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ev Bras Ciênc Esporte. 2018;40(1):62---69

www.rbceonline.org.br

Revista Brasileira de

CIÊNCIAS DO ESPORTE

RIGINAL ARTICLE

ctive videogames promotes cardiovascular benefits inoung adults? Randomized controlled trial�

orge L. de Brito-Gomesa,∗, Raphael J. Perrier-Melob, Aline de F. Britoc,anoel da C. Costab

Universidade Federal de Pernambuco, Recife, PE, BrazilUniversidade de Pernambuco, Recife, PE, BrazilUniversidade Federal de Piauí, Centro de Ciências da Educacão, Departamento de Métodos e Técnicas de Ensino, Teresina, PI,razil

eceived 29 October 2015; accepted 12 January 2018vailable online 5 February 2018

KEYWORDSVirtual reality;Heart rate;Blood pressure;Double product

AbstractObjectives: To investigate how quickly active video games, structured and unstructured, pro-vide changes in hemodynamic variables in young adults during a 6-week intervention.Method: Twenty participants after baseline assessments, participants were randomized: struc-tured active videogame (n = 6), unstructured active videogame (n = 7) and a control group (n = 7).Participants played their respective active videogame 3 times a week for 6-weeks (30 min-session).Results: Structured active videogame in exactly 6 weeks shown improvements reducing theheart rate (heart rate; 14% of variation; p < 0.05). Otherwise, not confirmed to both activevideogame interventions in systolic blood pressure but maintain the diastolic blood pressureduring these 6 weeks (systolic blood pressure-unstructured: −2% and Structured: 11%; diastolicblood pressure-unstructured: 0% and structured: 0%; p > 0.05).Conclusions: The 6-week training program with active videogame reduced the heart rate(structured --- 6th week). However, active videogames generally do not promoted benefits fornormotensive young adults.© 2018 Published by Elsevier Editora Ltda. on behalf of Colegio Brasileiro de Ciencias do Esporte.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

� Study was carried out in Pernambuco University, Recife, PE, Brazil. Zip Code: 50100-130. Phone: 3183 --- 3378.∗ Corresponding author.

E-mail: jorgelbritog@hotmail.com (J.L. Brito-Gomes).

ttps://doi.org/10.1016/j.rbce.2018.01.002101-3289/© 2018 Published by Elsevier Editora Ltda. on behalf of Colegio Brasileiro de Ciencias do Esporte. This is an open access articlender the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Videogames and cardiovascular changes 63

PALAVRAS-CHAVERealidade virtual;Frequência cardíaca;Pressão sanguínea;Duplo produto

Videogames ativos promovem benefícios cardiovasculares em adultos jovens? Ensaioclínico randomizado

ResumoObjetivos: Investigar o quão rápido os videogames ativos, estruturados e não estruturados, pro-porcionam mudancas em variáveis hemodinâmicas em adultos jovens durante uma intervencãode seis semanas.Método: Foram randomizados 20 participantes após avaliacões iniciais: videogame ativo estru-turado (n = 6), videogame ativo não estruturado (n = 7) e um grupo controle (n = 7). Osparticipantes fizeram seu respectivo videogame ativo três vezes por semana durante seis sem-anas (30 minutos por sessão).Resultados: videogame ativo estruturado em exatamente seis semanas mostrou reducão dafrequência cardíaca (frequência cardíaca; 14% de variacão; p < 0,05). Por outro lado, não con-firmou em ambas as intervencões de videogame ativo pressão arterial sistólica, porém mantevea pressão arterial diastólica durante essas seis semanas (pressão arterial sistólica não estrutu-rada: -2% e estruturadas: 11%; pressão arterial diastólica não estruturada: 0% e estruturada:0%; p < 0,05).Conclusão: O programa de treinamento de seis semanas com videogame ativo reduziu o fre-quência cardíaca (estruturado seis semanas). Porém, de forma geral, os videogames ativos nãopromoveram benefícios em adultos jovens normotensos.© 2018 Publicado por Elsevier Editora Ltda. em nome de Colegio Brasileiro de Ciencias doEsporte. Este e um artigo Open Access sob uma licenca CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).

