Maturitas 73 (2012) 239–243 Contents lists available at SciVerse ScienceDirect Maturitas j ourna l h o me page: www.elsevier.com/locate/maturitas Participating in a virtual reality balance exercise program can reduce risk and fear of falls Devinder K.A. Singh a,∗ , Bala S. Rajaratnam b , Vijayakumar Palaniswamy a , Hannah Pearson c , Vimal P. Raman a , Pei Sien Bong a a Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia b Nanyang Polytechnic, School of Health Sciences (Allied Health), 180 Ang Mo Kio Avenue 8, Singapore 569830, Singapore c Pantai Integrated Rehab Services Sdn. Bhd., MOB 1st Floor, Jln Perubatan 1, Pandan Indah, 55100 Kuala Lumpur, Malaysia a r t i c l e i n f o Article history: Received 4 April 2012 Received in revised form 16 July 2012 Accepted 17 July 2012 Keywords: Virtual reality Risk of falls Fear of falls Women a b s t r a c t Objective: The objective of this study was to quantify the effectiveness of virtual reality balance games (VRBG) to decrease risk and fear of falls among women. Methods: Thirty six community dwelling women aged 56 and above were randomly divided into experi- mental (exercises using VRBG focus on improving balance) and control (conventional balance exercises) groups. Both groups attended a twice 6 weekly exercise session for an hour. Risk and fear of falls were measured with Physiological Profile Approach (PPA) and Activity Specific Balance Scale (ABC-6). Pre and post intervention differences between the groups were examined using two way repeated measures ANOVA. Results: Both VRBG and conventional balance exercise groups had significant decrease in PPA (p < 0.001) and ABC-6 (p < 0.01) after the interventions. However, no significant effects were demonstrated between the groups in PPA (p = 0.18) and ABC-6 (p = 0.25) post intervention. Time and group interaction effect were not significant for PPA (p = 0.18) and ABC-6 (p = 0.45). Conclusions: Practising VRBG can increase balance confidence and decrease risk of falls among community dwelling women. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Approximately, one third of community dwelling older adults will experience at least one fall within the year [1]. Older women between the ages of 65 and 75 have twice the likelihood of expe- riencing a fall compared to men of the corresponding age [2]. The incidences of fall-related hip fractures among older women were also three times higher than males [3]. Although, the reasons associated with falls are multifactorial, deteriorating mobility, agility and balance with aging are recog- nized as common intrinsic causes [4]. Increased risk and fear of falling are strong determinants of future falls among the older adults that lead to disability, chronic conditions and deterioration of personal self-care [5]. Falls prevention strategies should be advo- cated as a standard procedure in postmenopausal women [6] as Abbreviations: VRBG, virtual reality balance games; PPA, Physiological Profile Approach; ABC-6, Activity Specific Balance scale-6; BMI, body mass index; MMSE, Mini Mental State Examination. ∗ Corresponding author. Tel.: +60 3 26878003/8019/8001; fax: +60 3 26878199. E-mail addresses: devinder@medic.ukm.my, devinderkas@gmail.com (D.K.A. Singh). deterioration in balance is known to start as early as at the 4th decade of life [7]. Regular exercise especially among women has been shown to reduce their risk of falls [8]. Older adults who regularly participate in evidence based reha- bilitation exercise programmes have better balance performance and quicker reaction time [9,10]. However, face-to-face rehabil- itation exercise programmes require significant supervision and commitment from health care professionals. With the growing worldwide population of older adults and greater service demand placed on health care professionals, new strategies that are tar- geted earlier in life need to be explored. These early intervention strategies hope to minimize demands on healthcare professionals, improve an adult’s compliance and increase their participation rate in rehabilitation exercise programmes. Virtual reality exercise games are useful rehabilitation tools that health care professionals may adopt to empower adults to exercise independently and regularly for their well-being [11]. Virtual reality exercise games provide visual feedback during exer- cise, promote physical activity anytime anywhere, and facilitate greater compliance to regular physical activity [12]. The approach of including virtual reality exercise games combined with auto- mated telemedicine for rehabilitation is novel [13]. This may also be an efficient way a health care professional can provide distance 0378-5122/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.maturitas.2012.07.011