Barry et al.

Journal of NeuroEngineering and Rehabilitation 2014, 11:33

http://www.jneuroengrehab.com/content/11/1/33 JNER JOURNAL OF NEUROENGINEERING
AND REHABILITATION

REVIEW Open Access

The role of exergaming in Parkinson’s disease

rehabilitation: a systematic review of the
evidence
Gillian Barry, Brook Galna and Lynn Rochester*

Abstract
Evidence for exercise based computer games (exergaming) as a rehabilitation tool for people with Parkinson’s
disease (PD) is only now emerging and is yet to be synthesised. To this end, we conducted a systematic review of
the exergaming literature to establish what is known about the safety, feasibility and effectiveness of exergaming
for rehabilitation of motor symptoms experienced by people with PD. Seven electronic databases were searched for
key terms surrounding exergaming and PD. Data were extracted by two reviewers independently. From an initial
yield of 1217 articles, seven were included in the review. Six studies used commercial games with the Nintendo Wii
fit platform. The scientific quality of reporting was generally good, however the overall methodological design of
studies was weak, with only one randomised controlled trial being reported. Safety: Participant safety was not
measured in any of the studies. Feasibility: People with PD were able to play exergames, improve their performance
of gameplay and enjoyed playing. However, one study observed that people with PD had difficulty with fast and
complex games. Effectiveness: Six studies showed that exergaming elicited improvements in a range of clinical
balance measures or reduction in the severity of motor symptoms. Results from the only randomised controlled
trial showed that exergaming was as effective as traditional balance training for people with PD to improve the
UPDRS II, standing balance and cognition, with improvements in both groups retained 60 days after the training
ended. In conclusion, exergaming is an emerging tool to help rehabilitate motor skills in people with PD. Although
we were able to establish that exergaming is feasible in people with PD, more research is needed to establish its
safety and clinical effectiveness, particularly in the home. The use of commercial games may be too difficult for
some people with PD and exergames tailored specifically to the rehabilitation needs and capabilities of people with
PD are required for optimal efficacy, adherence and safety.
Keywords: Nintendo Wii, Kinect, Balance, Exercise, Computer games

Introduction Exergames are computer games that are driven by gross

Exercise is emerging as an efficacious therapy to physical movements of the player. They work by combining
compliment the rehabilitation of problematic motor symp- real-time motion detection with engaging video games
toms in Parkinson's disease (PD) such as gait and balance that can help motivate people to exercise. Exergaming
which contribute to reduced mobility and increased risk of as a therapeutic tool incorporates functional, purposeful
falls [1,2]. Delivery of exercise as part of a rehabilitation and engaging exercise in a quantifiable and reliable way
programme remains challenging in terms of adherence, [6-8]. It has shown benefits in traumatic brain injury
acceptability, access and cost. There is growing interest in [9,10], Cerebral Palsy [11], stroke rehabilitation [12,13],
exergaming as a potential rehabilitation tool to facilitate young adults with physical and intellectual disabilities [5],
disease specific exercise in many clinical groups [3-5]. and older adults [14,15]. Emerging evidence in older adults
suggests that playing exergames may also improve cognitive
* Correspondence: [email protected] function [16]. Exergaming may therefore offer a low cost,
Clinical Ageing Research Unit, Institute for Ageing and Health, Campus for home-based tool to augment traditional rehabilitation of
Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK motor symptoms in people with PD. Home use and tailored