PALABRAS CLAVERealidad virtual;Frecuencia cardíaca;Presión sanguínea;Doble producto

¿Los videojuegos activos promueven beneficios cardiovasculares en adultos jóvenes?Ensayo clínico de distribución aleatoria

ResumenObjetivos: Analizar la rapidez con la cual los videojuegos activos, estructurados y no estruc-turados, generan cambios en las variables hemodinámicas en adultos jóvenes durante unaintervención de 6 semanas.Método: Se distribuyó aleatoriamente a 20 participantes según las evaluaciones iniciales:videojuego activo estructurado (n = 6), videojuego activo no estructurado (n = 7) y grupo control(n = 7). Los participantes jugaron con sus respectivos videojuegos activos 3 veces por semanadurante 6 semanas (sesiones de 30 minutos).Resultados: Los videojuegos activos estructurados en exactamente 6 semanas mostraron quereducían la frecuencia cardíaca (frecuencia cardiaca; 14% de la variación; p <0,05). En cambio,no se confirmó en ambas intervenciones de videojuegos activos la presión arterial sistólica, perose mantuvo la presión arterial diastólica durante estas 6 semanas (presión arterial sistólica enno estructurados: -2% y en estructurados: 11%; presión arterial diastólica en no estructurados:0% y en estructurados: 0%, p >0,05).Conclusiones: El programa de entrenamiento de 6 semanas con videojuegos activos redujo lafrecuencia cardiaca (estructurado - sexta semana). Sin embargo, de forma general los video-juegos activos no promueven beneficios en adultos jóvenes normotensos.© 2018 Publicado por Elsevier Editora Ltda. en nombre de Colegio Brasileiro de Ciencias doEsporte. Este es un artıculo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction

According to the guidelines about recommendations forexercise, young adults should perform 30---60 min of mod-erate physical activity (50---69% of maximal heart rate) at

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east 3 days a week to maintain the cardiovascular healthI Brazilian Hypertension Guidelines 2013; Garber et al.,011). Nevertheless, the sedentary life style is occur ringn parallel to the development of numerous technological

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dvancements that result in individuals spending more ofheir day on ‘‘screen time’’(Altenburg et al., 2012), thats defined as time spent on watching TV, using computers,martphones, tablets and playing videogames (Christie androut, 2007).

To change these habits, exist several types of physicalctives with trends to each one (Booth et al., 2014), onef them is the active videogames (AVGs) have been usedecause they can acutely elevate the heart rate (HR) duringhe gaming (Brito-Gomes et al., 2014) and promote hemody-amic responses in blood pressure (BP) (Perrier-Melo et al.,013) reaching the intensity recommended by the guide-ines. In another hand, knowing the negative correlationetween screen time and BP is observed the occurrencef chronic degenerative diseases (Altenburg et al., 2012)uch as hypertension, obesity and diabetes, elevating theardiovascular risks.

Thus, some fewer long-term studies have been using tonalyze the effects of this tool. In a 28 week-interventionith a transversal analysis at the 10th week by the sameariables, there were no significant differences on HR, SBPsystolic blood pressure) and DBP (diastolic blood pressure)t the 28th week in relation to baseline using an unstruc-ured AVG (in exception the SBP at the 10th week) (Maloneyt al., 2008). The same was observed in another study after2 week-intervention, with no statistical changes at theseariables (Kempf and Martin, 2013). However, statisticaleductions in SBP after 6 weeks were found in structuredVG (Warburton et al., 2007) but not in DBP.

If any physical activity, such as AVG, is used to improvetness with cardiovascular characteristics, they may pro-ote hemodynamic benefits (Haskell et al., 2007), such

s in the resting HR or SBP analysis for example becausef the cardiac output (McArdle et al., 2003). Therefore,n overview of AVG, there are two primary types (Gomes,015; Melo, 2015; Brito-Gomes et al., 2015): unstructuredVG which are designed for recreation, motivation, and/orehabilitation (Falcade et al., 2013; Perrier-Melo et al.,013; Taylor et al., 2012) and structured AVG which areesigned to improve physical fitness within a virtual real-ty by adhering to the principles of sport training (Christiend Trout, 2007; Warburton et al., 2007; Brito-Gomes et al.,015).

