Perceptions of a Videogame-Based Dance Exercise Program Among Individuals with Parkinson�s Disease
Natbony, L. R., Zimmer, A., Ivanco, L. S., Studenski, S. A., & Jain, S. (2013). Games for Health Journal, 2(3), 1-5.
Dr. Laurie Malone
Parkinson's disease is a progressive disorder of the central nervous system, resulting from the loss of dopamine-producing brain cells (www.apdaparkinson.org/publications-information/basic-info-about-pd/). Dopamine is a chemical that relays messages within the brain to control bodily movements and helps to produce smooth, coordinated muscle movements. When approximately 60 to 80 percent of the dopamine-producing cells are damaged, and do not produce enough dopamine, the motor symptoms of Parkinson’s disease appear.
Parkinson’s disease tends to progress slowly and, typically affects people over the age of 50., and men Men are one and a half times more likely to have Parkinson's than women (http://www.pdf.org/en/parkinson_statistics). The disease affects more than 1 million people in the United States and is characterized by the following symptoms (www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm):
- Tremor, or trembling in hands, arms, legs, jaw, and face
- Rigidity, or stiffness of the limbs and trunk
- Bradykinesia, or slowness of movement
- Postural instability, or impaired balance and coordination
As the disease progresses, these symptoms may begin to interfere with daily activities. There is currently no cure for Parkinson’s so the goal is to utilize treatments that help control the symptoms and improve quality of life.
Physical activity and exercise is an important component of a healthy lifestyle for everyone. However, for people with chronic health conditions such as Parkinson’s disease exercise is not only healthy, but a vital component to maintaining balance, mobility and daily living activities (www.parkinson.org). Discussion and videos related to the neuroprotective effects of exercise, exercise research, and tips on exercising are provided by the National Parkinson Foundation at http://www.parkinson.org/Parkinson-s-Disease/Treatment/Exercise.
Although the benefits of being physically active are numerous, adherence is often a problem. Dance can be a fun and engaging method of physical activity. With new interactive video games, dancing as a form of healthy physical activity can be done in your own home. One game in particular is called Dance Dance Revolution (DDR) (Konami Digital Entertainment, El Segundo, CA), an interactive game with high- energy music that may provide benefits similar to traditional dance such as improved balance, coordination, and strength (Earhardt, 2009).
DDR utilizes a 3’ x 3’ mat with 1' squares marked by arrows designating forward (up), backward (down), left, and right. The monitor guides the participant by a system of scrolling arrows. The participant’s goal is to step on the arrow on the mat corresponding to the scrolling arrow. The steps are synchronized to music selected by the participant and increase in complexity and speed as game skills are mastered. After each dance (about 90 seconds), the participant is given feedback with an overall letter grade based on the number of correct steps, how well timed those steps were, and the complexity of the song. As the participant’s dance performance improves, the grade improves, and new songs (of increasing complexity) are offered.
A recent study by Natbony et al. (2013) examined the perceived advantages and disadvantages of DDR among persons with Parkinson’s disease and explored the feasibility of DDR in promoting physical activity in this population. Participants included sixteen individuals with mild to moderate Parkinson’s, aged 40+ years, not currently participating in regular physical exercise. Participants received an orientation to the dance system, observed a demonstration by research staff, and then were given the opportunity to try DDR. Ratings of pain, discomfort, distress/fear and balance confidence were recorded. Participant feedback regarding the perceived advantages and disadvantages of DDR was collected through focus groups using the nominal group technique.
For all participants, the Borg rating scale (0–10) for pain was 0, a 3 for distress and fear, and 0 for discomfort for all but one participant, who rated it a 3. There were no reports of loss of balance or need to prevent a fall. Data analysis following the focus groups elicited 21 advantages and 17 disadvantages among individual participants. The top scores were as follows:
- Easy to use
- Improves balance or coordination
- Full-body aerobic activity
- Distracting or confusing interface
- Financial cost
- Limited range of movements
- Cannot customize game display
- Possible falls
- Did not like available music
The results suggest that DDR is a feasible activity for persons with Parkinson’s disease and is well-tolerated, fun, easy to use, and perceived to be of benefit. In addition, DDR meets the four key physical therapy treatment recommendations as described by Keus et al. (2009).
As compared to other forms of training (e.g., virtual reality) that require a controlled physical therapy environment, video-based exercise programs such as DDR can be done at home and are thereby accessible to a greater number of people with Parkinson’s disease. Furthermore, given that participants reported DDR to be “fun,”, the likelihood that participants would adhere to engaging in regular physical activity may be increased. In conclusion, interactive videogames that promote physical activity show promise for persons with Parkinson’s disease;, however, further study is needed to assess adherence, safety, and the long-term health effects of such exercise in this population.
- American Parkinson Disease Association. http://www.apdaparkinson.org/publications-information/basic-info-about-pd/
- Earhart, G. M. (2009). Dance as therapy for individuals with Parkinson disease. European Journal of Physical and Rehabilitation Medicine, 45, 231–238.
- Keus, S. H., Bloem, B. R., Hendriks, E. J., et al. (2007). Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research. Movement Disorders, 22, 451–460.
- National Institute of Neurological Disorders and Stroke, National Institutes of Health. http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm
- National Parkinson Foundation. http://www.parkinson.org/Parkinson-s-Disease/Treatment/Exercise
- Parkinson’s Disease Foundation. http://www.pdf.org/en/parkinson_statistics