© 2014 Barry et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited.
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training may also facilitate exercise compliance and discussed, with a third reviewer assessing any unresolved
motivation [17]. differences in extraction.
The use of exergaming for PD rehabilitation shows Data relating to the safety, feasibility and effectiveness
great promise however the evidence has not yet been were extracted from each study. For the purposes of this
formally reviewed or synthesised. Critical questions remain review: Safety referred to any subjective (researcher,
surrounding the use of exergaming for people with PD, clinician or participants perspectives) or objective measures
especially in relation to the prescription of home-based (fall or near falls); Feasibility referred to whether people
exercise and the suitability of commercial games. To ad- were able to play the games, whether they improved in
dress these questions, we conducted a systematic review their gameplay and whether they enjoyed and felt moti-
of the literature to evaluate the evidence for the safety, vated by the gameplay; and Effectiveness referred to
feasibility and effectiveness of exergaming as a rehabilita- whether participants improved on clinical tests of motor
tion tool in people with PD. performance (including balance) or disease severity, and
whether these improvements were retained after the
Methods exergaming intervention. One reviewer (GB) screened
The following databases were searched electronically the initial 1121 titles and abstracts before the full text of
in January 2013 and updated in December 2013: Web 10 publications was screened by two reviewers (GB & BG).
of science (1864-2013), CINAHL (1982-2013), Scopus Four publications were excluded as they did not include an
(1960-2013), Science Direct (1823-2013), IEEE (1872-2013), exercise intervention, rather, they assessed the psychomet-
PubMed (1869-2013) and Cochrane (1949-2013). We ric properties of the Wii balance board and Wii remote for
searched the titles, keywords and abstracts of database people with PD.
entries using the search strategy: (Exergam* OR active
video gaming OR Microsoft Kinect OR Kinect OR Results
Nintendo Wii OR Wii OR Sony EyeToy OR IREX OR Our search yielded 1121 articles (excluding duplicates,
Dance Dance Revolution) AND (Parkinson*), where * Figure 1) relating to exergaming and Parkinson's disease
denotes a wildcard to allow for alternate suffixes. We also (PD). Six papers from the original search and one article
searched the grey literature (such as generic internet found in the grey literature were included in the review.
search engines) to avoid missing relevant articles. Inclusion
Criteria: Articles were included if they reported an exer- Study design and methodological quality
gaming based intervention in people with PD and were Table 2 summarises the methodological quality of each
full scientific papers written in English. Exclusion criteria: study. Adequate details were provided to replicate the
Conference posters and abstracts were excluded. Papers studies. The aims, inclusion and exclusion criteria, and
that were virtual reality based treadmill interventions were exergaming interventions were well described. Six studies
excluded as we focused on interventions that could be used commercial Wii games [19-24] and one developed
practically implemented in the home. a game designed for PD using the Sony Playstation Eye™
The methodological quality of each article was assessed camera [25]. Participant demographic characteristics and
using a customised quality assessment tool based on the severity of their PD were generally well reported al-
previous systematic reviews [18] (see Table 1 for a list though the use of several different scales of disease severity
of items and Table 2 for the scoring criteria). To ensure (Hoehn and Yahr [26], UPDRS [27] and disease duration)
valid scoring of the quality assessment, two reviewers made comparisons between studies difficult and may
(GB and BG) independently scored the quality of the limit future meta-analyses. The rationale for sample size
articles. Incongruities between the two reviewers were was provided in three studies.
Table 3 summarises the study design, exergaming system
and intervention. The studies included two longitudinal
Table 1 Methodological quality assessment tool
trials (with healthy control groups) [19,20], a participatory
design study [25], a case study [22] a randomised controlled
Question number Question
trial [21], a prospective interventional cohort study [23]
1. Are inclusion and exclusion criteria stated?
and a pre-post test design [24]. Six of these studies trained
2. Are participant characteristics described in detail? people with PD over 12-18 sessions (over 4-8 weeks),
3. Was sample size justified? and measured performance on clinical tests directly
4. Was randomisation of groups explained? before and after the intervention [19-24]. A further three
5. Was the design clearly stated? studies tested whether improvements in clinical tests were
6. Were exergaming sessions explained in detail?
retained 60 days after the intervention [20,21,24]. The
final study outlined a game designed specifically for
7. Were baseline and post testing data presented?
people with PD using the Sony Playstation Eye™ and
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Table 2 Methodological quality assessment scores of each study

Question Scoring criteria Assad Zettergren Pompeu Mendes Esculier Mhatre Hertz
et al. [25] et al. [22] et al. [21] et al. [20] et al. [19] et al. [23] et al. [24]
Inclusion/exclusion criteria detailed 1 = yes; .5 = yes lacking 0 1 1 1 .5 1 1
detail; 0 = no
Participant characteristics detailed Number 1 1 1 1 1 1 1
Age 1 1 1 1 1 1 1
Sex 1 1 0 0 1 1 1
Disease severity .5 0 1 1 1 1 1
Sample size justified 1 = yes; 0 = no 0 0 1 1 0 1 0
Randomisation explained 1 = yes; .5 = yes lacking na na 1 na na na na
detail; 0 = no
Research design clearly stated 1 = yes; .5 = yes lacking .5 1 1 1 1 1 0
detail; 0 = no
Exergaming sessions explained 1 = yes; .5 = yes lacking .5 1 1 1 1 1 1
detail; 0 = no
Baseline and post test 1 = yes; .5 = yes lacking .5 1 1 1 1 1 1
data presented detail; 0 = no
na = indicates not applicable.

tested its feasibility during one session in a group of 13 represented across studies with participants ranging
people with PD [25]. from 44-91 years, and both males and females were in-
cluded. People with PD had relatively mild symptoms
Sample Characteristics (Hoehn & Yahr stage I & II) and were tested whilst on
The number of people with PD in each study ranged their medication, although medication status was not
between 1 and 32 (see Table 3). A broad age range was reported by Assad et al. [25].

