Comparison of neuromuscular and cardiovascular exercise intensity and enjoyment between standard of care, off-the-shelf and custom active video games for promotion of physical activity of persons post-stroke

Abstract

Background: Active video games have been embraced for the rehabilitation of mobility and promotion of physical activity for persons post-stroke. This study seeks to compare carefully matched standard of care stepping activities, off-the-shelf (non-custom) active video games and custom active video games that are either self-paced or game-paced for promoting neuromuscular intensity and accuracy, cardiovascular intensity, enjoyment and perceived effort.

Methods: Fifteen persons (ages 38-72) with mild to moderate severity in the chronic phase post-stroke (average 8 years) participated in a single group counter balanced repeated measures study. Participants were included if they were greater than 6 months post-stroke, who could walk 100 feet without assistance and stand unsupported for three continuous minutes. They were excluded if they had cardiac, musculoskeletal or neurologic conditions that could interfere with repeated stepping and follow instructions. In a single session located in a laboratory setting, participants executed for 8.5 min each: repeated stepping, the Kinect-light race game, two custom stepping games for the Kinect, one was repeated and self-paced and the other was random and game paced. Custom video games were adjusted to the participants stepping volume. Ten-minute rest periods followed the exercise during which time participants rested and completed the PACES an enjoyment questionnaire. Participants were instrumented with a metabolic cart and heart rate sensor for collection of cardiovascular intensity (METs and % of max HR) data. Stepping frequency, accuracy and pattern were acquired via video. Data were analyzed using a RMANOVA and post-hoc comparison with a Holm's/Sidak correction.

Results: Neuromuscular intensity (repetitions) was significantly greater for the off-the-shelf and self-paced custom game, however accuracy was greater for the custom games. Cardiovascular intensity for all activities took place in the moderate intensity exercise band. Enjoyment (measured with a questionnaire and rankings) was greater for the custom active video games and rate of perceived exertion was lower for the custom active video games.

Conclusions: Custom active video games provided comparable intensity but better accuracy, greater enjoyment and less perceived exertion than standard of care stepping activities and a carefully matched off-the-shelf (non-custom) video game. There were no differences between the game-paced and self-paced custom active video games.

Trial registration: NCT04538326.

Keywords: Active video games; Exergaming; Kinect; Stroke; Virtual reality.

Conflict of interest statement

Dr. Deutsch is a named inventor on the VSTEP which was the system used for the custom games reported in this study.

Figures

Fig. 1

The study protocol. The two blocks of the study conditions: kinect light race (Kinect-LR) and VSTEP random, and standard of care (SOC) and VSTEP repeated are counterbalanced for each subject; PAR-Q Activity Readiness Questionnaire, PACES Physical Activity Enjoyment Scale

Fig. 2

Comparison of total steps repetition (a) and total march repetition (b) between standard of care (SOC) and three active video games (n = 11)

Fig. 3

Comparison of step accuracy with the affected (AFF) and the unaffected (UNAFF) lower extremities between three active video games (n = 9)

Fig. 4

Comparison of mean percent of max heart rate between standard of care (SOC) and three active video games (n = 11). Area of recommended target heart rate for aerobic training for people after stroke is indicated between the doted lines [48]

Fig. 5

Comparison of mean and maximum metabolic equivalent (METs) between standard of care (SOC) and three active video games (n = 11). The mean values are marked with red dashed line. Area of moderate exercise intensity is indicated between the doted lines