Case study International Journal of Therapy and Rehabilitation, November 2014, Vol 21, No 11 539 © 2014 MA Healthcare Ltd The effect of the Nintendo Wii Fit on exercise capacity and gait in an elderly woman with CREST syndrome Background/Purpose: Physical deconditioning and impaired balance and gait are common barriers to exercise in frail older adults. This case report describes the eficacy of Nintendo Wii Fit exercises in improving functional capacity, exercise tolerance, strength and balance in an elderly woman with CREST syndrome and multiple chronic conditions. Case description: A sedentary 77-year-old woman with: scleroderma (CREST syndrome) and secondary Sjögren’s syndrome; pulmonary hypertension; coronary artery disease; interstitial lung disease; and tremor. The patient could ambulate with a cane and had a high risk of falling. Methods: The participant completed three 30-minute sessions of Wii Fit exercises per week for 12 weeks. The exercises included step aerobics, marching and interactive games to develop balance, weight transfer and upper and lower body strength. Results: Substantial improvements were seen in the following: 6-minute walk test (6MWT) (100%); Timed Up and Go (TUG) (5.3%); 30-second sit to stand (25%); hand grip strength (right 21%; left 8.6%); ankle plantarlexion (right 16.7%; left 33.3%) and dorsilexion (right 125%; left 88.9%), Tinetti Balance and Gait Assessment (balance score 35.5%; falls eficacy scale score 21.4%); resting systolic blood pressure (5.1%); and oxygen saturation (3.3%). The average movement of centre of pressure decreased post-intervention, but average velocity increased. Conclusions: Speciic Wii Fit games may improve health, exercise capacity, mobility, balance and fall risk in older adults affected with CREST and associated severe cardiopulmonary symptoms. Key words: n Sjögren’s syndrome n Pulmonary hypertension n Nintendo Wii Fit n Exercise rehabilitation Submitted 9 May 2014, sent back for revisions 17 July 2014; accepted for publication following double-blind peer review 6 October 2014 Suzanne Broadbent, Zachary Crowley-McHattan, Shi Zhou C REST syndrome is the limited cutaneous form of systemic sclerosis, a multisystem connective tissue disorder (Alkotob et al, 2006). The acronym ‘CREST’ refers to the five main features of the condition: calcinosis; Raynaud’s phenomenon; esophageal dysmotility; sclerodactyly; and telangiectasia. Further signs and symptoms include: pulmonary arterial hypertension; dyspnoea; joint inflammation; muscle weakness and fatigue (Berends et al, 2000). There is no cure and the management involves medications to reduce symptoms (Sanchez et al, 1999). Individuals with CREST syndrome are likely to be physically deconditioned (Geirsson et al, 1989; Morelli et al, 2000). Although exercise may improve aerobic capacity and morbidity in cardiac patients, it is often restricted in CREST patients on medical advice to reduce the likelihood of right heart failure and severe pulmonary hypertension (Sanchez et al, 1999). Barriers to exercise and mobility include: increased cardiac output leading to worsening cardiac symptoms (heart failure, conduction disorders, arrhythmias); exertional dyspnoea; and fatigue (Sanchez et al, 1999; Alkotob et al, 2006). Joint pain and muscle weakness affect muscular strength, balance and gait (Hackett et al, 2012). Age-related decrements in walking speed, stride, hip, knee and ankle torque, ankle range of motion (ROM), and balance contribute to increased risk of falls, as do changes in visual, vestibular and somatosensory systems, and reac- tion time (Menz et al, 2005; Barak et al, 2006; Cao et al, 2007). Evidence suggests combined aerobic, strength, gait and balance training can significantly improve cardiorespiratory fitness and falls risk in older adults (Shumway-Cook et al; 2000 Menz et al, 2005; Cao et al, 2007). Suzanne Broadbent, senior lecturer in clinical exercise physiology and rehabilitation, School of Health and Human Sciences, Southern Cross University, Lismore, NSW Australia; Zachary Crowley- McHattan, lecturer in motor control, School of Health and Human Sciences, Southern Cross University, Lismore, NSW Australia; Shi Zhou, professor of exercise physiology, School of Health and Human Sciences, Southern Cross University, Lismore, NSW Australia. Correspondence to: Suzanne Broadbent E-mail: suzanne. broadbent@scu.edu.au