Figure 1 Results of the literature search strategy conducted in December 2013.

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Barry et al. Journal of NeuroEngineering and Rehabilitation 2014, 11:33
Table 3 Summary of participant characteristics, study design and exergaming interventions
Author Participants PD diagnosis Design and aim System Games Intervention Setting
Assad et al. [25] 13 PD (Aged 54-86 years) Mean duration Participatory design Sony 5 Upper body movement games. 1 session Duration NS Clinic
9 males and 5 females of PD = 9 yr Playstation
Assess PD subjects’ perception of playing an Eye™
exergame developed for PD.
Zettergren et al. [22] 1 male (69 years old) PD duration <3 yr Single subject case study Nintendo Penguin slide, Table tilt, Balance 2 sessions/week 8 weeks Clinic
Wii™ bubble, Free step, Island cycling, 40-60 minutes per session
Evaluate the effects of multiple Nintendo Wii
Obstacle course and Rhythm parade.
Fit activities on gait, balance and mobility.
Pompeu et al. [21] 32 PD (Aged 60-85 years) HY I & II Single-blind randomized controlled Nintendo Balance games: (Table tilt, Tilt city, 2 sessions/week 7 weeks Clinic
trial (RCT) Wii™ Penguin slide, Soccer heading) 60 minutes per session
Static balance (Torso twist and
Single leg extension).
Test if PD patients improve their performance Stationary gait: (Rhythm parade,
on the Wii & compare the effects of Wii Obstacle Course, Basic Step and
exercise on motor and cognitive training Basic Run)
with balance therapy.
Mendes et al. [20] 16 PD (No mean age data) HY I = 2; HY II = 14 Longitudinal controlled trial Nintendo Table tilt, Tilt city, Penguin slide, 2 sessions/week 7 weeks Clinic
11 Healthy elderly Wii™ Soccer heading, Obstacle course, 60 minutes per session
To evaluate the learning, retention and
Rhythm parade, Basic run plus, Basic
transfer of performance after using the Wii.
step, Single leg extensions games.
Esculier et al. [19] 10 PD (61.9 ± 11.0) Mean duration of Longitudinal controlled trial Nintendo Wii sports: Table tilt, Ski slalom, 3 × 6 weeks 40 minutes Home
PD = 8.5 (3.6) years Wii™ Balance bubble, Ski jump and each session
8 Healthy elderly To evaluate whether PD subjects balance and
Penguin slide.
(63.5 ± 12.0) functional activities improved using the Wii
Compare the effects against a healthy
elderly sample.
Mhatre et al. [23] 10 PD (Aged 44-91 years) Mean Duration Prospective interventional cohort study Nintendo Balance board games: Marble game, 3 sessions/week 8 weeks Clinic
6 female and 4 males of PD = 6.7 years Wii™ Skiing, and bubble game. 30 minutes each session
Assess the effectiveness of using the Wii Fit on
people with PD for gait and balance training.
Hertz et al. [24] 20 PD (66.7 ± 7.2) 13 Mean Duration of Pre-post design trial Nintendo Tennis, boxing and bowling 3 sessions/week 4 weeks Clinic
male and 7 female PD = 5.5 (4.3) years Wii™ 60 minutes each session
Assess the effectiveness of Wi on both motor
and non–motor symptoms of PD.
HY = Hoehn and Yahr stage.

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Safety commercial Nintendo Wii balance board (Wii Fit) games

