Physical Training


Current Trends and Propositions for the LLM service


Physical inactivity is a major risk factor for developing chronic diseases such as coronary artery disease and undergoing a serious stroke. It also increases the possibility for other risk factors to occur, like obesity, high blood pressure, a low level of HDL ("good") cholesterol and diabetes. Even modest levels of physical activity are beneficial and could act as a great prevention strategy against the development of any chronic disease. Older adults and people with disabilities can gain significant health benefits with a moderate amount of physical activity, preferably on a daily basis. Physical activity does not need to be strenuous to cause changes on one’s fitness. Therefore it is really important for seniors to include physical activity as part of a regular routine.

Effects of physical exercise on older adults
Nowadays, it is a common knowledge that older adults, aged 65+ years, lack physical health and more often they suffer from severe mobility problems of the upper and lower body [1]. A significant amount of older population tends to have a sedentary life, which is characterized by a complete absence of any kind of physical activity among their daily living activities [2]. Therefore, the observed physical health deficit must not be considered only as a result of the aging process itself, but it is also reinforced by their lifestyle and especially their sedentary lifestyle. To that extent, increased physical activity has to become a part of the daily habits of seniors, as it will certainly have many positive physical and psychological effects on both healthy and chronically ill older adults [3].
According to a definition given by WHO (World Health Organization): “Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure” Why Move for Health. Everyone needs to be engaged in moderate physical exercise, on a daily basis, for at least 30 minutes . There is sufficient evidence that people, who try to keep fit through exercise, are benefited to a certain extent in several aspects of their health, including the following:

A reduced risk of cardiovascular disease (coronary artery disease), which is responsible for a significant percentage of deaths among the western world.
• Prevention of the development of arterial hypertension (number one factor for stroke incidents) and improved control of arterial blood pressure in individuals who suffer from hypertension.
• Increased fat utilisation which can help to control weight, lowering the risk of obesity.
• Maintenance and improvement in muscular strength and endurance, resulting in an increase in functional capacity to carry out activities of daily living.
• Maintenance of motor functions, including strength and balance.
• Maintenance of cognitive functions and decreases the risk of developing depression and dementia in senior citizens.
• In older adults, a lower risk of falling and prevention or delaying of chronic illnesses associated with ageing.

Physical activity, including strength and balance plays an important role in improving the quality of life of seniors. While studies have not shown any significant effects of regular physical activity on life expectancy of older adults, improved physiological and psychological conditions help maintain independence, better quality of life and reduce demands for intensive and chronic care services.

A systematic exercise program targeted to elderly people should include four types of exercise, which will contribute to the improvement of the overall fitness of the seniors. The types of exercises considered for incorporation into such kind of program include:
• Exercises such as gait, swimming, running and cycling, which target to the improvement of the cardio respiratory system. They should be executed on a daily basis for at least 30 minutes.
• Muscle strength exercises are related to weightlifting. These exercises shall be executed 2-3 times a week.
• Balance targeted exercises are important because they prevent falls. They could be incorporated into a daily program of muscle strengthening.
• Flexibility exercises (distensions) conserve muscle flexibility and protect from injuries. Distensions should be executed in the beginning and at the end of every training program.

In order for a training program to deliver promising results on the seniors’ fitness, it is very important to personalize it, corresponding to the level of fitness that can be achieved and taking into account their specific needs. Last but not least, special attention is needed for the role of physical activity in case of development of age-associated impairment, functional disability, and cognitive decline. The effectiveness of a training program depends on the total period and the frequency that an individual participates into it. Therefore a fitness program shall be applied for at least three times a week for a continuous period of 3 months. Also a training session is recommended to last one hour and has to be divided into three parts: the warm-up phase, the main part phase and recovery phase. Time to be spent at warm up phase should be around 25 minutes, at main part around 30 minutes and at recovery 5 to 10 minutes.

ICT and physical activity: Current trends and the LLM project

Currently, there are many available technological resources that could be incorporated into a fitness training program. Apart from the traditional gym equipment, such as plain stationary or ergometer bikes, treadmills, dumbbells, there is also a new trend in the way physical exercise is performed, the “exergaming”. Exergaming, which has drawn lately the attention of training experts, is a form of exercise through the use of video games whose main focus is the improvement and promotion of physical health of individuals. The way individuals can train themselves through a video game, is to physically interact with its content. Physical interaction means that a trainee via his/her body movements can manipulate a virtual character on the game screen, imitating this way a plethora of sport activities, like walking or running. Great examples of exergaming platforms are Nintendo Wii Fit, DDRs (Dance Dance Revolution) like Dance Town (focuses on the elderly population), ConnectAndPlay, Positive Gaming and many others. Nintendo Wii is a semi-virtual game platform, where end users move their body according to the advices of a virtual trainer. Sensors that are attached to the peripheral devices of the console (Nintendo Wii Remote and Wii Balance Board), such as 3D accelerometers and pressure sensors, recognize the type and orientation of movement and provide these raw data to the game logic, where they are processed and depicted through an avatar. Charts and motivation messages provide users appropriate information on their progress and encourage them to continue practicing. DDR is a representative genre of a dance game, where people have to follow dance patterns by hitting the correct arrow with their feet, according to the way arrows are being displayed on a screen. DanceTown consists such a platform which mainly targets seniors and focuses on the locomotion training of its participants through interactive dancing.

LLM approach
Throughout the LLM trials a combination of traditional training equipment and exergaming facilities will be used in order to carry out the physical training program of the intervention group. The intention of the project is to integrate into its ICT system different kinds of training platforms, providing users the flexibility to choose among them the most suitable to their needs and their socio-economical status. Therefore, LLM incorporates ergometer bikes, treadmills and low-cost exergaming facilities like the ones of Nintendo Wii. More specifically, LLM makes use of a custom-developed game platform, namely the FitForAll platform , which is operated by end users movements. The only prerequisite is Wii related peripheral devices such as Wii Remote and Wii Balance Board.
Several games have been developed according to the needs of a special target group as the elderly citizens. FitForAll apart from being a game platform, used by many categories of players of all ages, can be used for the monitoring of senior patients’ physical health progress. FitForAll can be used by therapists in order to collect statistics from games played by seniors, helping them assess more easily seniors’ physical condition and where possible, to adapt each senior’s training program according to their observations. Each game has many different levels of difficulty, which vary from easy to expertise level. This way, seniors who are starters could cope with game tasks and are encouraged to continue their efforts to the next level. Also more experienced players will not be frustrated and bored in case they find to easy a game play, as they can move on to the next more challenging level. The above approach helps seniors stay engaged to the game until they finish their training and achieve their goals. Finally, attention has been paid to the design of the user interface of the games, as it stands as the main feedback means between the game and the end user (seniors). As seniors may face several vision deficits, suffer from hearing loss or cognitive decline special care must be taken on the way game content and feedback information and messaging is being presented and passed to them.
The main interaction scenario between the senior and the FitForAll platform is clearly depicted in the following image.

Figure 1 FitForAll exergame platform


1. Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age Ageing 1999; 28:121–5.
2. Berger, B.G., McInman, A. Exercise and the quality of life. In: Singer, R.N., Murphey, M., Tennant, L.K. (Eds.) 1993, Handbook of Research on Sport Psychology. Macmillan, New York, pp. 729-760.
3. Geffken D, Cushman M, Burke G et al. Association between physical activity and markers of inflammation in a healthy elderly population. Am J Epidemiol 2001; 153:242–250.