The Ring Fit Adventure (RFA) (, Kyoto, Japan) is a novel exergame that combines exercise and video game elements. Although previous RFA intervention studies have reported the health effects of the RFA, exercise intensity among older adults has not yet been documented. We hypothesized that the exercise intensity of older adults in the current RFA setting may be low. This preliminary study developed a range of prototype RFA intensity conditions and to evaluate exercise intensity among older adults. Six older adults (1 male/5 females, mean age 75.2±10.3 years old) participated in this study. Three RFA conditions were developed: “LOW” (the ‘default’ load. Older individual input actual gender and age), “MODERATE” (as defined by the American College of Sports Medicine [ACSM]: 40%-59% heart rate reserve [HRR]), and “HIGH” (highest exercise intensity that older individuals could set in the game). Exercise intensity was assessed using the %HRR. The results show that the %HRR values for the conditions were 34.9%±4.1% (LOW), 40.0%±2.9% (MODERATE), and 52.3%±3.1% (HIGH). In conclusion, this preliminary study showed that, among the three prototype RFA conditions, both MODERATE and HIGH conditions generally attain moderate or greater intensity for older adults when assessed using the heart rate.

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This article focuses on ’s influential and much-celebrated 1998 videogame The Legend of Zelda: Ocarina of Time (hereafter OoT). In particular, it explores the often unexpectedly creative and wholly transformative ways in the game is played by ‘speedrunners.’ Seeking to race through the game as quickly as possible, speedrunners play in a distinctive way that combines mastery of performance execution with a deep knowledge of the game’s operation and how its systems may be exploited. Speedrunning performances are creative because they involve astonishingly detailed investigations of the minutiae of game behaviors. They are transformative because they disrupt and even invert much-vaunted aspects of the game as sequences that slow down progress are circumvented. As such, what would otherwise class as crucial moments in the storyline, key character development and even locales, are not only raced through but are actively skipped. Compared with the game’s narrative, the connectivity of its spaces, and the complex but clearly mapped passage of time as set out in ’s officially-endorsed ‘Strategy Guides’ (see Buchanan et al 1998; Hollinger et al 1998; Loe and Guess 1998), the OoT speedrun constructs an altogether different game with vastly altered priorities. And so, the offer to, ‘Join legendary hero Link as he journeys across Hyrule, and even through time, to thwart the plans of Ganondorf.’ ( 2017), is recast as a breakneck dash to the closing credits sequence evading and avoiding all but the essential moments of gameplay.

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[Purpose] The purpose of this study was to investigate the effects of a Wii exercise program on chronic work-related LBP compared with stability exercise. [Methods] Twenty-four workers participated in this study. All of the participants were diagnosed with chronic LBP by a physician. Participants were randomly assigned to three groups: a control group (CG), lumbar stabilization exercise group (LSE), and Wii exercise group (NWE). Participants were treated 3 times a week for 8 weeks. Each session lasted 30 minutes. [Results] The results demonstrated that exercise programs improved significantly physical functions related to LBP. In health-related QOL, the Wii exercise program significantly improved both the mental and physical health composites, but other groups had significant improvement only in the physical health composite. [Conclusion] The Wii exercise program could be a biopsychosocial intervention for work-related LBP in factory workers.

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[Purpose] This study evaluated the changes in balance ability and obstacle gait after lumbar stabilization exercise and Wii^TM 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 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 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 Wii Sports groups. [Conclusion] Lumbar stabilization exercises and Wii Sports improve falling related balance and obstacle negotiation function in elderly women at risk for falls.

