Introduction: Impairment of postural control and functional mobility are debilitating symptoms of Parkinson\'s disease (PD). In addition to limiting performance in activities of daily living, it is associated with a higher prevalence of falls in this population. Particularly, dysfunction in postural control does not respond to dopaminergic replacement therapy, but physiotherapy can improve this outcome in patients with PD. Objective: The aim of this study was to analyze the effects of training based on Kinect Adventures games compared with a conventional physiotherapy protocol based on the core areas of the European physiotherapy guideline in patients with PD on postural control, functional mobility, self-perception of confidence in the balance, quality of life (QoL), lower limb muscle strength, transfer skill and motor function, as well as to observe adherence and safety interventions. Methods: Thirty-eight patients diagnosed with idiopathic PD were randomized into two groups, and performed 14 training sessions, twice a week for 60 minutes. The primary outcome assessed postural control using the Mini-Balance Evaluation Systems Test (Mini-BESTest). The following were evaluated as secondary outcomes: limit of stability; balance functional reserve and center of pressure area by computerized posturography; functional mobility by the Timed Up and Go test; self-confidence in balance through the Activities-specific Balance Confidence scale; QoL through the Parkinson\'s Disease Questionnaire; lower limb muscle strength by the Five Times Sit-To-Stand test; and motor function by the Unified Parkinson\'s Disease Rating Scale. Results: Patients completed training sessions with high rates of safety and adherence. After training, there was a significant improvement in postural control, motor function, and QoL. Conclusion: Both interventions proved to be safe, applicable, and effective to improve postural control, QoL, and motor function in patients with PD. However, there was no difference between the effects of Kinect Adventures games and conventional physiotherapeutic protocol in patients with PD. Brazilian Registry of Clinical Trials (RBR-27kqv5).

BACKGROUND: Although full-body seated exercises have been studied in a wide range of settings (ie, homes, hospitals, and daycare centers), they have rarely been converted to seated exergames. In addition, there is an increasing number of studies on immersive virtual reality (iVR) full-body gesture-based standing exergames, but the suitability and usefulness of seated exergames remain largely unexplored.
OBJECTIVE: This study aimed to evaluate the difference between playing a full-body gesture-based iVR standing exergame and seated exergame in terms of gameplay performance, intrinsic motivation, and motion sickness.
METHODS: A total of 52 participants completed the experiment. The order of the game mode (standing and sitting) was counterbalanced. Gameplay performance was evaluated by action or gesture completion time and the number of missed gestures. Exertion was measured by the average heart rate (HR) percentage (AvgHR%), increased HR%, calories burned, and the Borg 6-20 questionnaire. Intrinsic motivation was assessed with the Intrinsic Motivation Inventory (IMI), whereas motion sickness was assessed via the Motion Sickness Assessment Questionnaire (MSAQ). In addition, we measured the fear of falling using a 10-point Likert scale questionnaire.
RESULTS: Players missed more gestures in the seated exergame than in the standing exergame, but the overall miss rate was low (2.3/120, 1.9%). The analysis yielded significantly higher AvgHR%, increased HR%, calories burned, and Borg 6-20 rating of perceived exertion values for the seated exergame (all P<.001). The seated exergame was rated significantly higher on peripheral sickness (P=.02) and sopite-related sickness (MSAQ) (P=.004) than the standing exergame. The score of the subscale \"value/usefulness\" from IMI was reported to be higher for the seated exergame than the standing exergame. There was no significant difference between the seated exergame and standing exergame in terms of intrinsic motivation (interest/enjoyment, P=.96; perceived competence, P=.26; pressure/tension, P=.42) and the fear of falling (P=.25).
CONCLUSIONS: Seated iVR full-body gesture-based exergames can be valuable complements to standing exergames. Seated exergames have the potential to lead to higher exertion, provide higher value to players, and be more applicable in small spaces compared with standing exergames. However, gestures for seated exergames need to be designed carefully to minimize motion sickness, and more time should be given to users to perform gestures in seated exergames compared with standing exergames.