Thus, while evidence support the use of structuredVGs (with moderate intensity of physical activities) pro-ote hemodynamic benefits after 6 weeks, and the use of

he unstructured AVG maybe present benefits if used in aedium-long term, however, due to the pre-post method-

logy of analysis is impossible to show any change. Thereemain critical gaps in the literature: how quickly do struc-ured and unstructured AVGs decrease the resting SBP, HRnd (or promote maintenance on) DBP. Thereby the pri-ary purpose of this investigation was to analyze howuickly AVGs, structured and unstructured, provide bene-ts in cardiovascular variables in young adults, improvingheir fitness, resulting in better results during a 6-weekntervention. We hypothesized that structured AVG willeduce more quickly resting heart rate, blood pressure

nd double product than unstructured because the char-cteristics of the game. Once the structured AVG shouldave evolution based in the principle’s prescriptions of thexercise.

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Brito-Gomes JL et al.

aterial and methods

esign and participants

his Brazilian randomized controlled trial (registration num-er: U1111-1159 7242) which was conducted in the Humanerformance Laboratory --- UPE/ESEF. Participants included:4 volunteer normotensive university students between8 and 25 years of age (age: 19.8 ± 2.0 years, height:.78 ± 0.07 m, body mass: 73.0 ± 9.5 kg). All participantsere healthy eutrophic males who were physically inactive

3 months with no practice of structured physical activ-ties) and had no previous experience playing AVGs. Allarticipants read and signed the informed consent formpproved by the University of Pernambuco (UPE) Researchthics Committee (#577 277) prior to participation accord-ng 466/2012 Resolution. Additionally, all participants werecreened using the Physical Activity Readiness QuestionnairePAR-Q) prior to initiating the investigation. Once eligible,articipants underwent baseline testing to determine theody mass, height, resting heart rate, blood pressure anderobic capacity.

tudy design

fter completing the baseline assessment, participantsere randomized to one of three groups: (a) unstruc-

ured AVG (Kinect Sports: Boxing), (b) structured (Nikeinect Training) and (c) control (normal daily activities).he scores of aerobic capacity were computed in aanking the highest to lowest and they were allocatedollowing the order: (1) unstructured; (2) structured;3) control; (4) control; (5) structured; (6) unstructured;estarting the cycle until completing the groups. Eachreatment group then performed an AVG familiarizationession. The unstructured group (Boxing --- Kinect Sports

-- https://www.youtube.com/watch?v=uF1KApa7hRE) per-ormed 20 min of gaming and was allowed to see the tutorialideos of the game. The structured group (Nike Kinect Train-ng --- https://www.youtube.com/watch?v=D5glY K8u14)erformed a brief evaluation (∼20 min) that the AVGrovides to prescribe the exercises that will be performeduring gameplay and was allowed to see the tutorial videosf the game.

All training sessions were completed with an Xbox 360◦

inect console. All AVGs were displayed, via a multimediarojector (Power Lite S10+, EPSON) mounted to the labora-ory ceiling, on a wall with an image size of approximately.3 m high by 1.6 m wide (82 in.). Sound was broadcast via

single amplified speaker (COM 126 Professional, ONEAL,razil) connected to the Xbox 360◦ console. The laboratoryas keep at 24 ± 2 ◦C, with 40---60% relative humidity (Envi-

onmental Station, Barigo, Germany). The types of activeideogames used were boxing (Kinect Sports) and functionalhysical activities (Nike Kinect Training), which are dividedccording Table 1.

Two days (48 h) after baseline testing and game orien-

ation, participants initiated the 6-week intervention. Eacharticipant completed 3 sessions per week for each week ofhe intervention of 18 sessions (30 min each). The Unstruc-ured AVG is composed by various 3-min round of punches

Videogames and cardiovascular changes 65

Table 1 Types and characteristics of active videogames.

Types of AVG Characteristics Examples

Structured AVG Uses basic exercises such as squates, push-ups, cycling.Incorporates planned movement patterns. Movementpattern feedback may or may not be provided based onthe operating system.

