Farooq Azam Rathore  ( Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi )
Dilshad Hunain Al Arabia  ( Institute of Physical Medicine and Rehabilitation (IPM&R), Dow University Of Health Sciences (DUHS), Karachi )

We have read "Effect of balance training in older adults using Wii fit plus" by Afridi and colleagues with interest.¹ We would like to appreciate the authors for highlighting an important yet neglected issue of balance training in older adults. They have shared their experience of using an innovative exergaming technique to impart balance training in this group. This manuscript is important for couple of reasons.
The current Pakistani healthcare system is disease orientated and more focused on the curative medicine rather than prevention and maintenance of health in all age groups. Most of the complaints of the older adults are dismissed as a normal aging process. To the best of our knowledge, there is no structured evaluation and training programme for older adults in Pakistan focusing on their general wellbeing and mobility. Gait and balance disorders are among the most common causes of falls in older adults. They can lead to injury, compromised mobility and a poor quality of life in this age group. This can result in social isolation. As a result this important segment of the society is excluded and not able to contribute. Technology has influenced every sphere of healthcare including rehabilitation and physiotherapy. Exergaming is one of the promising technologies that has shown benefit in different groups including the older adults. American College of Sports Medicine defines exergaming as "technology-driven physical activities, such as video game play, that requires participants to be physically active or exercise in order to play the game."² Exergaming is not limited to the traditional video games played on a console while comfortably sitting on the couch or floor. These games demand high physical activity and sometimes movement of the whole body in order to perform the tasks being displayed on the screen. Randomized controlled trials and Systematic reviews published in the last 5 years support the use of exergaming as a safe, entertaining and sustainable alternative to HE programmes.^3-6 This technology is affordable and now available in Pakistan. The number of old age people in our population is on the rise and projected to be 22.07% of the total population by 2030.⁷ Therefore it is important that strategies like the use of videogames in therapy that has both cognitive and physical benefits be utilized.⁸ As exergaming is designed in a wy which is motivating and an interesting activity for the individual therefore it is more likely to increase compliance as compared to the conventional therapy programmes. This will result in improving their mobility and quality of life, enabling them to become a contributing member of the society.

Disclaimer: None to declared.
Conflict of Interest: None to declared.
Funding Sources: None to declared.

References

1.  Afridi A, Malik AN, Ali S, Amjad I. Effect of balance training in older adults using Wii fit plus. J Pak Med Assoc 2018; 68: 480-3.
2. Witherspoon. L. Exergaming.[Brochure]. American College of Sports Medicine Consumer Information Committee; 2013. (Online) (Accessed 28th March 2018). Available from URL: https://www.acsm.org/docs/brochures/exergaming.pdf.
3.  Karahan AY, Tok F, Taskin H, Küçüksaraç S, Basaran A, Yildirim P. Effects of exergames on balance, functional mobility, and quality of life of geriatrics versus home exercise programme: randomized controlled study. Cent Eur J Public Health. 2015; 23: S14-8.
4.  Laufer Y, Dar G, Kodesh E. Does a Wii-based exercise program enhance balancecontrol of independently functioning older adults? A systematic review. Clin Interv Aging. 2014; 9: 1803-13. doi: 10.2147/CIA.S69673.
5.  Tahmosybayat R, Baker K, Godfrey A, Caplan N, Barry G. A systematic review and meta-analysis of outcome measures to assess postural control in older adults who undertake exergaming. Maturitas. 2017; 98: 35-45.
6.  Donath L, Rössler R, Faude O. Effects of virtual reality training (exergaming) compared to alternative exercise training and passive control on standing balance and functional mobility in healthy community-dwelling seniors: a meta-analytical review. Sports medicine. 2016; 46: 1293-309.
7. Ashiq U, Asad AZ. The rising old age problem in Pakistan. Journal of the Research Society of Pakistan. 2017; 54: 325-33.
8. Lange BS, Requejo P, Flynn SM, Rizzo AA, Valero-Cuevas FJ, Baker L, Winstein C. The potential of virtual reality and gaming to assist successful aging with disability. Physical Medicine and Rehabilitation Clinics. 2010; 21: 339-56.