Caregivers who need to spend a significant amount of time caring for family members who are elderly, ill or living with disability often neglect their own health. It’s been demonstrated that regular exercise can improve a person’s health and relieve stress, depression and fatigue, but often caregivers don’t feel comfortable leaving homebound loved ones alone so they can hit the gym or the running track.

“Caregivers may feel guilty about going out, and that can increase their stress,” says Daniel Rosney, assistant professor of instruction in kinesiology. In earlier research, Rosney established that caregivers' recreational physical activity is decreased due to their caregiving duties.

He saw that clinicians were starting to get patients undergoing physical rehabilitation to use home videogame systems like the Nintendo Wii, which can recognize body movements. Therapy using videogame systems to encourage physical movement became widespread enough to earn the nickname “Wii-habilitation,” though it’s somewhat more formally called “exergaming.”

“I thought, if this can be used in a clinical setting, and caregivers are growing in numbers as Baby Boomers age and need to be cared for, this could be helpful to family caregivers as well,” says Rosney. “If they can no longer get to the gym, maybe we can bring a virtual gym component to them.”

In a study whose first results were published in Health Science Journal in 2018, Rosney and Peter Horvath of the State University of New York recruited a group of sedentary adults with similar age, gender and minority composition as the caregiving population in Erie County outside of Buffalo, NY. Subjects were tested for balance, endurance and cardiovascular fitness before and after an eight-week regimen of activities using a “virtual personal trainer” on the Wii Fit system. The group showed improvement in cardiovascular endurance, balance, and lower extremity functional fitness.

The next phase of Rosney’s research, in a paper soon to be published based on the same study, looks more specifically at the stress-mitigation potential of the exergaming intervention. Throughout the testing period, participants completed surveys to self-report their feelings of stress and burden. Separately, their levels of cortisol production, a biomarker of stress, were measured via saliva and hair samples.

“Hair grows roughly one centimeter per month, so when you pluck a strand of hair, it literally becomes like a timeline, so you can see how the cortisol levels chronically have changed over time,” Rosney says.

Analysis shows that the exergaming regimen helped in these stress measures, suggesting the intervention could be helpful to stressed-out caregivers who find it hard to make time for themselves. One factor that shouldn’t be overlooked is that exergaming, like all play, is meant to be fun. That could motivate caregivers to exercise more enthusiastically or regularly, and it can relieve stress as a distraction from everyday problems, Rosney says. It’s the advantage that gaming has over a more work-like exercise intervention such as putting people on a treadmill, he says. Rosney feels the gaming approach could be especially beneficial to caregivers who provide demanding in-home care to patients with dementia. These caregivers experience high stress and elevated rates of morbidity and mortality even years after their time as caregivers. 

“Dementia can have an additional component, where it devolves into an emotionally abusive situation, where the care recipient starts accusing or berating the caregiver,” Rosney says. The problem can build, as caregivers with compromised physical and emotional welfare are less likely to provide quality care, Rosney adds.

Rosney next plans to extend his testing of exergaming’s benefit to active caregivers. “When you put that system in the home, it becomes something that perhaps the caregiver and the care recipient could even do together,” he says.