Systematic order of exercise progression and/orintensity (e.g. sets, reps, rate, duration).

Gym games YourShape Fitness GameBikeNike Kinect Training

Unstructured AVG Activities that do not mimic formal exercises but rathersporting movements and general body movements.

Players are free to move as they wish during game playand there is no formal progression to higher levels ofphysical activity difficulty as game play progresses.

Boxing

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against the computer and the participant can move to sidesand undertake short squats to give a hook. The structuredAVG is composed by different functional exercises using thebody mass doing flexion, extension, adductions, abductionsand circumduction of limbs and shoulder and pelvis cinc-tures. Also, move to sides, jump and stationary running.

Participants in the experimental groups were required tocomplete at least 85% of the training sessions or they wouldbe dropped from the investigation. The control group keptwith their normal daily activities with no structured physi-cal activities. After the first assessment (Baseline) in eachbegin of the subsequently week (following the final trainingsession; 3-week sessions) participants completed anothersix assessments of HR, SBP and DBP using the methodologydescribed for the baseline assessment.

Procedures and instruments

In baseline, body mass in kilograms was measured using amechanical scale (Filizola, Brazil), with accuracy of 0.1 kg.Height was measured in centimeters using a wooden sta-diometer fitted with a scale in millimeters. Anthropometricmeasurements were performed by trained professionalsand obeyed by ISAK standardized international techniques(Stewart et al., 2012). Then body mass and stature wereused to calculate the Body Mass Index (BMI) by kilogram persquare stature.

After, the hemodynamic measurements were monitoredin the rest of five minutes in seated position. The heart rate(HR) was assessed by using a Polar FT1 (Polar, Finland) heartrate monitor. Next the systolic (SBP) and diastolic (DBP)blood pressure were measured by the automated method(OMRON HEM-7113) according to Guidelines of BrazilianHypertension (Nobre, 2010). The resting double product wascalculated using the systolic blood pressure multiplied by

heart rate.

After, we determined the individuals’ aerobic capacityas a sample characterization parameter. All participantswore a facemask and adult head cap (Metalyser, Germany)

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onnected to a metabolic gas analyzer (CPX/D, Cortex,ermany) during a maximal Astrand-Ryhming cycle test per-

ormed on a Cateye EC-1600 Ergociser (Ergociser, Japan)ollowing the protocol used by ASCM of Astrand and Ryh-ing (1954). In brief, this test is completed by initial 2 min

f warming with 25 W of load. After was added 75 W to keepnto 100 W during 2 min. Next each 2 min was added 50 Weaching until the fatigue.

For the baseline and all subsequent assessments (only HR,BP and DBP), participants were instructed to wear min-mal clothing, to avoid moderate or vigorous exercise for4 h prior to testing, to eat at least three hours before thessessments, and to refrain from alcohol and smoking theay prior to the assessments.

ata analysis

ll data initially underwent tests of normalityShapiro---Wilk). After determining normal distributionf the data, the baseline data were compared among theontrol, structured AVG and unstructured AVG groups usingne-way ANOVA to each variable. Change in resting heartate, blood pressure and double product over the weeks wasssessed using a repeated measures (intragroup). ANOVA.onferroni’s post hoc test was used to identify the locationf significant differences if appropriate. An additionalNOVA one way was performed to verify the differences ofhe groups at the end of the study. An a priori alpha level of.05 was adopted for all statistical tests in Graph Pad Prism.0 program.

esults

n total four participants were excluded for failing to com-lete at least 85% of the training sessions. The demographic

haracteristics and baseline assessments of the remaining0 participants are show in Table 2. The initial analysis overhe variables among the groups shows no differences at theaseline moment (p > 0.05).

66 Brito-Gomes JL et al.

Table 2 Characterization of sample characterization recruited for the study (n = 20).

