#NHS70 The NHS highlights its use of digital innovation through MIRA and other solutions. Watch the video here

Case study of an 80-year-old woman and 90-year-old man using MIRA

Case study

by Dr. Emma Stanmore, Lecturer in Nursing at the School of Nursing, Midwifery and Social Work – The University of Manchester and Wytske Meekes, Research assistant.



One in three older people (aged 65 years or older) fall each year, which can result in physical and psychological problems such as fractures, disability, reduced independence, fear of falling and poor quality of life. Falls also result in a significant economic burden due to increased healthcare utility. Specific strength and balance exercises are associated with a reduced risk of falling. MIRA Rehab in conjunction with the University of Manchester have developed evidence based falls prevention Exergames with and for older people to reduce falls risk. Two people who have used these Exergames are Bert and Joy. Bert is a 90-year-old man who used the Exergames independently in his apartment. He enjoys playing the Exergames because they keep him fit and he enjoys the mental challenge. Joy is an 80-year-old woman who played Exergames to maintain her physical and cognitive function, and to maintain her independence. The University of Manchester research study in which Bert and Joy participated and previous studies have shown that Exergames are an enjoyable way to exercise and improve health. Therefore, MIRA Exergames are recommended for older people to improve their physical function and reduce the risk of falling.



Worldwide, the proportion of older people is increasing (UN, 2013). Falls are a common and often devastating problem among older people, with a third of people aged 65, and half of people over the age of 85 fall each year (Gillespie et al., 2012). Falls may result in increased morbidity, mortality, use of health care services and may precipitate entry into institutional care. Most falls are associated with identifiable risk factors (e.g. muscle weakness, unsteady gait, and certain medications), and research has shown that modifying these risk factors can significantly reduce rates of falling (Rubenstein, 2006). Robust evidence now documents that the most effective and cost-effective fall reduction programmes involve fall risk assessment and interventions such as exercise programmes and hazard-reduction programmes. One of the best singular methods to reduce the risk of falling is by improving lower limb strength and balance through exercise (Gillespie et al., 2012). For this reason MIRA Rehab and the University of Manchester have co-developed Exergames with older people to improve physical function and reduce falls risk in an enjoyable way.


Bert and Joy

One of the people who currently uses MIRA-Exergames to prevent falls and to improve his physical function is Bert. He is 90 years old and was not previously familiar with computers. Bert lives alone in his apartment in an extra care housing facility. He fell the year before using the exergames which caused some minor injuries. He started doing the Exergames because he wanted to reduce his risk of falling and improve his health. In the beginning he had found the exercises more difficult to do but after playing them more often he said “it improved my hip and back and things like that. It helps you”. Bert played the Exergames 3 times a week for about 20 minutes. He says that the Exergames “keep you fit and active… It keeps you active.. It’s healthy for you. And it’s recommended for everybody”. Besides the physical improvements he also believes that “It helps your mind as well. It keeps your mind active”.



Bert using MIRA at home


Another person who used MIRA-Exergames is Joy. She is 80 years old and lives in the same extra care housing facility as Bert. She is a healthy woman who is involved in different activities. Joy noticed the improvements in Bert and said: “Well I can see the improvement in Bert, I can see that for myself. Because he now doesn’t use his walking stick.” Joy started using the Exergames because “It makes me feel that I am doing the right thing trying to keep myself mobile. Because otherwise I would have trouble with bending down and those kind of things. So I think it helps to keep me where I should be or where I need to be.” Joy also believes that MIRA-exergames help her to maintain and improve her cognitive function, which is very important for her because she wants to reduce the risk of getting dementia.


