Wii‐fit as an Adjunct for Mild Cognitive Impairment: Clinical Perspectives

To the Editor: Mild cognitive impairment (MCI) is defined as slight impairment in cognition but with preserved functional status.1 Subjects with MCI have greater gait and balance problems than age-matched subjects with normal cognition.2, 3 Subjects with MCI do poorly on standard tests of equilibrium and limb coordination, making them vulnerable to falls.4 Exercise interventions improve gait and balance in older adults.5 Even low-intensity exercises are useful in improving balance and gait in deconditioned older adults at high risk of falling.6 Despite many proven benefits of exercise, many older adults remain sedentary.7 Several barriers, such as lack of transportation, costs of physical therapy, and poor engagement, prevent older adults from participating in exercise programs.8 Off-the shelf video games may address some of these barriers. Wii-Fit is a Nintendo gaming console used for aerobic, strength training, and balance activities.9 Wii-Fit uses television-based equipment and provides self-directed activity. Although some nursing homes have started using Wii-Fit in conjunction with physical therapy, there has been little work in using Wii-Fit for community-dwelling patients with MCI.10 This letter presents two people with MCI in whom the use of Wii-Fit led to improvement in balance and gait. Mr. A, a 63-year-old Caucasian man with MCI, presented with balance problems over the previous year, with two episodes of near falls and fear of falls. He reported good mood, poor concentration, and fatigue. Past medical history included osteoarthritis, hypertension, constipation, depression, and MCI. Medications included fluoxetine 20 mg/d, lactulose 10 g/d, acetaminophen 1,000 mg three times per day, and lisinopril 5 mg/d. The Get Up and Go Test showed that he needed to use the arm rest to rise from a chair and that he walked at a slow pace. He was deemed at risk for falls and was asked to increase his physical activity. He was given several options, including Wii-Fit. He took a liking to Wii-Fit and used balance games, strength training, and yoga regularly. His wife also started using the Wii-Fit. They used Wii-Fit for approximately 30 to 40 minutes per day, 6 days per week. He reported substantial improvement in his balance, concentration, and energy at 2-month follow-up. At 6 months, he continued to use the Wii-Fit three times per week and had lost 9 lbs of weight. No injuries or adverse events were reported. The Get Up and Go Test showed that he got up from the chair without using the arm rests. He was deemed to be no longer a fall risk. Mr. B, a 64-year-old widowed white man with MCI, was seen in the geriatric clinic for new-onset balance problems and a recent fall. Past medical history included hyperlipidemia, hypertension, diabetes mellitus, depression, MCI, and a myocardial infarction 2 years before the visit. Medications included fluoxetine 20 mg/d, lisinopril 20 mg/d, metformin 1,000 mg two times per day, enteric-coated aspirin 81 mg/d, and gemfibrozil 300 mg two times per day. He was dependent on family and friends for transportation, which severely impaired his participation in outpatient physical therapy. He completed the Timed Up and Go (TUG) Test in 32 seconds. He was asked to use a Wii-Fit, which he used for approximately 2 hours per day for 2 months. He reported that it was easy to get used to the system and reported doing the strength training, yoga, and balance exercises. He reported feeling more confident about his balance. No adverse events were reported. At 2 months, his TUG Test score was 18 seconds, and no falls were reported in the interim. Commercially available video games have the potential to address many barriers encountered with traditional exercise programs. Wii-Fit, a television-based gaming device, has many user-friendly features. The size of the balance board allows assistive devices, such as walkers, to fit around it. Wii-Fit is a self-directed activity not limited by the constraint of a therapist's presence. Virtual trainers talk the user through the activity while tracking their progress, and visual and auditory feedback improves engagement. Two community-dwelling subjects with MCI were able to use the Wii-Fit successfully. Participation by the caregiver in the first case improved adherence. Subjects also reported high levels of engagement. Weight loss in the first patient was an added benefit. Both patients reported improvement in balance and reduced fear of falls. No falls were reported in either patient during the intervention. A limitation of this report is that subjective report was used to ascertain the use of Wii-Fit, improvement in balance, and concentration. It is feasible to use the Wii-Fit in community-dwelling patients with MCI. Conflict of Interest: None of the authors have any conflict or financial disclosure to report. Prasad R. Padala is an employee of the U.S. government. Author Contributions: KPP was involved in the study concept, acquisition of subjects, writing the first draft of the paper, and subsequent review. PRP contributed to acquisition of one of the subjects and critical review of the paper. WJB was involved in the study concept and critical review of the paper. Sponsor's Role: None.