Variable Unstructured Structured Control group p value

(n = 7) (n = 6) (n = 7)

Age (years) 18.8 ± 0.9 19.0 ± 1.0 21 ± 3 0.454Body mass (kg) 72.3 ± 10.2 71.7 ± 13.7 69.2 ± 8.1 0.616Height (m) 1.70 ± 0.05 1.70 ± 0.06 1.77 ± 0.07 0.746BMI (kg/m2) 22.6 ± 2.0 23.6 ± 3.3 22.2 ± 4.3 0.545HR (bpm) 79.0 ± 12.7 69.3 ± 5.2 78.0 ± 8.5 0.292SBP (mmHg) 125.4 ± 10.8 124.8 ± 12.0 117.1 ± 11.3 0.333DBP (mmHg) 68.5 ± 4.3 69.5 ± 7.7 69.6 ± 8.9 0.960DP (mmHg bpm) 9717 ± 2147 8316 ± 1152 9779 ± 709 0.695AE (mL/kg/min) 36.0 ± 5.2 39.0 ± 5.9 37.9 ± 3.3 0.572

BMI, body mass index; HR, heart rate; DBP, diastolic blood pressure; DP, double product; AE, aerobic capacity; SBP, systolic blood pressure.

A B CUnstructured AVG Structured AVG Control

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igure 1 Resting heart rate of the AVG’s intervention and ceasurements of each week training. *p < 0.05 in relation to ba

The resting heart rate of the AVG’s intervention and con-rol group during the weeks are presented in Fig. 1. Thenstructured AVG (panel A) reduced but with no signifi-ant difference (p = 0.061). The structured AVG (panel B)hown difference only at the sixth week (p = 0.003). Theontrol group (panel C) did not shown significant differencep = 0.734). A percentage’s variation at the end of the studyn relation to the baseline shown values with 8%, 14% and1%, respectively.

Fig. 2 shows systolic and diastolic blood pressure of theVG’s intervention and control group during the weeks. Com-ared to baseline, during and post intervention, in SBPo groups shown statistical differences with p-values of:he unstructured AVG (panel A; p = 0.628); the structuredVG (panel B; p = 0.121) and the control group (panel C;

= 0.718). The same verified in DBP of the AVG’s interven-ion and control group shown no statistical differences with-values of: the unstructured AVG (panel D; p = 0.910); thetructured AVG (panel E; p = 0.272) and the control grouppanel F; p = 0.502). A percentage’s variation in the SBP athe end of the study in relation to the baseline shown valuesith −2%, 11% and −1%, respectively. A percentage’s vari-tion in the DBP at the end of the study in relation to the

aseline shown values with 0%, 0% and 5%, respectively.

The resting double product of the AVG’s intervention andontrol group during the weeks are present in Fig. 3. Sta-istical differences were observed in the Unstructured AVG

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ol group during the weeks. 1, 2, 3, 4, 5 and 6: Indicates thee.

p = 0.021) in the fourth week, however, no differences in thetructured AVG (p = 0.141) and the control group (p = 0.745).

percentage’s variation at the end of the study in relation tohe baseline with values were 7%, 11% and −2%, respectively.

An additional ANOVA was performed to verify the differ-nces of the groups at the end of the study. And, in thenal of the study was difference by RHR of control group vsnstructured and vs structured AVG (p = 0.000). But no dif-erence to RSBP (p = 0.2240) and RDBP (p = 0.734). However,he RDP of structured AVG group was different vs controlroup (p = 0.018).

iscussion

he present study analyzes the impact of six weeksngagement in two different active video games programstructured and unstructured) on hemodynamic variablesheart rate, blood pressure and double product) in nor-otensive individuals. Despite seeing clinical benefits, in

eneral, no significant differences were seen. Thus, theesults demonstrated weeks of structured training withVG improve their fitness reducing the resting heart rate.

therwise, both AVG interventions were not enough to pro-ote significant reductions in SBP and DBP in the analyzed

roups. In addition, however, it can be noted significantecreases on double product obtained by the unstructured

Videogames and cardiovascular changes 67

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AVG practitioners at the fourth week, it not maintain untilthe end. Nevertheless, analyzing just in the end of thestudy, the structured AVG shown greater reductions in dou-ble product in comparison to unstructured and control group(p = 0.018), once they were with no difference among thegroups in the baseline.

