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approximately 2835% and 3242% of people more than 60 and 70  years old , respectively , 
 experience falls every year worldwide1 , 2 ; 30% of those experiencing falls require 
 medical attention to treat resultant abrasions and sprains , and approximately 10% require 
 hospitalization for fractures3 . for elderly women in particular ,
aging - related organ degeneration is enhanced by a 
 significant reduction of bone mass due to menopause ; therefore , they are more vulnerable to 
 serious fractures caused by falls , which can lead to secondary illnesses4 . as people age ,
their abilities to maintain balance and ambulate degrade which increases 
 falling risk during walking5 . in 
 particular , falling caused by obstacle such as thresholds , bath sills , and speed bumps in 
 parking lots occur frequently6 , 7 . among various intervention methods for fall prevention and obstacle negotiation , exercise 

improves muscular strength , flexibility , and balance , aiding the maintenance of body 
 balance ; therefore , it is widely used in programs to prevent falls8 . however , existing exercise methods to prevent falls largely depend on physical therapists . 

therefore , patients tend to become bored performing passive exercises with simple 
 repetitions ; together with cost , time , and location constraints this results in decreased 
 desire for treatment9 .
therefore , an in - home exercise method that is interesting with fewer time and spatial 
 limitations , and enables continuous exercise is desirable .
in addition , it offers immediate 
 visual and audio feedback from exercise , generating interest and improving the effect of 
 motor learing10 .
previous studies using 
 nintendo wii sports involved basic balance assessment for patients and elderly11,12,13 , but few have focused on the negotiation 
 of obstacles that frequently cause falls .
hence , this study evaluated the changes in balance ability and obstacle gait after lumbar 
 stabilization exercise and nintendo wii sports in elderly at risk for falls .
furthermore , we 
 whether nintendo wii sports are appropriate and effective as self - help exercises to prevent 
 falls when performed at home by elderly women at risk of falls .
the study participants were selected by convenience sampling from 3 senior citizen centers ; 
 24 elderly women above the age of 65 ( table 
 1table 1.general characteristics of the participants ( n=24)control ( n = 8)lse ( n = 8)nws ( n = 8)age ( years)73.6  2.474.3  3.574.3  2.1height ( cm)151.6  5.4152.5  4.4152.9  4.5weight ( kg)55.3  6.254.9  9.655.3  7.6mean  sd .
t test ( p < 0.05 ) ) who scored between 19 and 24 points on the tinetti performance oriented 
 mobility assessment ( poma ) without neurological or orthopedic disorders , experience 
 participating in regular fall prevention programs ( i.e. , balance exercises ) at least twice 
 per week within the last 6 months , or a history of falls were selected14 .
the purpose and methods of this study were explained to 
 the participants , who signed an informed consent that outlined all details of the study 
 protocol , which was approved by the ethics committee of kangwon national university ( no . 
 2014 - 05 - 002 - 001 ) .
t test ( p < 0.05 ) the participants were randomly divided into the control , lumbar stabilization exercise 
 ( lse ) , and nintendo wii sports ( nws ) groups .
participants in the lse and nws groups , but not 
 the control group performed an exercise program . participants
lse included 7 positions based on the 
 back bridge , hands and knees , and side bridge as follows15 : ( 1 ) standard back bridge , ( 2 ) back bridge with alternate leg 
 straight , ( 3 ) back bridge with one leg , ( 4 ) standard hands and knees , ( 5 ) hands and knees 
 with alternate arm straight forward , ( 6 ) hands and knees with alternate leg straight 
 backward , and ( 7 ) side bridge .
lse group participants were instructed to maintain each 
 position for 15 seconds for 3 sets . the nintendo wii sports program including the wakeboard , 
 frisbee dog , jet ski , and canoe games was used for the nws group .
nws group participants 
 controlled a virtual character on the screen by swinging , rowing , or tilting remote 
 controllers with motion sensors .