Joy using MIRA at the clinic



The results of the study, in which Bert and Joy participated, show that MIRA-Exergames do improve physical function and are an enjoyable way for older people to reduce the risk of falling. The results also indicate that the Exergames may improve cognitive function, however larger studies are needed to test this further. The findings of the study in which Bert and Joy participated are in line with other studies about Exergames. Some previous studies show that the Exergames do improve cognitive function which might reduce the risk of, for example, dementia (Anderson-Hanley et al., 2012; Staiano & Calvert, 2011). Previous studies also have shown that Exergames are an enjoyable way to improve physical function (Fitzgerald, 2010; Osorio et al., 2012; Rosenberg et al, 2010; Van Diest, 2013). Therefore, MIRA-Exergames are recommended for older people to improve physical function and reduce the risk of falling.


Key points

  • Exergames can improve the user’s physical function and reduce the risk of falling.
  • Exergames are an enjoyable way to exercise and reduce the risk of falling.

More about this research has been presented at the Conference of the Gerontological Society of America in November 2015, Orlando, USAand in the Journal of Software Sustainability Institute in February 2015.



Anderson-Hanley, C., Arciero, P. J., Brickman, A. M., Nimon, J. P., Okuma, N., Westen, S. C., … & Zimmerman, E. A. (2012). Exergaming and older adult cognition: a cluster randomized clinical trial. American journal of preventive medicine, 42(2), 109-119.
Den Hertog, P., Stam, C., Valkenberg, H., Bloemhoff, A., Panneman, M., & Klein Wolt, K. (2013). Letsel in Nederland. Letsels en letselpreventie.
Fitzgerald, D., Trakarnratanakul, N., Smyth, B., & Caulfield, B. (2010). Effects of a wobble board-based therapeutic exergaming system for balance training on dynamic postural stability and intrinsic motivation levels. journal of orthopaedic & sports physical therapy, 40(1), 11-19.
Geraets, J. J. X. R., Calders, P., Nijs, J., & van Wilgen, C. P. (2014). Oefentherapie. In Jaarboek Fysiotherapie Kinesitherapie 2015 (pp. 107-109). Bohn Stafleu van Loghum.
Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 9(11).
Glerum E. (2013). Wat is vallen, en wat zijn de oorzaken en gevolgen? Regionaal Kompas Volksgezondheid. Retrieved March 10th, 2015 from http://www.regionaalkompas.nl/zuid-holland-west/thema-s/vallen-ouderen/wat-is-vallen-en-wat-zijn-de-oorzaken-en-gevolgen/.
Karlsson, M. K., Vonschewelov, T., Karlsson, C., Cöster, M., & Rosengen, B. E. (2013). Prevention of falls in the elderly: a review. Scandinavian journal of public health, 41(5), 442-454.
Osorio, G., Moffat, D. C., & Sykes, J. (2012). Exergaming, exercise, and gaming: Sharing motivations. GAMES FOR HEALTH: Research, Development, and Clinical Applications, 1(3), 205-210.
Rosenberg, D., Depp, C. A., Vahia, I. V., Reichstadt, J., Palmer, B. W., Kerr, J., … & Jeste, D. V. (2010). Exergames for subsyndromal depression in older adults: a pilot study of a novel intervention. The American Journal of Geriatric Psychiatry, 18(3), 221-226.
Rubenstein, L. Z. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing, 35(suppl 2), ii37-ii41.
Staiano, A. E., & Calvert, S. L. (2011). Exergames for physical education courses: Physical, social, and cognitive benefits. Child development perspectives, 5(2), 93-98.
United Nations (UN) (2013). World population ageing 2013, Economic & Social affairs. Retrieved November 5th, 2014 from http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf.
Van Diest, M., Lamoth, C. J., Stegenga, J., Verkerke, G. J., & Postema, K. (2013). Exergaming for balance training of elderly: state of the art and future developments. J Neuroeng Rehabil, 10(101), 0003-10.
World Health Organization. Ageing, & Life Course Unit. (2008). WHO global report on falls prevention in older age. World Health Organization.

Subscribe to our Newsletter

We'd love to stay in touch and if you're interested to hear about some of our most important news and achievements, please consider subscribing to our periodic newsletter below.