Knowing that a physical activity with cardiovascular char-

acteristics should be use to promote hemodynamic benefits(Haskell et al., 2007) such as in the resting heart rate orsystolic blood pressure because for example: the cardiac

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ntrol group during the weeks. 1, 2, 3, 4, 5 and 6: Indicates thee.

utput, blood flow and better use of substrates into theecruitment of large muscle groups during the differentypes body movements which provide increase in cardiores-iratory stimulus (McArdle et al., 2003). This phenomenonay be seen by the use of the structured AVG as a form

o exercise by reducing resting heart rate (variation of4%), perhaps elevating the systolic volume (cardiac out-

ut = systolic volume vs heart rate). According to Maloneyt al. (2008), using an unstructured AVG in 28 weeks, thishanges were not observed with a variation of only 1.7% of

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eart rate by the end of the study. In this present study,he unstructured AVG present 8%, unfortunately with noifferent statistical changes. In another hand, the controlroup elevates the heart rate (−1% variation), showing the‘benefits’’ of the AVGs intervention over this variable.

However, this cardiovascular impact was not sufficient tohange the SBP and DBP in both AVGs. These results areccording to some AVG studies with no statistical differ-nces over these variables in relation to baseline (Kempfnd Martin, 2013; Maloney et al., 2008), these studies alsosed normotensive people. A brief explanation should be theolunteers were normotensive and it has been seen that thisopulation who was blood pressure close to normality border<130/<80 mmHg); and distance from hypertension level 1:40---159/90---99 mmHg (I Brazilian Hypertension Guidelines,013) that is very difficult to present hemodynamic bloodressure differences because of their normality function ofhis system (Cardoso et al., 2010).

Different from these results, Warburton et al. (2007),ound differences in SBP using a structured AVG (GameBike)fter 6-week intervention, in another hand, their sub-ect had elevated SPB with 131 ± 7 mmHg (pre-hypertension30---139/85---89 mmHg (I Brazilian Hypertension Guidelines,013), but reduced to 123 ± 6 mmHg (6% of variation).s the phenomenon explained before. Meanwhile, ourtudy presents 11% of variation (pre: 125 ± 12 mmHg; post:11 ± 47 mmHg) at the end of the intervention to structuredVG. It is known that a minimum reduction of 2 mmHg is clin-cally important because may promote 6% in the incidencef mortality from stroke and 4% for coronary artery dis-ase (Chobanian et al., 2004). Thus, even with normotensiveeople use the structured AVG, they may promote cardio-ascular SBP changes in percentage analysis. The same weannot replicate to unstructured AVG, which have valuesimilar to control group.

Specifically, in DBP analysis, the AVGs and control groupsad no statistical and evident reductions. However, accord-ng to the literature this response is expect because with in

long-term DBP analysis, this variable should maintain orave a little decrease (Cardoso et al., 2010; McArdle et al.,003). These were already seen by Maloney et al. (2008)n children (0.4% of variation), Kempf and Martin (2013) inlderly (0.6%) and now in the young adults (0.0% structured;.5% unstructured).

In addition, although the mechanisms involving cardio-ascular variables were not investigated in this clinical trial,t is believed that many mechanisms may contribute to sev-ral change. It has been seen that changes in blood pressures related by chronic exercise based in neuro-anatomicalesponses, as like reduction in the sympathetic activity andncreased in parasympathetic activity, lowering blood pres-ure (Brum and Negrão, 2004). Furthermore, people who arehysically inactive when starting an intervention respondositively to an increase in the capillaries and the oxygenonsumption is elevated, favoring the decline in blood pres-ure (Monteiro and Sobral Filho, 2004; Cardoso et al., 2010;

Brazilian Hypertension Guidelines, 2013). The interven-ion with AVGs perhaps may not promote these mechanisms

hanges over normotensive young adults.

