Not all Wii fit balance interventions have been game-based. Shih[ 42], for example, used a unique approach that encouraged individuals with Cerebral Palsy to become more aware of their COP location. In this experiment, a customized WBB setup was used to activate participants’ favorite television programs when standing on the board with their COP centered between the feet. Deviation from this ideal resulted in the television program being turned off. Even though the participants had reduced cognitive abilities, they were able to implicitly learn COP control over multiple trials and keep the television on for longer periods of time than normal. An increased percentage of trials with the desired COP location were also found in retention trials with the television stimulus constantly on. Efficacy of Wii Fit-based interventions BC is currently pursuing a Master’s degree in Rehabilitation Sciences and has Undergraduate Training in the field of Exercise and Nutritional Sciences. He has clinical experience in the field of physical therapy including balance intervention for individuals with disabilities. Padala KP, Padala PR, Malloy TR, Geske JA, Dubbert PM, Dennis RA, Garner KK, Bopp MM, Burke WJ, Sullivan DH: Wii-Fit for Improving Gait and Balance in an Assisted Living Facility: A Pilot Study. J Aging Res 2012, 2012: 597573. According to Puhl, kids are especially vulnerable when it comes to weight. “We know from research that weight is one of the most prevalent reasons that kids are teased or bullied,” she said.

Fitness, in this instance, isn’t a harsh reality, full of punitive measures. Ring Fit Adventure poses being active as an expression of joy.Of the studies gathered for this review, only three were identified as having some form of randomized control design. The best insight into the overall effectiveness of Wii Fit interventions might be gained from this work by calculating effect sizes for the mean outcome measure differences. First, in a study by Franco et al.[ 28], it was shown that six, 15-minute sessions of Wii Fit exer-gaming had a strong effect (Cohen’s d = 0.7) on Berg Balance score in a group of community dwelling older adults compared those that did not use the Wii Fit. Toulotte et al.[ 14] also found moderate to strong effects across all balance outcome variables in a study of older adults who played Wii Fit games one hour per week for 20 weeks. Balance measures in this study included unilateral stance tests with eyes open (Cohen’s d = 0.5) and eyes closed (Cohen’s d = 1.3), Tinetti’s static (Cohen’s d = 3.8) and dynamic (Cohen’s d = 1.0) tests, as well as the Wii Fit test of center of balance (Cohen’s d = 1.9). Toulotte C, Toursel C, Olivier N: Wii Fit(R) training vs. Adapted Physical Activities: which one is the most appropriate to improve the balance of independent senior subjects? A randomized controlled study. Clin Rehabil 2012, 26: 827-835. 10.1177/0269215511434996 Shih CH: A standing location detector enabling people with developmental disabilities to control environmental stimulation through simple physical activities with Nintendo Wii Balance Boards. Res Dev Disabil 2011, 32: 699-704. 10.1016/j.ridd.2010.11.011 Gray P, Hildebrand K: Fall risk factors in Parkinson's disease. J Neurosci Nurs 2000, 32: 222-228. 10.1097/01376517-200008000-00006 Owens SG, Garner JC 3rd, Loftin JM, van Blerk N, Ermin K: Changes in physical activity and fitness after 3 months of home Wii Fit use. J Strength Cond Res 2011, 25: 3191-3197. 10.1519/JSC.0b013e3182132d55

Billis AS, Konstantinidis EI, Mouzakidis C, Tsolaki MN, Pappas C, Bamidis PD: A Game-Like Interface for Training Seniors’ Dynamic Balance and Coordination. In IFMBE Proceedings Edited by: Bamidis PD, Pallikarakis N. 2010, 691-694.The Wii Fit software includes several means of assessing balance ability. Once the Wii Fit software is loaded, participants are first encouraged to perform a “body test” that comprises both “center of balance” and “body control” measures of balance control. In the center of balance assessment, participants stand still on the WBB for 7 s while COP data is collected. From this data, the participant’s average COP deviation from body midline is calculated, indicating a measure of weight bearing asymmetry. Overall, this assessment is thought to provide information about body posture with the assumption that having an equal distribution of weight between left and right legs is ideal. This frustrated Osu, because the Wii Fit avatars weren’t very accurate. “Body types are so different,” she said, noting that “just because you got a certain score doesn’t mean you look a certain way, yanno?” We know from research that weight is one of the most prevalent reasons that kids are teased or bullied.” This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Gil-Gomez JA, Llorens R, Alcaniz M, Colomer C: Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. J Neuroeng Rehabil 2011, 8: 30.

Reed-Jones RJ, Dorgo S, Hitchings MK, Bader JO: WiiFit Plus balance test scores for the assessment of balance and mobility in older adults. Gait Posture 2012, 36: 430-433. 10.1016/j.gaitpost.2012.03.027 Teasell R, McRae M, Foley N, Bhardwaj A: The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk. Arch Phys Med Rehabil 2002, 83: 329-333. 10.1053/apmr.2002.29623 Several attempts have been made to use raw COP data from a customized WBB for balance assessment. Young et al.[ 19], demonstrated that customized WBB COP data could be used to assess changes in older adult balance following a specially designed, game-based intervention over four weeks. Before and after training, six elderly participants undertook a traditional balance test (i.e. Romberg Test) whereby they stood as still as possible on the WBB for two, 30 s trials - one with eyes open and one with eyes closed. The COP data collected showed anterior-posterior COP variability was positively reduced by the intervention, but only in more difficult trials where visual information was not available (i.e. eyes closed conditions). Increases in body sway for individuals with Autism[ 12] and Hearing Loss[ 37] have also been measured with custom WBB COP.DG is currently an Assistant Professor and director of the Sensorimotor and Rehabilitation Technology Laboratory (SMaRTlab). He has a Master’s degree in Biomechanics, Phd in Human Motor Control and has done post-doctoral work in the field of sensorimotor neuroscience. His past work on balance has focused on proprioception and brain function using neuroimaging. Most balance interventions involving the Wii Fit system have relied on the balance-specific exer-games included with the Wii Fit software. The goal of the Wii Fit balance games is to move a virtual representation of the participant (called a “Mii”) on a television screen via displacement of participant COP over the WBB. In some games, COP control is only required along a single axis (e.g. medial-lateral), making control of the character more simplistic for the user. In contrast, other games entail greater COP control through simultaneous displacement along both medial-lateral and anterior-posterior axes. Most games last between 30s and 3 min and participants are given a game-specific score after playing that is reflective of their overall performance. An excellent analysis of the various games included in the Wii Fit software was recently provided by Deutsch and colleagues[ 25]. Esculier JF, Vaudrin J, Beriault P, Gagnon K, Tremblay LE: Home-based balance training programme using Wii Fit with balance board for Parkinsons's disease: a pilot study. J Rehabil Med 2012, 44: 144-150. 10.2340/16501977-0922