participants chose their 3 favorite games and took a 
 2-minute break every 10 minutes .
before and after 8 weeks of intervention , the participants of each group were evaluated for 
 static balance ability , dynamic balance ability , and obstacle gait by using the following 
 instruments : berg balance scale ( bbs ) and functional reach test ( frt ) for static balance 
 ability ; the timed up - and - go ( tug ) test for dynamic balance ability ; and crossing velocity 
 ( cv ) and maximum vertical heel clearance ( mvhc ) for obstacle gait .
cv was calculated by 
 dividing the horizontal distance from where the leading limb takes off the ground to where 
 the heel of the leading limb touches the ground after obstacle negotiation by time spent . 

mvhc was calculated by measuring the vertical distance between the height of an obstacle and 
 the ball of the leading limb before obstacle negotiation16 ; the obstacle s dimensions were 60  10  15.2  cm ( width  length  
 height ) .
the participants were instructed to start walking 5  m behind the obstacle , 
 negotiate the obstacle , and then walk 3 more meters .
obstacle gait - related factors were 
 recorded by a camcorder and stored on a computer .
the independent 
 samples t - test was used to compare the two groups at the baseline .
two - way repeated - measures 
 anova was used to compare the differences among groups , and post hoc analysis was conducted 
 using the tukey least significant difference test .
the general characteristics of the participants are shown in table 1 ; there were no significant differences among groups with 
 respect to age , height , or weight ( p > 0.05 ) .
repeated measure anova to analyze changes in the bbs , the frt , the tug , cv , and mvhc 
 according to the measurement periods showed that there was a statistically significant 
 difference in the interaction between time and the groups and that the changes in the bbs , 
 the frt , the tug , cv , and mvhc according to time differed ( p < 0.001 ) ( table 2table 2.changes in physical and psychological functionscontrol ( n = 8)lse ( n = 8)nws ( n = 8)post hocbbs ( score)pre - intervention39.8  1.839.3  1.539.1  1.4a < b , c b > cpost - intervention38.4  1.943.8  1.341.0  2.2frt ( cm)pre - intervention18.7  1.018.7  1.818.8  2.4a < b , c b > cpost - intervention18.6  1.022.3  2.021.0  2.2tug ( s)pre - intervention12.0  1.212.1  1.412.1 
2.3a > b , c b > cpost - intervention12.0  1.610.5  1.29.4  2.3cv ( m / s)pre - intervention1.4  0.11.4  0.11.4  0.1a < b , cpost - intervention1.4  0.11.5  0.11.5  0.1mvhc ( cm)pre - intervention5.9  1.56.0  1.35.9  0.7a > b , cpost - intervention6.0  1.65.0  1.34.9  0.4mean  sd .
lse : lumbar stabilization exercise ; nws : nintendo wii sports ; bbs : berg 
 balance scale ; frt : functional reach test ; tug : timed up - and - go test ; cv : crossing 
 velocity ; mvhc : maximum vertical heel clearance .
the lse and nws groups exhibited significantly greater increases in mean bbs 
 score , frt score , and cv than the control group and significantly greater reductions in mean 
 tug test time and the mvhc .
lse : lumbar stabilization exercise ; nws : nintendo wii sports ; bbs : berg 
 balance scale ; frt : functional reach test ; tug : timed up - and - go test ; cv : crossing 
 velocity ; mvhc : maximum vertical heel clearance .
the findings of this study suggest lumbar stabilization exercise and nintendo wii sports 
 might be useful fall prevention interventions for improving fall - related balance and 
 obstacle negotiation function in elderly women at risk of falls .
when elderly people perform gait to overcome an obstacle , their trailing limbs is far more 
 behind the obstacle than that of normal adults ; meanwhile , their leading limb makes the 
 distance between the peak of the obstacle and their foot too long , thus reducing the 
 crossing velocity and increasing mvhc7 , 17 .
