The Effect of Eight Weeks of Game-Based Activity on Static and Dynamic Balance Levels of Boys 8 to 10 Years Old with Flat Feet

The increasing impact of technology on sports is easily visible. Virtual games have entered and embraced sports activities and competitions. In less than a decade, computer games have become so popular that many parents have expressed concern that children's previous physical activity in organized sports competitions has given way to home computer games, but some research has suggested that such games it can play an important role in improving children's brain and intellectual activity (1, 2). Studies show that computer games can have a negative and positive effect on children's behavioral and cognitive processes (2, 4). In recent years, the occurrence of skeletal abnormalities, including flat feet, has been recognized as the most common postural abnormalities of the lower extremities (5). Flat feet have many side effects, including decreased agility, crossed knees, pain in the inner edge of the foot, pressure on the arteries and nerves of the foot, premature fatigue, back pain, and misalignment of the big toe (6). Also, due to the anatomical structure of the foot and its position in the lowest part of the lower limb movement chain and the relatively small level of support on which the body maintains its balance, the smallest body changes in the level of support affect postural control. Due to the fact that the flatness of the soles of the feet changes the way a person walks, it seems that the balance of these people is different from people with normal feet and the body is out of its normal position in the same proportion. And the damage caused by this disruption of the biomechanical structure of the foot will also increase (8). Factor balance is very effective in performing daily movements as well as successful execution of complex sports movements. A review of research shows that skeletal abnormalities, especially abnormalities in the arch of the foot, can have detrimental effects on postural control. Hertel et al. (2002) presented data showing that subjects with flat feet did not show a significant difference in the speed of displacement of the pressure center compared to those with normal soles (16). Tsai et al. (2006) also reported that people with flat feet had poorer postural control than normal people (17). However, some studies have reported different results. For example, in the study of Kamala et al. (2019) who compared physical skills in children with and without flat feet, they reported that there was no difference in the physical function of the lower limbs. There was no strength, balance and agility in a healthy 14- to 17-year-old male athlete with flat feet (18). On the other hand, regarding the effect of computer games on cognitive and motor processes, it has been reported that if a person uses games that rely mainly on increasing speed, one can expect an increase in motor and visual speed in these people (19, 20). In another study on the effect of computer video games on people's behavior, thoughts, and development, Wang (2017) states that video games have an effect on cognitive and motor performance (21). Review studies have shown that computer games have an effective role in improving postural control and balance in children with cerebral palsy (22, 23). Which shows the effect of computer exercises on improving perceptual function to maintain balance. In the field of balance in children with flat feet and also the effect of activity with game console on static and dynamic balance of boys with flat feet, so far a study to investigate the effect of physical activity with game console on static and dynamic balance of boys 8 to 10 years old with flat feet A flexible leg has not been performed, which justifies the need for the present study. Therefore, the present study aimed to determine the effect of eight weeks of active play with game consoles on the arch of the foot and balance in boys aged 8 to 10 years with flat feet.

In the present quasi-experimental study, 30 patients with flat feet (mean age 9.03 years, mean height 138.43 cm and weight 27.52 kg) were selected from non-profit schools in Takestan city by purposive sampling method and were randomly divided into two groups of control and experimental intervention. In the intervention group, the activity with the game console was performed in 8 weeks and every week for 3 sessions of 50 minutes of Gran Tursimo Sport game by the Logitech G29 game command and manual gear. While no intervention was performed in the control group. The stork balance test (24) was used to measure static balance and the star rotation balance test (25) was used to measure dynamic balance. In order to statistically analyze, repeated measures analysis of variance test was used to investigate the effect of intervention on research variables. Statistical analysis was used with SPSS software version 26 and a significant level (P 05 0.05) was considered.

The results showed that no significant difference was observed in the static balance scores of the right and left legs of the subjects. But a significant increase was observed in the dynamic balance index of right and left foot of the subjects (F (1,28) = 21.29 and P = 0.001). The interactive effect of the test and group sessions (F (2,28) = 15.11 and P =0.001) was also significant.

The results of the present study showed that participation in eight weeks of active play with game consoles had a significant effect on the dynamic balance and arch of the soles of the feet of boys 8 to 10 years with flat feet; There is no research that specifically examines the effect of exercise with a game console game on the balance of children with flat foot deformities, and this is the first study to be conducted in this regard. However, in similar studies that have examined the effect of different types of computer games on the balance level of different subjects, the benefits of these games have been identified. In a review study evaluating the effect of computer games on balance and posture control in children with cerebral palsy, Pin (2019) reported that this style of play with moderate to large effect size increases postural control and balance in children with cerebral palsy. Has become cerebral palsy (22). Warner et al. (2020) also reported in a review study that the use of virtual reality games plays an effective role in controlling posture and improving balance in children with cerebral palsy (23). In the present study, although a significant improvement in dynamic equilibrium was observed, no significant difference was observed in static equilibrium. Conner et al. (2019) also reported in their study that dynamic, but not static, standing balance performance may improve with normal growth between the ages of 5 and 12 (28). Dynamic balance practicability in the present study is probably due to the lack of change in dynamic balance due to the short duration of the intervention and also the role of growth as an interfering factor on static balance practicability. In the field of improving the dynamic balance of people with flat feet after participating in games with active game consoles, it is clear that physical activity leads to improved perceptual and physical parameters related to balance and also according to the results of the present study to help improve children's foot arch. In total, it can be said that eight weeks of activity with computer games has a beneficial effect on improving dynamic balance in children with flat feet, which can play an effective role in their motor function.