Table 4 summarises the safety, feasibility and effectiveness [19,20,22-24]. However, none of these studies included
of the interventions. Only two studies addressed patient a control intervention. First, Esculier et al. showed that
safety, whereby the researchers set up a Wii platform 18 sessions (over 6 weeks) of exergaming resulted in
in the participants home and monitored the first exer- people with PD being able to stand on one leg for longer
cise session to ensure their safety [19]. Otherwise, nei- (with eyes open but not closed), improved bipedal standing
ther objective (such as falls or near falls) nor subjective balance with their eyes open (but not closed), and faster
(participant perceptions) measures of safety were reported performance on the timed up and go, sit to stand and
in any of the studies. 10 m walk tests [19]. Participants also scored better on
the Community Balance and Mobility scale after the
Feasibility intervention. Second, Mendes et al. found 14 sessions
Three studies measured performance in gameplay before of exergaming elicited improvements in the functional
and after an exergaming intervention (14 sessions [20,21] reach test immediately after the last training sessions,
or 16 sessions [22]). In all three studies, people with PD which was retained 60 days after the last session [20].
improved their performance on the games. Two of these Zettergren et al. showed that the gait speed, timed up
studies tested participants 60 days after the cessation of and go, and Berg balance scale all improved in a case
the intervention and reported that improvements in study of one 69 year old man with PD [22]. Mhatre et al.
gameplay were retained [20,21]. However, Mendes et al. found significant improvements in Berg Balance Scale,
also found that people with PD failed to improve in two Dynamic Gait Index and static balance over an 8 week
games that required fast reactions in response to virtual intervention, [23]. Hertz found significant improvements
targets and did not learn as quickly as controls in those in in the Nottingham Extended Activities of Daily Living
games that required dual tasking [20]. Test (NEADL) at post intervention (12 sessions), however
Only one study offered a detailed review of the game these improvements were short lived as the NEADL scores
playing experience [25]. Good levels of motivation during returned to baseline levels four weeks post intervention.
game play were reported although difficulties with the fast Quality of life as assessed by the PDQ-39 showed sig-
pace and cognitive complexity of some games were raised. nificant improvement post intervention for ADL, emotion,
Esculier et al., presented the only study to use home-based communication, bodily discomfort and total score. At
exergaming and used participant logbooks to assess satis- 4 week post intervention only ADL and emotion remained
faction of the exergaming intervention [19]. Fifty percent significantly improved with the addition of mobility sig-
liked the exercise program very much, 33% liked the nificantly improving. The UPDRS motor score showed a
program, and 17% rated the program as neutral, with significant decrease post exercise and improvements
no subjects disliking the program. were retained 4 weeks post intervention. Other outcome
measures which showed significant improvement post
Effectiveness intervention were the timed up and go (TUG), timed
The only randomised controlled trial included in our tap (right side, Purdue score (left-side) and 9 – hole peg
review tested the effects of playing commerical games on test score (right side).
the Nintendo Wii for 14 sessions (over 7 weeks) compared
to traditional balance training in 32 people with mild PD Discussion
(16 in each group) [21]. The primary outcome was section The aim of this systematic review was to explore whether
II of the Unified Parkinson’s Disease Rating Scale (UPDRS) exergaming is a safe, feasible and effective rehabilitation
and secondary outcomes included balance and cognitive tool for people with PD. Exergaming as a method of
tests. Both groups also received stretching, strengthening rehabilitation for people with PD is still very novel, as
and axial mobility exercises. There were no differences seen by the small number of studies included in this
between the two training groups at baseline and both review. These preliminary studies indicate that exer-
groups improved by the same amount after 7 weeks on the gaming is feasible for PD however games may need to
primary or secondary measures. When data from both be tailored towards specific clinical populations, and
groups were combined, small improvements were observed safety and feasibility as a home-based rehabilitation
in the UPDRS II, Berg balance scale, single leg stance (eyes tool is yet to be fully established.
open and eyes closed, but not eyes open with a dual task)
and Montreal Cognitive Assessment (MoCA) immediately Safety
after training. These improvements were retained 60 days More evidence is needed regarding the safety of people
after the final training session. with PD playing exergames before it can be recommended
Five further studies reported improvements on clinical for wide spread clinical use, particularly in home-based
tests in response to an exergaming intervention using settings. For this reason, we recommend future studies
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Barry et al. Journal of NeuroEngineering and Rehabilitation 2014, 11:33
Table 4 Safety, feasibility and effectiveness of exergaming interventions
Author Safety Feasibility Effectiveness
Gameplay (perception) Game play Clinical Test
Improvement post intervention Retention Improvement post intervention Retention
Assad et al. [25] n/s 5/13 participants reported having n/s n/s n/s n/s
success during the game and this
was the main reason for having fun.
3/13 subjects criticized the game for
not having clear goals. Participants
like the fairy tale theme to the game
and most would play the game with
their children or grandchildren.
Zettergren et al. [22] n/s n/s Sun Salutation, Half Moon, Chair, n/s Berg Balance Scale, Timed up and n/s
Rowing, Squats, Torso Twist, Go, Gait Speed.
Penguin Slide, Table Tilt, Balance
Bubble, Free Step.
Pompeu et al. [21] n/s n/s Static balance (Single leg Improvements UPDRS-II, Berg Balance Scale, Improvements retained
extension and Torso Twist), retained Unipedal stance eyes open,
Dynamic balance (Table Tilt, Tilt Unipedal stance eyes closed,
City, Soccer Heading, and Montreal Cognitive, Assessment.
Penguin Slide), Stationary gait
(Rhythm Parade, Obstacle
Course, Basic Step and Basic Run).
Mendes et al. [20] n/s n/s Similar learning curve for 7 Wii fit Improvements Functional reach test. Improvements retained
games in PD compared to controls retained
(Table tilt, Rhythm parade, Tilt city,
Single leg extension, Basic step,
Torso twist, Penguin slide), yet did
not learn the fast and complex
games as well as the controls
(Obstacle course, Basic run plus,
Soccer heading).
Esculier et al. [19] First home session 55% of liked the games very n/s n/s Timed up and go, Sit to Stand, n/s
supervised by research much, 33% liked it and 17% were Unipedal and bipedal standing
staff to ensure safe and neutral, and no subject disliked balance, 10 m walking speed,
effective training. playing the Wii. Favourite games Community Balance and Mobility
included; Ski Jump, Ski Slalom and Assessment (CBM), Tinetti
Table Tilt. Performance Orientated
Mobility Assessment (POMA).
Mhatre et al. [23] Exercise sessions were n/s n/s n/s Berg Balance Scale, Dynamic gait n/s
supervised and a balance index, postural sway (eyes open
bar was available if static and dynamic).
needed during gaming

