effects of wii versus traditional supervised exercise on the functional fitness of moderately frail...

Cindy Ng · Lori Pang · Lionel Lim · Nurul Atiqah · Vicky Neo

Effects of Wii versus traditional supervised exercise on the functional fitness of moderately frail Chinese population- A Pilot Study

Contents

I. Introduction

II. Objective

III. Clinical Significance

IV. Hypothesis

V. Outcome measures

VI. Exercise protocol

VII. Methodology

VIII. Results & Discussion

X. Limitations

XI. Current Directions

XII. Conclusion

IntroductionFFunctional fitness unctional fitness is the physiologic capacity to perform normal everyday activities safely and independently without undue fatigue (Rikli & Jones, 1999)

Increasing age, frailty sets in. (Gobbens et al, 2010)

Frail = Frail = Functional fitnessPhysical activity(Fried et al, 2001) ExerciseExercise

(Barreto, 2009, Peterson et al, 2010)(Barreto, 2009, Peterson et al, 2010)

Exercise Effects on Frailty

• Improved muscular strength and endurance

• Increased aerobic capacity

• Enhanced joint flexibility

• Improved balance and coordination

• Improved psychological well-being

(ACSM’s exercise Management for Persons with Chronic Diseases and Disabilities, 2003)

Why Wii?

Easily available

Fun and engaging

Ongoing feedback

Choice of exercising at home

Objective

To compare the effects of a 12 week program of Wii vs traditional supervised exercise in the

improvement of the functional fitness of the moderately frail elderly

There is no difference between the effects of Virtual Reality (Wii) and traditional supervised exercise in

improving functional fitness

Methodology100 subjects screened

1) Inclusion and exclusion criteria2) Patient information sheet

Informed consent

Subjects

Methodology

65 subjects excluded

according to criteria/ unwilling

to be part of project

Short Physical Performance Battery Abbreviated Mental Test

100 subjects screened 1) Inclusion and exclusion criteria

2) Patient information sheet Informed consent

Methodology

Short Physical Performance Battery (SPPB):

Methodology

Abbreviated Mental Test (AMT):

Methodology

65 subjects excludedaccording to criteria/ unwilling to be part of

projectShort Physical Performance Battery

Abbreviated Mental Test

35 subjects includedBaseline outcome measures:

1) SF36v2 (QOL)2) 4m test (Gait speed)

3) 6min walk test (CV fitness)4) FSST (Agility)

100 subjects screened 1) Inclusion and exclusion criteria

2) Patient information sheet Informed consent

Methodology

Outcome Measures

Reliability 0.95 (Harada et

al., 1999)

Reliability 0.98 (Dite &

Temple, 2002)

Reliability 0.90 (Ware et al.,

1994)

Reliability and test retest reliability (Guralnik et al, 2000)

Methodology100 subjects screened

1) Inclusion and exclusion criteria2) Patient information sheet

Informed consent65 subjects excluded

according to criteria/ unwilling to be part of

projectShort Physical Performance Battery

Abbreviated Mental Test

35 subjects includedBaseline outcome measures:

1) SF36v2 (QOL)2) 4m test (Gait speed)

3) 6min walk test (CV fitness)4) FSST (Agility)

Randomization

Assessors were blinded to the

subjects intervention group

2 dropouts postrandomisation

Traditional Exercise (n= 17)

Wii Exercise (n= 16)

Exercise Protocol

Results (Wii vs Gym)•Normal Data

10.2%

24.1%

Results (Pre-post values)

Results (Pre-post values)

36.9% 59.7%

.00

Results (Pre-post values)

29.8% 20.6%

0

SF36 Physical SF36 Mental SF36 Total

18.5% 15.9% 20.7%

-2.23%

6.8% 18.3%

Results (Pre-post values)

.000

00 0 0

Statistical Significance versus

Clinical Significance

Results (95% CI)

Results (95% CI)

Wii: 18.70m

Gym: 43.30mClinical significance

Clinical significance

Improvement

MDC = 20mMDC = 20m

Results (95% CI)

Clinical significance

Clinical significance

MDC = 0.1m/sMDC = 0.1m/s

Wii: 0.11m/s

Gym: 0.37m/s

Improvement

Results (95% CI)

MDC = 16.67MDC = 16.67

Clinical significance

Clinical significance

Wii: 0.85

Gym: 19.00

Improvement

MDC = 21.5sMDC = 21.5s

Gym: 3.30s

Clinical significance

Clinical significance

Wii: 8.77s

Improvement

MDC = 16.67MDC = 16.67

Clinical significance

Clinical significance

Wii: 6.80

Gym: 5.65

Improvement

MDC = 16.67MDC = 16.67

Clinical significance

Clinical significance

Gym: 9.65

Wii: 0.35

Improvement

Results (95% CI)

Discussion

Objective?

p value for 6 min walk test = 0.424

There is no difference between the effects of virtual reality (Wii) and traditional supervised

exercise in improving the functional fitness

Discussion

10.2%24.1%

36.9% 59.7%

TRENDS

• Gym has more improvements

• Started at lower baselines

• Greater room for improvement

6 minute walk test (m)

Discussion

TRENDS

• Wii has more improvements

4 square step test:

• Agility is a component of balance

• Wii program has components of reaction time and coordination required

SF36 physical:

• Dynamic real-life tasks replication with ongoing feedback given

• Enhancement of ADL practise through stimulation of cognitive, mood and social interaction

TRENDS

• Wii-decrease in SF36 mental

• Studies (eg: Plante, 2003) show otherwise

Discussion

RECAP:

• Gym had higher levels of improvement in areas of Cardiovascular fitness, Gait speed and SF36 total

• Wii had lowered levels of SF36 mental

• WHY?

Exercise intensity kept the same?

2 possible reasons

Gym Exercise Band Calisthenics Treadmill Cross trainer Cycle

Wii

Programs

Preset

Exercise Band

Balance board

RPE=13

Home exerciseCompliance?

Exercise Log

-Hard to verify

Conclusion We fail to reject the null hypothesis

Wii and Gym interventions appear to benefit different outcomes and perhaps stages in a person’s rehabilitation program

Relevance of the Study

Pilot Study

Randomised Controlled Trial

Wii can be used as an adjunct for improving the overall functional fitness of the moderately frail elderly population

Limitations

Short term effect investigated due to time constraints

Unable to generalise results across general population

Unable to control subject’s physical activity outside of study

Current Directions

Investigate long term effects of Wii and Gym exercise on functional fitness over multiple sessions

Include larger sample size

Standardize home exercise intensity and duration through means of a caregiver or have two supervised sessions

Special Thanks to:1) Mr. Kwok Boon Chong

– Physiotherapist, Singapore General Hospital

2) Dr. Bala S. Rajaratnam– SHS Project Manager– FYP Coordinator and Supervisor

3) Mr. Patrick Tan– SHS Technical Support Officer