About the double product, only at the unstructured AVGn the 4th week can be seen significant reduction in DPeturning with no statistical differences by 5th and 6th

aiwA

Brito-Gomes JL et al.

eek. Although the structured AVG shown no statisticalhanges during the intervention, it is observed that after thend this intervention promote a reduction of 11%. Greaterhan unstructured with 2% of variation and control grouphat elevate this variable in the end (−2% variation). Thisecrease in the DP at rest is important result due to theelationship with cardiovascular problems and health, withhese reductions is possible to reduce the cardiovascularisks which seems to be mediated to the decreased of adren-rgic activity, the expected behavior by a chronic responseForjaz et al., 1998; Gerage et al., 2007; Polito and Fari-atti, 2003). To our knowledge, there is no other study athe literature to analyze DP in a long-term intervention withVG. In this sense, this clinical trial results shows that train-ng with these two AVGs is possible to provide only clinicalenefit (with no statistical changes) by decreasing cardio-ascular work reducing the risks and shown that is securityntervention to use to exercise in a long-term analysis.

As a practical implication, the results of this studyemonstrated for the first time, two AVGs, unstructuredVG (Kinect Sports Boxing; without prescription of train-ng) and the specifically structured AVG (Nike Kinect Fitness;rogressively) and their cardiovascular changes. Which thetructured were better than unstructured due to principlesf exercise prescription. Indicating that after 6 weeks ofractice of this structured AVG, you must enter this activity

new stimulus of exercise prescription, as the frequencyr duration, to acquire new benefits in RHR (only). Thats possible on this type of AVG, once it has options insidehe game to evolve the exercise. However, the authors trulyecommend a physical education’s attendance.

The limitations of this study were use a sample ofnly young adult males. Research has shown that mennd women have different exercise motivations, attitudesoward video gaming (Graf et al., 2009) and cognitive func-ions (Teixeira-Arroyo et al., 2014). These differences mayesult in different exercise intensities during game play andubsequently different hemodynamic changes. It was usednly a single structured and unstructured AVG and it is shownhat not all game produce the same cardiovascular responseBrito-Gomes et al., 2014; Miyachi et al., 2010; Perrier-Melot al., 2013). Other limitation maybe the time of 6 weekso analyze these variables, perhaps another study shouldone this weekly methodology longer than 6 weeks. Further-ore, future research is needed to test the effectiveness of

broad range of structured and unstructured AVG to analy-es the health cardiovascular benefits observed from othersVG and other populations such as women and hypertensiveeople.

onclusions

he initial hypothesis were not confirm, just to structuredVG in the heart rate, in exactly 6 weeks. To both AVGnterventions in SBP because their intervention were notnough to promote significant reductions in SBP, just toaintain the DBP during these 6 weeks of experiment. In

ddition, significant decrease observed on double productn the unstructured AVG practitioners only at the fourtheek, but do not maintain until the end of the study.nother information, in the end of the study thestructured

G

G

G

H

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M

M

M

M

M

N

P

P

S

T

T

Videogames and cardiovascular changes

AVG shown greater reductions (%) in comparison to unstruc-tured and control group. However, in general, this types ofactive videogames unstructured (Boxing --- Kinect sports) andStructured (Nike Kinect Fitness) do not promote real car-diovascular benefits in young normotensive adults. Futurestudies should analyze other populations with cardiovascularalterations such as hypertensive people.

Conflicts of interest

The authors declare no conflicts of interest.

References

Altenburg TM, Hofsteenge GH, Weijs PJ, Delemarre-van de Waal HA,Chinapaw MJ. Self-reported screen time and cardiometabolicrisk in obese Dutch adolescents. PLoS ONE 2012;7:e53333.

Astrand PO, Ryhming I. A nomogram for calculation of aerobiccapacity (physical fitness) from pulse rate during submaximalwork. J Appl Physiol 1954;7:218---21.

Booth VM, Rowlands AV, Dollman J. Physical activity tempo-ral trends amongst children and adolescents. J Sci MedSport 2014;18:418---25.

Brasileira Sociedade. I Diretriz Brasileira de Prevencão Cardiovas-cular. Arq Brasil Cardiol 2013;101:15.

Brito-Gomes JLD, Perrier-Melo RJ, Wikstrom EA, Da Cunha Costa M.Improving aerobic capacity through active videogames: a ran-domized controlled trial. Rev Motriz 2015;21:305---11.