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[Purpose] The objective of this study was to examine the effects of a training program using the Wii Fit Plus on the ankle muscle strengths of subjects with functional ankle instability. [Subjects and Methods] This study was conducted using subjects in their 20s who had functional ankle instability. They were randomized to a strengthening training group and a balance training group with 10 subjects in each, and they performed an exercise using Wii Fit Plus for 20 minutes. In addition, every participant completed preparation and finishing exercises for 5 minutes, respectively. [Results] The muscle strengths after conducting plantar flexion and dorsiflexion significantly increased at the angular velocities of 60° and 120° in the strengthening training group. Furthermore, the muscle strengths after conducting plantar flexion, dorsiflexion, eversion, and inversion significantly increased at the angular velocities of 60° and 120° in the balance training group. [Conclusion] The balance training group using Wii Fit Plus showed better results than the strengthening training group. Consequently, it is recommended to add the balance training program of the Wii Fit Plus to conventional exercise programs to improve ankle muscle strength in functional ankle instability at a low cost.

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[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Methods] Forty children with cerebral palsy spastic diplegia aged 6–10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System (GMFCS) were enrolled. Participants were divided randomly into equal groups: group (A) that practiced with the Wii Fit game for at least 20 minutes/day for 12 weeks and group (B) that underwent no training (control group). The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance, because it mainly involves motor tasks very similar to those involved in playing Wii Fit games, e.g., goal-directed arm movements, balancing, and jumping. [Results] There were significant improvements in the subscales of the motor performance test of those who practiced with the Wii, while the control group showed no significant changes. [Conclusion] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy.

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[Purpose] The aim of this study was to investigate the efficiency of ® Wii games in addition to neurodevelopmental treatment in patients with cerebral palsy. [Subjects and Methods] Thirty hemiparetic cerebral palsy patients (16 females, 14 males; mean age, 6–15 years) were included in the study and divided into two groups: a neurodevelopmental treatment+ Wii group (group 1, n=15) and a neurodevelopmental treatment group (group 2, n=15). Both groups received treatment in 45-minute sessions 2 days/week for six weeks. Use of the upper extremities, speed, disability and functional independence were evaluated using the Quality of Upper Extremity Skills Test, Jebsen Taylor Hand Function Test, ABILHAND-Kids test, and Pediatric Functional Independence Measure (self-care) before and after treatment. [Results] There were statistically significant improvements in all parameters for group 1 and group 2 (except quality of function) after six weeks of treatment. Intergroup analysis showed that group 1 was superior to group 2 in mean change differences in the Jebsen Taylor Hand Function Test. [Conclusion] Our results showed that neurodevelopmental treatment is effective for improving hand functions in hemiplegic cerebral palsy. To provide a enjoyable, motivational, safe, and effective rehabilitation program, the ® Wii may be used in addition to neurodevelopmental treatment.

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[Purpose] This investigation evaluated the acute cardiovascular responses that occur while playing virtual games (aerobic and balance) emulated by Wii^®. [Subjects] Nineteen healthy male volunteers were recruited. [Methods] The ergospirometric variables of maximum oxygen consumption, metabolic equivalents, and heart rate were obtained during the aerobic (Obstacle Course, Hula Hoop, and Free Run) and balance (Soccer Heading, Penguin Slide, and Table Tilt) games of Wii Fit Plus^® software. To access and analyze the ergospirometric information, a VO2000 analyzer was used. Normalized data (using maximum oxygen consumption and heart rate) were analyzed using repeated measures analysis of variance and Scheffe’s test. [Results] Significant differences were found among the balance and aerobic games in all variables analyzed. In addition, the Wii exercises performed were considered to be of light (balance games) and moderate (aerobic games) intensity in accordance with American College Sports Medicine exercise stratification. [Conclusion] Physical activity in a virtual environment emulated by Wii^® can change acute cardiovascular responses, primarily when Wii aerobic games are performed. These results support the use of the Wii^® in physical activity programs.

