"Recently there has been an increase in the development of physically interactive gaming systems. Wii Fit Plus, a follow-up to the initial Wii Fit, was released for the Nintendo Wii in North America in 2009. The Ninendo Wii combines player's total body movements with motion sensitive joysticks which elicits virtual in-game response (Barkley & Penko, 2009). Wii Fit Plus uses a combination of a balance board and joysticks to allow players to undergo different exercise protocols. The original Wii Fit is currently the third bestselling console game in history, while Wii Fit Plus is the seventh bestselling (Nintendo Co., Ltd., 2010). The sales records indicate the extreme popularity of the Wii Fit franchise and its use as an alternative form of exercise. A complete physical fitness program in adults should include cardiovascular endurance, muscular strength, flexibility, and balance training (Clark, 2007). The Wii Fit Plus incorporates all of these components through programs such as yoga, strength training, aerobics, and balance training. The purpose of this study was to determine if the adult population can increase strength and balance after utilizing a Wii Fit Plus exercise protocol. Can the Wii Fit Plus be used as a practical alternative to traditional exercise? It is important to explore alternative forms of exercise because public facilities can be too expensive to utilize. One study shows that easy access to a facility or equipment was a major factor in compliance with an exercise program (Nitz et al., 2009). Since the Wii Fit Plus is easily accessible and relatively inexpensive, it has the potential to be an alternative exercise tool if proven to be effective. Furthermore, it can also be significant in determining if the Wii Fit Plus can be used as a tool for rehabilitation of leg strength and balance or as a preventative exercise tool to decrease the risk of falls related to poor balance. It was hypothesized that the experimental population will experience greater improvements in balance and lower extremity strength as compared to the control population."--Ch. 1.

Background: Since 2006 there has been a surge in the production of interactive video game systems. The Nintendo Wii was the first in this generation of physically active gaming systems as well as the first to utilize the system for exercise. An exercise program for adults should consist of balance training, flexibility training, cardiovascular endurance, muscular strength and muscular endurance training. The Wii Fit Plus incorporates all of these physical fitness components with games that involve yoga, strength training, aerobics and balance games. Purpose: To determine if the Wii Fit Plus can increase flexibility and bone mineral density in an adult population and establish if it can be an effective alternative to traditional exercise. Methods: 28 male and female participants were recruited from the University of Akron's ZipFit program and were evenly distributed into an experimental and a control group. Pre and Post-test measurements were assessed for the dependent variables: flexibility and bone mineral density. Flexibility was assessed using the YMCA Sit and Reach Test while bone mineral density was assessed using the QUS-2 Calcaneal Ultrasonometer. The experimental group underwent an eight week exercise protocol utilizing the Wii Fit Plus while the control group continued on with their normal activities of daily living. Results: 25 participants completed the study successfully. Results were based on numbers from thirteen experimental group members and 12 control group members. An independent samples t-test compared the mean difference of the pre and post-test measurements of the two groups. No statistically significant data was found. A repeated measures ANOVA between the groups also showed no statistical significance in flexibility or bone mineral density. While not statistically significant, an increase in flexibility was observed in the experimental group when compared to the control group. Conclusion: Short time frame and small sample size could explain the lack of significant results. When looking at the results it cannot be concluded that the Wii Fit Plus can sufficiently replace a traditional exercise program and does not have a significant effect on flexibility or bone mineral density.

