. J Geriatr Phys Ther. 34:161–167CrossRefGoogle Scholar
  22. 22.
    Kliem A, Wiemeyer J (2010) Comparison of a traditional and a video game-based balance training program. Int J Comp Sci Sport. 9:80–91Google Scholar
  23. 23.
    Bohannon RW (2006) Reference values for the timed up and go test: a descriptive meta-analysis. J Geriatr Phys Ther. 29:64–68CrossRefGoogle Scholar
  24. 24.
    Horak FB (1987) Clinical measurement of postural control in adults. Phys Ther 67:1881–1885CrossRefGoogle Scholar
  25. 25.
    Pollock AS, Durward BR, Rowe PJ et al (2000) What is balance? Clin Rehabil. 14:402–406CrossRefGoogle Scholar
  26. 26.
    Horak FB, Macpherson JM (1996) Postural orientation and equilibrium. In: Shepherd RL (ed) Handbook of physiology 1 exercise: regulation and integration of multiple systems. Oxford University Press, New York, p 255Google Scholar
  27. 27.
    Clark RA, Bryant AL, Pua Y et al (2010) Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait Posture. 31:307–310CrossRefGoogle Scholar
  28. 28.
    Bieryla KA, Dold NM (2013) Feasibility of Wii Fit training to improve clinical measures of balance in older adults. Clin Interv Aging 8:775–781CrossRefGoogle Scholar
  29. 29.
    Nasreddine ZS, Phillips NA, Bédirian V et al (2005) The Montreal cognitive assessment MoCA: a brief screening tool for mild cognitive impairment: MOCA: A brief screening tool for MCI. J Am Geriatr Soc 53:695–699. CrossRefGoogle Scholar
  30. 30.
    Mast BT, Gerstenecker A (2010) Screening instruments and brief batteries for dementia. In: Lichtenberg PA (ed) Handbook of assessment in clinical gerontology, 2nd edn. Wiley, Hoboken, pp 503–530.
  31. 31.
    Luis CA, Keegan AP, Mullan M (2009) Cross validation of the Montreal cognitive assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry. 24:197–201. CrossRefPubMedGoogle Scholar
  32. 32.
    Bomberger S, Allene S (2010) The effects of Nintendo Wii FIT on balance of elderly adults. Undergraduate Honors ThesesGoogle Scholar
  33. 33.
    Clark R, Kraemer T (2009) Clinical use of Nintendo Wii bowling simulation to decrease risk in an elderly resident of a nursing home: a case report. J Geriatr Phys Ther. 32:174–180. CrossRefPubMedGoogle Scholar
  34. 34.
    Rojas VG, Cancino EE, Silva CV et al (2010) Impact of balance training with a virtual reality in elderly [in Spanish]. Int J Morphol. 28:303Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Faculty of Public Health, Department of Physical TherapyLebanese German UniversityJouniehLebanon

Personalised recommendations