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[Purpose] The aim of the present study was to investigate the accuracy of a digital weight scale relative to the Wii in limb loading measurement during static standing. [Methods] This was a cross-sectional study conducted at a public university teaching hospital. The sample consisted of 24 participants (12 with osteoarthritis and 12 healthy) recruited through convenient sampling. Limb loading measurements were obtained using a digital weight scale and the Wii in static standing with three trials under an eyes-open condition. The limb load asymmetry was computed as the symmetry index. [Results] The accuracy of measurement with the digital weight scale relative to the Wii was analyzed using the receiver operating characteristic (ROC) curve and Kolmogorov-Smirnov test (K-S test). The area under the ROC curve was found to be 0.67. Logistic regression confirmed the validity of digital weight scale relative to the Wii. The D statistics value from the K-S test was found to be 0.16, which confirmed that there was no significant difference in measurement between the equipment. [Conclusion] The digital weight scale is an accurate tool for measuring limb load asymmetry. The low price, easy availability, and maneuverability make it a good potential tool in clinical settings for measuring limb load asymmetry.

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[Purpose] Cerebral palsy is a sensorimotor disorder that affects the control of posture and movement. The ® Wii Fit offers an inexpensive, enjoyable, suitable alternative to more complex systems for children with cerebral palsy. The aim of this study was to investigate the efficacacy of Wii-based balance therapy for children with ambulatory cerebral palsy. [Subjects] This pilot study design included fourteen ambulatory patients with cerebral palsy (11 males, 3 females; mean age 12.07 ± 3.36 years). [Methods] Balance functions before and after treatment were evaluated using one leg standing, the functional reach test, the timed up and go test, and the 6-minute walking test. The physiotherapist prescribed the Wii Fit activities,and supervised and supported the patients during the therapy sessions. Exercises were performed in a standardized program 2 times a week for 12 weeks. [Results] Balance ability of every patient improved. Statistically significant improvements were found in all outcome measures after 12 weeks. [Conclusion] The results suggest that the ® Wii Fit provides a safe, enjoyable, suitable and effective method that can be added to conventional treatments to improve the static balance of patients with cerebral palsy; however, further work is required.

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[Purpose] The present study aimed to determine the effect of virtual reality exercise using the Wii Fit on the muscle activities of the trunk and lower extremities of normal adults. [Subjects] The subjects of the study were 24 normal adults who were divided into a virtual reality exercise group (VREG, n=12) and a stable surface exercise group (SEG, n=12). [Methods] The exercises of the VREG using the Wii Fit and the SEG using a stable surface were conducted three times a week for six weeks. Electromyography was used to measure the muscle activities of the tibialis anterior (TA), medial gastrocnemius (MG), erector spinae (ES), and rectus abdominal (RA) muscles. [Results] VREG showed significant within group differences in TA and MG muscle activities, while the SEG showed a significant difference in the muscle activity of the MG. [Conclusion] Virtual reality exercise using the Wii Fit was an effective intervention for the muscle activities of the TA and MG of normal adults.

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[Purpose] This study aimed to explore the possibility of improving functional balance using an exercise program with

and the Balance Board peripheral in subjects with cerebral palsy. [Subjects and Methods] This study included 4 male outpatients of a neurological center. All participants received an exercise program based on the use of with the Balance Board peripheral. Training consisted of three 25-min sessions per week for 6 weeks. Each session was guided by a physical therapist. Timed up-and-go and one-leg standing tests were conducted before and after the intervention. [Results] All subjects showed significant improvements in the results of the timed up-and-go test. However, there were no significant changes in the results of the one-leg standing test. [Conclusion] The exercise protocol involving with the Balance Board peripheral appears to improve functional dynamic balance in patients with cerebral palsy. However, static functional balance does not improve after 6 weeks of training.

