Addition of Virtual Reality To Treadmill Training Reduced Falls in Older Adults Interview with:

Anat Mirelman, PhD Director- Laboratory of Early Markers of Neurodegeneration (LEMON) Center for the study of Movement , Cognition and Mobility (CMCM) Department of Neurology Tel Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv 64239, Israel

Dr. Anat Mirelman

Anat Mirelman, PhD
Director- Laboratory of Early Markers of Neurodegeneration (LEMON)
Center for the study of Movement , Cognition and Mobility (CMCM)
Department of Neurology
Tel Aviv Sourasky Medical Center
Sackler School of Medicine, Tel Aviv University
Tel Aviv 64239, Israel What is the background for this study? What are the main findings?

Response: The main aim of this research was to evaluate the efficacy of using a motor cognitive training using virtual reality in reducing fall frequency and fall risk in older adults.

Falls are a leading cause of morbidity and mortality in older adults. The prevalence of falls is huge, with one out of every 3 adults aged 65 years or older will fall at least once per year, with approximately half of these fallers suffering multiple falls in this period . These statistics are even higher in neurodegenerative conditions such as in Parkinson’s disease and in people with cognitive impairments. For example, studies have shown that as much as 80% of people with Parkinson’s disease fall each year. So many older adults are falling.
The consequences of falls are huge.

The most dramatic result is hip fracture. But this is relatively rare. However, even in the absence of a fracture or other injury, falls often lead to fear of falling, social isolation, and depression, which in turn often leads to inactivity, muscle weakness, impaired balance and gait, more falls, more social isolation. In other words, falls often start a vicious cycle, which has many important negative health consequences. Falls are associated with morbidity and mortality and they also have a huge economic impact. In many western countries, 1-2% of healthcare dollars are spent on falls.

For many years, age-associated changes in muscle strength, balance and gait were viewed as the key factors that contribute to the risk of falls. However, more recently, we and others showed that certain aspects of cognition are also critical to safe ambulation. For example people with AD often fall, almost to the same amount as people with PD, highlighting the cognitive component of falls. This makes sense intuitively if we Imagine the cognitive skills we need just to cross a busy intersection. These tasks require executive function, specially, planning, the ability to avoid obstacles, and the ability to perform two or more tasks at the same time.

Our idea was to use the virtual reality environment to safely train both the motor or gait aspects that are important to fall risk, while also implicitly teaching the participants to improve the cognitive functions that are important for safe ambulation. Virtual reality also has the advantage of being a game that encourages participation and compliance. In the virtual environment, we can match the obstacle negotiation and cognitive challenges to their abilities, give feedback about performance to enhance the learning of new motor strategies of movement, and simultaneously address motor and cognitive aspects of fall risk that are crucial to safe ambulation.

The results were in line with our hypothesis. We saw a reduction of 42 % in falls 6 months post intervention. The finding of a 42% reduction in falls is in line with the most effective fall preventions that have assessed more traditional group-based and homed-based exercise interventions in older people and well above the average reduction of 17% for exercise interventions reported in systematic reviews.

In addition we were pleased by the high adherence and motivation of the participants. We had 87% adherence in a trial that lasted 8 months and evaluated older adults age 60-90. This by itself is an achievement as we increased the activity of these older adults and hopefully promoted to their health. What should readers take away from your report?

Response: The findings have important implications for clinical practice. Engaging in a motor cognitive intervention could reduce falls and fall risk in older adults. This type of training should be encouraged as the impact of falls on the individual, care givers and society as a whole are huge. We should continue to investigate potential interventions that can promote health, prevent falls and improve motor and cognitive function. What recommendations do you have for future research as a result of this study?

Response: We believe the study has important implications for clinical practice.
Adherence and participation were very high, there were no serious adverse events and participants reported high satisfaction and enjoyment.
We think the next step is to show effectiveness and not just efficacy in a less confined research environment. The study showed that this type of training is effective and we think it can be administered in community gyms and rehabilitation clinics.

There are also some research questions that remain such as for example, what are the cognitive changes that took place, what are the neural mechanisms at play and if these gains can be sustained even longer or perhaps can we adapt intensity and dosing and still show efficacy. Thank you for your contribution to the community.


Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial
Mirelman, Anat et al.
The Lancet , Volume 388 , Issue 10050 , 1170 – 1182

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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