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Barry et al. Journal of NeuroEngineering and Rehabilitation 2014, 11:33
Table 4 Safety, feasibility and effectiveness of exergaming interventions (Continued)
Hertz et al. [24] n/s n/s n/s n/s Nottingham Extended Activities NEADL decreased post
of Daily Living Test (NEADL) post intervention. PDQ
intervention, PDQ decrease in ADL, mobility, ADL and
emotion, communication, bodily emotion remained
discomfort. improved at 4 weeks
post intervention.
UPDRS motor scores, timed UPDRS motor scores
tapping test (right side only), decreased from baseline
Purdue score (left side only), to post intervention and
9-hole peg test (right side only), remained decreased at
and time up and go (TUG). 4 weeks post intervention.
n/s = not stated; UPDRS = Unified Parkinson’s Disease Rating Scale.

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report both objective and subjective measures of safety. Effectiveness

Importantly, six of the seven studies we reviewed used There is also little known regarding the efficacy of
the Nintendo Wii and Wii fit balance board [19-24]. exergaming as compared to traditional rehabilitation.
The Wii fit is a raised platform and so may present a Pompeu et al. has conducted the only randomised
trip risk for people with PD, particularly when they are controlled trial of exergaming for people with PD [21].
focused on the television screen. New commercial exer- The findings of the study suggest that 14 sessions
gaming systems are now available, such as the XBOX (over 7 weeks) of playing the Nintendo Wii™ can im-
Kinect™, that do not require a raised platform. Using these prove clinical measures of balance to the same extent
systems may improve the safety of exergaming for people as traditional balance training in people with PD. A po-
with PD, however this remains to be tested, as does the tential confounder to this study was that participants
clinical efficacy of these new exergaming systems. in both groups also received stretching, strengthening
and axial mobility exercises before each session. As
Feasibility such, it is difficult to conclude whether changes in the
Three studies reported improvement in gameplay perform- clinical tests can be ascribed to the balance training
ance in PD participants using commercial Nintendo (either traditional or exergaming). Bateni found similar
Wii exergames [20-24], suggesting commercial games are results when analysing the effects of the Wii on balance in
feasible. Two studies that sought participant feedback about healthy elderly adults, in that a combination of the Wii and
gameplay and reported that people with PD enjoyed playing standard balance training had the greatest improvement in
the games and were motivated to play them [19,25]. balance outcomes at post test compared to Wii or balance
Despite these promising results and the potential of training alone [29]. Therefore, it is possible that exergaming
commercial exergames as a means of low-cost home-based may be more useful for PD as an adjunct to standard clin-
exercise, there is concern that the commercial games are ical treatment than as a stand alone intervention.
too difficult for some people with PD [28]. This reflects the Six of the seven studies examined whether people
need for appropriate game selection and design. A key ad- with PD improved on clinical tests after an exergaming
vantage of exergames is that they can provide immediate intervention [19-24]. All six showed that people with
biofeedback of performance. This is a useful attribute that PD improved on various clinical measures of balance
may be exploited to improve motor learning in people with (Berg balance score, single leg stand, functional reach test),
PD, especially given their increased reliance on visual cues. motor function (Sit to stand, Timed up and go, 10 m
Setting an appropriate threshold of difficulty is essential. If walk, timed tapping) and severity of PD motor symptoms
feedback is too negative, for example when playing games (UPDRS II). Two of these studies also showed that im-
that are too fast or complex, motivation, adherence and provements in clinical tests were retained 60 days after
safety may suffer. This was particularly highlighted when the intervention [20,21]. With Hertz et al. showing im-
Mendes et al. assessed motor and cognitive ability of game provements were attained 4 weeks post intervention
play using the Nintendo Wii for PD and healthy elderly for PDQ-39 ADL and emotion, and motor scores for
