Nymbl app

Nymbl describes itself as an app-based digital health platform. It involves a combination of balance and cognitive games and training to target improving balance and mobility – especially for older populations. It's designed to improve balance and mobility for people with a recognised risk of falling who are over the age of 50 years.

The app has an initial questionnaire, training modules, feedback and calendar options to ensure that training can be tracked and progressed at an appropriate level.

It would be most helpful for people with a history of falling, or with concerns around balance or mobility. It's unlikely that younger people without balance concerns would get significant benefit from the app.

It's acknowledged that currently in Aotearoa New Zealand, if someone is having a fall/accident, they are likely to get physiotherapy input aimed at improving their balance. However, if they haven’t yet had a fall, but are concerned about their balance, they might not necessarily get health professional input. This app will be especially helpful to ensure that those in that group can work on their balance, and hopefully prevent future falls.

For the complete app description, go to the app website(external link), Google Play(external link), App Store(external link) or, for a more detailed review, see reviews below. 

Clinical review

Reviewer: Chris Lawrence, Community-based Physiotherapist
Date of review: October 2023
Version: 9.02.29111
Platform: Android
Comments: This is an excellent app. It assesses, and then looks to improve users' balance through a range of balance and cognitive activities.
Each activity starts with a clear description of the balance exercise, as well as instructions for how to make it easier, or how to make it harder. The user then selects a cognitive task to do, while balancing. These tasks are generally quite fun, and are helpful to direct the attention of the user away from the balancing task.
In summary, the app is a safe, and effective way of helping an individual to work on their balance, in a fun way and time-effective manner.
Safety concerns: No. It is acknowledged that any app-based model for delivering balance exercises does have a degree of safety risk. The app mitigates this well by having an initial questionnaire, by having regular check-ins focused on exercise difficulty, and giving options for making exercises easier if needed.
New Zealand relevance: Yes.
Concerns: Although the app has been created in the US, it is very applicable to a NZ audience. There is a ‘Kia ora’ section of trivia questions too, which are very specifically for a New Zealand population.

Clinical review

Reviewer: Chris Lawrence, Community Physiotherapist
Date of review: June 2023
Version:8.05.038
Platform: Android
Comments: Overall, this is an excellent app. Acknowledging that there is a limit to what can be provided through an app designed to correct balance (as compared to face-to-face input), this is very well-designed. The app is aimed at a really safe level, and pre-training questionnaire questions and post-training feedback help to ensure this. The app has excellent explanations and the level of variety of options, coupled with the calendar and reminder functions, should help to ensure that most users will get a lot of benefit out of the app.
Safety concerns: No – this app is designed at an appropriate level.
There is a statement very early on that the app should be used following medical advice and is not a substitute for medical input – this is important information to have.
There is a very good questionnaire that a user does at the start of the app, which helps to determine a safe level of exercises. This includes questions such as whether someone has a history of falling, how they get up from a chair and questions related to mood. My assessment based on these results is that the level of training is still quite conservative based on these results, which is an appropriate safety response to take from an app.
In general, any face-to-face balance training would typically try and involve a high level of challenge. This would allow for the quickest improvement in balance. However, in an app, there isn’t the same option to have someone standing nearby for support, so as a result it is appropriate for an app to be more conservative, or safety-conscious with the level of training, to minimise risk. This app does that well.
Additionally, feedback questions around pain in a session, and level of difficulty make sure that it is pitched at a safe level.
New Zealand relevance: Yes.
Concerns: This app provides excellent practical advice that would be very applicable to a NZ (or wider) context.