Adults in industrialized countries are less physically fit than their counterparts twenty-five years ago. Exergames (encouraging players to be physically active through game play) are proposed as one means of encouraging inactive individuals to be active. The Wii Fitness Study tracked physical activity by midlife and older women after they were asked to play the commercially-produced exergame Wii Fit Plus as part of their overall program of physical activity. Thirty participants (ages 40-79) were tracked for three to six months. The data was collected and analyzed based on Kathy Charmaz's constructivist grounded theory approach. Data collection methods included semi-structured interviews, self-reported weekly minutes of activity, Wii console data, and previously validated fitness tests for aerobic endurance, lower body strength, and standing balance. The interviews and fitness tests were conducted at the beginning, mid-point, and conclusion of the study. Unlike traditional approaches, the numerical and textual data were compared using the constant comparative method of qualitative analysis. The frequency of Wii Fit Plus use was determined by the participants. While older and more sedentary players used the exergame throughout the study period, younger and more active participants preferred vigorous-intensity outdoor activities to indoor monitor-based play. For participants whose balance was poor earlier in the study, regular use of Wii Fit Plus improved their ability to stand one-legged. Wii Fit Plus balance games helped women over age fifty-four to determine that many of them could retrain their balancing ability. To participants who had been previously sedentary, the moderate-intensity forms of activity offered by Wii Fit Plus appeared optimal, and success playing the game encouraged those participants to continue their positive exercise experience. Participants wanted to remain 'fit for life', sustaining physical activity in multiple locations using diverse individualized approaches. This study has provided both reasons and evidence suggesting that exergame designers might usefully exhibit the same level of functional creativity as cell phone designers have done. Only then can the exergame become a vital part of an overall program of physical activity, equipping many more of us with the confidence and competence to become, and to remain, fit for life.

The purpose of this study was to determine weather the Wii Fit would improve or maintain balance in elderly women 65--80 years of age. The female participants (n=3) participated in a Wii Fit balance program, which consisted of three sessions per week for 20 minutes, over an eight-week period. The balance games that were implemented for the study were Balance Bubble, Ski Slalom, Table Tilt, Hula Hooping, and the Tightrope Walk. Of the three participants, that completed the study, the mean Pre Berg total was 40 (SD=17.43). The Post Berg total was 41 (SD=20.50), p=.012 indicating a slight improvement in balance. Although the data collected did support the hypothesis, the data did not show a significant difference due to the small sample size.

Abstract: The study was designed to determine if Wii Fittm' training had an effect on balance in participants who have sustained lower extremity injuries. Nineteen participants with a previous history of a lower extremity injury sustained in the last 6 months completed pre- and post- Star Excursion Balance Tests (SEBT), in the following directions: anterior (A), anteromedial (AM), medial (M), posteromedial (PM), posterior (P), posterolateral (PL), lateral (L), and anterolateral (AL). The participants then completed Wii FitTM rehabilitation 3 times a week for 6 weeks. The four Wii Fit games played were Table Tilt, Tightrope Walking, Penguin Slide, and Balance Bubble. Significant differences were seen in pre- and post- SEBT testing through the use of a dependent T-Test. Four-repeated measures ANOVAs were utilized to compare the 6 weeks of rehabilitation for each video game (Table Tilt, Tightrope Walking, Balance Bubble and Penguin Slide). The ANOVAs showed differences in performance on those games across the six weeks. The current video game rehabilitation program improved balance significantly after a 6-week rehabilitation program in college age participants and could be used as an additional rehabilitation tool.

Therapeutic exercises can be found spread out amongst numerous texts, handouts, card boxes, and websites, which has sent clinicians, practitioners, and trainers searching for reliable, evidence-based exercises for the entire body, all packaged into a single, all-inclusive manual. To that end, The Comprehensive Manual of Therapeutic Exercises: Orthopedic and General Conditions was written as a fundamental resource on exercise theory and techniques, and as a comprehensive guide for designing exercise programs. Dr. Elizabeth Bryan has compiled thousands of clinically relevant exercises to create a text that will teach students theory and proper application that they will then return to again and again in their career as a reference to aid in designing evidence-based exercise programs for their clients or patients. Introductory chapters cover exercise parameters, exercise progression, the importance of form, muscle soreness, and a reference for body position terminology, then subsequent chapters are organized by body area to cover most of the clinical exercises in use today. Each exercise includes photographs, a list of muscle systems that will be affected, specific substitutions to look for, and detailed instructions directed at students and clinicians. Also included are sections devoted to protocols and specialty exercises including yoga and tai chi. Embracing the principles of evidence-based practice, “Where’s the Evidence?” boxes are prominently featured throughout the text to support the exercises and theory with up-to-date, relevant, sufficient, valid, and reliable studies. Combining theory with practice, The Comprehensive Manual of Therapeutic Exercises: Orthopedic and General Conditions is an essential tool for students as well as clinicians, practitioners, or trainers to find the most appropriate exercises for their client’s or patient’s needs and apply them properly.