adults [20], and showed that PD participants failed to im- UPDRS [24]. These results indicate that exergaming
prove on games that required fast decision making and may be effective for the rehabilitation of motor and
movements to avoid virtual obstacles. balance symptoms in people with PD. However, more
Of the reviewed papers, Assad and colleagues were the rigorous research designs need to be adopted in future
only authors to design their own exergame specifically trials to confirm whether improvements in these tests
tailored towards people with PD (WuppDi) [25]. Five are clinically meaningful and are not due to increased
games were developed to rehabilitate upper body move- familiarity with the clinical tests.
ments and elements of cognition. Games were played, One of the potential benefits of exergaming inter-
either with a hand held marker (wooden stick) or with ventions is that they can be administered in the home
no markers. The results showed that the majority of [17]. Although not formally tested, the resources re-
the participants enjoyed the experience and gained quired for exergaming are likely to be less than those
positive feedback from playing the games, and would required by formal rehabilitation services. To date,
enjoy playing with others especially their grandchil- there has only been one home-based exergaming inter-
dren. However, the authors noted some of the games vention reported in people with PD [19]. The authors
were too complex and needed to be made easier for were able to show that people with PD improved on
people with PD. Some participants also had difficulty several clinical tests and on gameplay over the 6 week
with the hand held controllers. Hand held devoices training period. Questions remain, however, whether
may not be appropriate for people with severe tremor home-based exergaming interventions are safe and as
or dyskinesia who could find it difficult to keep a hold effective as traditional clinic based interventions for
of and manipulate the controller. people with PD.
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Limitations and clinical effectiveness. Exergaming may augment

We included only full articles in this review, which resulted exercise therapy for people with PD although the use
in the exclusion of two relevant abstracts relating to exer- of commercial exergames may prove too complex for
gaming and PD [30,31]. Dos Santos et al., showed that 14 people with PD. Exergames specifically tailored towards
sessions of dance based exergaming using a balance board PD symptoms may help improve both player enjoyment,
resulted in improved balance and reduced motor symptoms motivation and effectiveness.
(UPDRS) in people with PD [30]. Alvarez et al. trained 12
Competing interests
people with PD using three commercial XBOX Kinect™ The authors declare that they have no competing interests.
games. Twenty-four sessions over eight weeks resulted in
improvements in the UPDRS (II&III) and Tinetti scale for Authors' contributions
GB carried out the initial search strategy and drafted the manuscript. BG
gait and balance [31]. Another limitation of this review was was the second reviewer to carry out the quality assessment on the
the heterogeneity of the different exergames included in relevant articles with GB and helped to draft the manuscript. LR
each intervention limited our ability to distinguish which structured the review and helped to draft the manuscript. All authors
read and approved the final manuscript.
particular games, and which aspects of those games, are
useful for rehabilitation of specific symptoms in PD. Acknowledgements
We wish to acknowledge funding received through a Parkinson’s UK
Innovation grant (K-1106) to conduct this research. This research was also
Recommendations supported by the National Institute for Health Research (NIHR) Newcastle
This systematic review indicates that exergaming appears Biomedical Research Unit based at Newcastle upon Tyne Hospitals NHS
feasible for people with PD, however it also highlights the Foundation Trust and Newcastle University. The views expressed are
those of the authors and not necessarily those of the NHS, the NIHR or
current paucity of evidence for exergaming as a rehabilita- the Department of Health.
tion tool. The studies we reviewed adopted relatively weak
designs and small sample sizes. As such, we can not state Received: 16 April 2013 Accepted: 20 February 2014
Published: 7 March 2014
with confidence whether or not exergaming is a safe and ef-
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