elderly people place their leading limb 
 too high when negotiating the obstacle , which elevates their center of mass and consequently 
 reduces balance18 .
thus , cv and mvhc are 
 important factors in their obstacle gait and basic balance ability , which are required to 
 negotiate obstacles in a natural way and thus prevent falls .
the nintendo wii sports program involves exercise games and offers various visual and audio 
 feedback .
it can be developed into a program that both spurs interest and improve motor 
 learning ; it is especially useful for balance - related exercise effects in connection with 
 various virtual sports programs .
thus , it enables elderly people to improve their obstacle 
 gait and manage their health with respect to falls in a continuous and active manner .
this study used , the bbs and frt as static balance ability assessments , the tug test as a 
 dynamic balance ability assessment , and measurement of cv and the mvhc for kinematic changes 
 related to obstacle gait to investigate the effects of the nintendo wii sports program and 
 lumbar stabilization exercise on elderly womens balance ability with respect to falls and 
 kinematic changes related to obstacle gait .
the results of the present study showed that the bbs , the frt , the tug test , cv , and mvhc 
 were significantly improved .
consistent with the present study , rose and clark19 , report that elderly people who experience 
 falls exhibited significant improvements in their bbs scores and tug test results after 
 visual feedback balance exercise .
meanwhile , chen et al.20 and madureira et al.21 report that frt and tug test results improved significantly in 
 elderly participants as a result of lower - limb power rehabilitation using interactive video 
 games ; this is also consistent with the present results in that balance training for elderly 
 women significantly increased bbs score by 5.5 points in the experimental group and reduced 
 the tug test time by 3.65 s. in addition , park and lee22 report that elderly people were significantly slower in obstacle 
 negotiation than young adults .
choi and yoon23 report that elderly women tend to progressively increase the speed 
 at which they negotiate obstacles 0% , 30% , and 50% of the length of their lower limbs after 
 12 weeks of aquatic exercise .
meanwhile , kim and yu24 report that mvhc decreased in elderly women after aquatic exercise . 

the lse group performed their exercise on a stable floor , which increased their trunk 
 muscle strength , improving their static balance ability .
meanwhile , the nws group performed 
 their exercise on a relatively unstable floor under various virtual conditions according to 
 their reaction to visual and audio feedback , increasing their mobility and thus improving 
 dynamic balance ability .
in addition , the improved static balance ability due to increased 
 trunk muscle strength in the lse group and improved balance ability by stimulus reception 
 from their vestibular system through various stimuli from virtual environments and 
 proprioception improved their obstacle negotiation ability in various environments . in summary ,
the 8-week nws program improved the physical balance and obstacle negotiation 
 abilities of elderly women to the same extent as lse .
therefore , nintendo wii sports is an 
 effective home support exercise programs to prevent obstacle - related falls in the 
 elderly .
[ purpose ] this study evaluated the changes in balance ability and obstacle gait after 
 lumbar stabilization exercise and nintendo wiitm sports in elderly at risk for 
 falls . [ subjects and methods ] twenty - four elderly women with at risk for falls were 
 randomly divided into the control , lumbar stabilization exercise , and nintendo wii sports 
 groups . 
 static balance was measured by the berg balance scale and functional reach test , 
 dynamic balance by the timed up - and - go test , and obstacle negotiation function by crossing 
 velocity and maximum vertical heel clearance . 
 [ results ] both the lumbar stabilization 
 exercise and nintendo wii sports groups showed significant improvements in obstacle 
 negotiation function after the exercise compared to the control group . 
 berg balance scale 
 and functional reach test scores were greater in the lumbar stabilization exercise group , 
 while the timed up - and - go test time was significantly better in the nintendo wii sports 
 groups . 
 [ conclusion ] lumbar stabilization exercises and nintendo wii sports improve 
 falling related balance and obstacle negotiation function in elderly women at risk for 
 falls .