Currently accepted at: JMIR Serious Games
Date Submitted: Feb 14, 2018
Open Peer Review Period: Feb 15, 2018 - Apr 19, 2018
Date Accepted: Jul 12, 2018
(closed for review but you can still tweet)
Active video games for rehabilitation in respiratory conditions: a systematic review and meta-analysis
Exercise and physical activity are key components of treatment for chronic respiratory diseases. However, physical activity levels and adherence to exercise programs is low in people with these diseases. Active video games (AVG) may provide a more engaging alternative to traditional forms of exercise.
This review examines the effectiveness of game-based interventions on physiological outcome measures, as well as adherence and enjoyment, in subjects with chronic respiratory diseases.
A systematic search of the literature was conducted, with full-texts and abstracts included where they involved an AVG intervention for participants diagnosed with respiratory conditions. A narrative synthesis of included studies was performed. In addition, meta-analysis comparing AVGs to traditional exercise was undertaken for four outcome measures: mean heart rate (HR) during exercise, peripheral blood oxygen saturation (SpO2) during exercise, dyspnoea induced by the exercise and enjoyment of the exercise.
A total of 13 full-text articles corresponding to 12 studies were included in the review. Interventions predominantly used games released for the Nintendo WiiTM (eight studies) and Microsoft Xbox KinectTM (three studies). Trials conducted over more than one session varied in duration between 3 and 12 weeks. In these, AVG interventions were associated with either similar or slightly greater improvements in outcomes such as exercise capacity when compared a traditional exercise control and also generally demonstrated improvements over baseline or non-intervention comparators. There were few studies of unsupervised AVG interventions, but these reported adherence was high and maintained throughout the intervention period. In addition, AVGs were generally reported to be well-liked and considered feasible by participants. For outcome measures measured during a single exercise session, there was no significant difference between AVGs and traditional exercise for HR (mean difference=1.44 beats per minute, 95% CI (confidence interval) [-14.31, 17.18]), SpO2 (mean difference=1.12 percentage points, 95% CI [-1.91, 4.16]) and dyspnoea (mean difference=0.43 Borg units, 95% CI [-0.79, 1.66]), but AVGs were significantly more enjoyable than traditional exercise (standardised mean difference=1.36, (95% CI [0.04, 2.68]).
This review provides evidence that AVG interventions, undertaken for several weeks, can provide similar or greater improvements in exercise capacity and other outcomes as traditional exercise. Within a single session of cardiovascular exercise, AVGs can evoke similar physiological responses as traditional exercise modalities but are more enjoyable to subjects with chronic respiratory diseases. However, there is very limited evidence for adherence and effectiveness in long-term unsupervised trials, which should be the focus of future research.
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