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[Purpose] This study was conducted to investigate the effect of Wiihabilitation on the ankle dorsiflexion/plantar flexion strength ratio in adults. [Subjects and Methods] Thirty-two healthy male volunteers were randomly assigned to two equal groups (experimental and control). Participants in the experimental group received a Wiihabilitation training program for six weeks. Data were collected using a Biodex system 3 Isokinetic dynamometer. Peak torques of the dorsiflexors and plantar flexors were measured at an angular velocity of 60°/sec which in turn were used to derive the ankle dorsiflexion/plantar flexion strength ratio. [Results] The mean values of the ankle dorsiflexion/plantar flexion strength ratio decreased significantly between before and after the training in the experimental group, meanwhile there was no significant difference between before and after the training period in the control group . [Conclusion] Wiihabilitation has an impact on the ankle dorsiflexion/plantar flexion strength ratio, so it can be considered an effective training tool in terms of the ankle strength ratio. Thus, it could be recommended for both prevention and rehabilitation of ankle instability patients.

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[Purpose] The objective of this study was to determine the effect of indoor horseback riding and virtual reality exercises on the dynamic balance ability of normal adults. [Subjects] This study enrolled 24 normal adults and divided them into two groups: an indoor horseback riding exercise group (IHREG, n = 12) and a virtual reality exercise group (VREG, n = 12). [Methods] IHREG exercised on indoor horseback riding equipment and VREG exercised using the Wii Fit three times a week for six weeks. The Biodex Balance System was used to analyze dynamic balance as measured by the overall stability index (OSI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI). [Results] In the within-group comparison, IHREG and VERG both showed significant decreases in the dynamic balance indexes of OSI, APSI, and MLSI after the intervention, but no significant difference was found between the groups. [Conclusion] Both indoor horseback riding and virtual reality exercises were effective at improving the subjects’ dynamic balance ability as measured by OSI, APSI, and MLSI, and can be used as additional exercises for patients with conditions affecting postural control.

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[Purpose] This study compared the effect of the

Wii balance board (NWBB) and Tai Chi Chuan (TCC) on the standing balance (SB) of older adults. [Participants and Methods] Twelve older adults (NWBB=7 and TCC=5) completed the intervention and two testing sessions (pre-post). SB was assessed using posturographic measures with the center of pressure (CoP) in five modes: quiet eyes open (QSB-EO) and eyes closed (QSB-EC), on sponge (SBS-EO and SBS-EC), and with optokinetic field (SB-OF). [Results] Both interventions significantly decrease the area of CoP sway (CoP_Sway) in QSB-EO and SB-OF. The NWBB-group decreased CoP_Sway in SBS-EC and CoP velocity (V_mean) in QSB-EO, QSB-EC, and SBS-EC. The TCC-group decreased the V_mean in SBS-EO and conversely the V_mean in QSB-EC increased. [Conclusion] Sponge and optokinetic field were the most unstable assessments. These findings reveal the potential benefits for SB of both interventions, however the NWBB improved more variables in the postural control of older adults.

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Objective: This study aimed to define the efficacy and features of physical therapy (PT) using the

Wii Fit U ( Inc., Kyoto, Japan) in patients with hematological malignancies confined to a bioclean room. Method: A total of 33 patients with hematological malignancies confined to a bioclean room were enrolled in this study. This study was designed as a randomized crossover test between two weeklong interventions: PT program (Therapist PT) and Wii Fit U program (Wii PT). We compared the efficacy of Wii PT and Therapist PT with regard to physical and psychological function test scores. Results: Of the 33 patients, 22 were analyzed. The validity of the crossover design was demonstrated, as there were no significant differences in period and carryover effects between the two groups. Therapist PT resulted in significantly better improvements in fatigue scores and total mood disturbance (TMD) scores in the Profile of Mood States short-form Japanese version compared to Wii PT (fatigue score, -5.2±8.3 vs 2.7±8.2; TMD score, -22.5±32.8 vs -2.6±20.5; p<0.05). Physical function improved post-Wii PT and post-Therapist PT interventions (p<0.05), and there was no difference in treatment effect. Conclusion: Improvements in physical function were clearly observed following the use of Wii PT in patients confined to a bioclean room. However, compared to Therapist PT, Wii PT was less effective in improving the psychological function of patients.

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