A literature review by Collard et al. (2012) states that 4-17% of the community-dwelling elderly is frail and 38-53% pre-frail. Fried’s classification lists five physical characteristics of the frailty phenotype: unintentional weight loss, muscles weakness, self-reported exhaustion, slow walking speed and low physical activity (Gobbens et al., 2010). Presence of 1 or 2 of the characteristics is defined as pre-frail and presence of 3 to 5 of the characteristics is defined as frail (Fried et al., 2001). Frail elderly people have a higher chance of becoming functionally dependent (Chodzko-Zajko et al., 2009). 


The Study

Exercise is an evidence-based intervention which can slow down functional dependence and improve physical functioning (Liao et al., 2019). Combined exercise (CE) can improve gait, balance and muscle strength, as well as reduce fall risk in community-dwelling elderly. It is yet unclear what the effect is of CE on frailty status.

Next to CE, exergaming (EXR) has turned out to be a regarded tool for therapy. Nevertheless, it is unknown whether exergaming has a larger effect on frailty and physical performance, compared to CE. Therefore, the goal of the study of Liao et al. (2019) was to see what the effects of exergaming and CE are on frailty and physical performance of elderly.

In total, 52 frail and pre-frail elderly participated in this study (27 in the EXR-group and 25 in the CE-group). Elderly in the EXR-group joined 36 sessions of exergaming of 60 minutes, over 3 months. Elderly in the CE-group joined 36 sessions of CE of 60 minutes, over 3 months.

Results of the study

43.7% of the elderly in the EXR-group improved their frailty status from frail to pre-frail and 72.7% improved from pre-frail to a robust status.

- 37.5% of the elderly in the CE-group improved their frailty status from frail to pre-frail and 44.4% improved from pre-frail to a robust status.

-Elderly in the EXR-group showed a significant greater improvement in dynamic balance compared to elderly in the CE-group.

- Elderly in the EXR-group showed a significant improvement in 4 out of 5 physical characteristics and elderly in the CE-group showed a significant improvement in 3 out of 5 physical characteristics. Elderly in the EXR-group showed a significant improvement in the physical characteristic exhaustion, elderly in the CE-group didn’t;

- Elderly in the EXR-group showed a significant improvement in the lower extremity muscle strength, endurance, agility, dynamic balance, walking speed, grip strength and fear of falling.


Liao et al. (2019) concluded that exergaming is at least as beneficial as combined exercise for frail and pre-frail elderly, and results in an improvement in frailty status and the physical characteristics of frailty, possibly based on an improvement in physical performance.


The SilverFit 3D, a virtual therapy system, has been designed specifically for use by older people. It offers exergames to train gross motor skills and ADL tasks during rehabilitation sessions or supervised exercise programs.

The SilverFit 3D also includes an exercise program specifically for fall prevention.

Would you like to see the SilverFit 3D at work? We gladly demonstrate our products at your location, without obligation.


Chodzko-Zajko, W. J., Proctor, D.N., Fiatarone Singh, M.A., Minson, C.T., Nigg, C.R., Salem, G.J., & Skinner, J.S. (2009). American College of Sports Medicine position stand. Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise, 41, 1510-1530.

Collard, R.M., Boter, H., Schroevers, R.A., & Oude Voshaar, R.C. (2012). Prevalence of frailty in community-dwelling older persons: A systematic review. Journal of the American Geriatrics Society, 60, 1487-1492.

Gobbens, R.J., Luijkx, K.G., Wijnen-Sponselee, M.T., & Schols, J.M. (2010). Toward a conceptual definition of frail community dwelling older people. Nursing outlook, 58, 76-86.

Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., McBurnie, M.A. (2001). Frailty in older adults: evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(3), M146-156.  

Liao, Y.Y., Chen, I.H., & Wang, R.Y. (2019). Effects of Kinect-based exergaming on frailty status and physical performance in prefrail and frail elderly: A randomized controlled trial. Scientific Reports, 9(9353).