Brito-Gomes JL, Perrier-Melo RJ, de Albuquerque FL, da CunhaCosta M. Comportamento Da Frequência Cardíaca Durante UmaSessão Com Diferentes Vídeo Games Ativos. Manual Ther PosturolRehabil J 2014;12:81---95.

Brum PC, Negrão CE. Adaptacões Agudas E Crônicas Do Exer-cício Físico No Sistema Cardiovascular. Rev Paul Educ Fís2004;18:21---31.

Cardoso CGJr, Gomides RS, Queiroz AC, Pinto LG, da Silveira LoboF, Tinucci T. Acute and chronic effects of aerobic and resistanceexercise on ambulatory blood pressure. Clinics (Sao Paulo Brazil)2010;65:317---25.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, IzzoJL Jr, et al. Seventh report of the joint national committee onprevention, detection evaluation, and treatment of high bloodpressure. Hypertension 2004;42:1206---52.

Christie B, Trout J. Rather than contribute to a sedentary lifestylethese games demand activity from the players. Interact VideoGames Phys Educ 2007;78:29---45.

Falcade AC, Baroncini LAV, Hanna EDA. Análise Do Consumo deOxigênio Da Frequência Cardíaca E Equivalentes MetabólicosAtravés de Um Videogame Ativo. Inspirar 2013;5:20---4.

Forjaz CLM, Matsudaira Y, Rodrigues FB, Nunes N, Negrão CE.Post-exercise changes in blood pressure heart rate and rate pres-sure product at different exercise intensities in normotensivehumans. Braz J Med Biol Res 1998;31:1247---55.

Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, LeeIM, et al. American College of Sports Medicine Position Stand.Quantity and quality of exercise for developing and maintain-ing cardiorespiratory, musculoskeletal, and neuromotor fitness

W

69

in apparently healthy adults: guidance for prescribing exercise.Med Sci Sports Exerc 2011;43:1334---59.

erage AM, Cyrino ED, Schiavon D, Nakamura FY, Ronque ER, Gur-jão ALD, et al. Efeito de 16 Semanas de Treinamento ComPesos Sobre a Pressão Arterial Em Mulheres Normotensas E Não-Treinadas. Rev Bras Med Esporte 2007;13:361---5.

omes JLdB. Efeitos Nos Parâmetros Metabólicos E HemodinâmicosEm Intervencão de 6 Semanas Com Videogames Ativos: EstudoClínico Randomizado. Univesidade de Pernambuco; 2015.

raf DL, Pratt LV, Hester CN, Short KR. Playing activevideo games increases energy expenditure in children.Pediatrics 2009;124:534---40.

askell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA,et al. Physical activity and public health: updated recommen-dation for adults from the American College of Sports Medicineand the American Heart Association. Circulation 2007;116:1081---93.

empf K, Martin S. Autonomous exercise game use improvesmetabolic control and quality of life in type 2 diabetes patients--- a randomized controlled trial. BMC Endocr Disord 2013;13:57.

aloney AE, Bethea TC, Kelsey KS, Marks JT, Paez S, Rosenberg AM,et al. A pilot of a video game (DDR) to promote physical activityand decrease sedentary screen time. Obesity (Silver Spring Md)2008;16:2074---80.

cArdle WD, Katch FI, Kantch VL. Fisiologia Do Exercício: Energia,Nutricão E Desempenho Humano. 5ed. Rio de Janeiro: Guan-abara Koogan; 2003.

elo RJP. Efeito Do Treinamento Com Videogames Ativos NasDimensões Morfológicas E Funcional-Motora: Estudo Clínico Ran-domizado. Universidade de Pernambuco; 2015, 2010.

iyachi M, Yamamoto K, Ohkawara K, Tanaka S. METs in adults whileplaying active video games: a metabolic chamber study. Med SciSports Exerc 2010;42:1149---53.

onteiro MdF, Sobral Filho DC. Exercício Físico e o Controle DaPressão Arterial. Rev Bras Med Esporte 2004;10:513---9.

obre F. VI Diretrizes Brasileiras de Hipertensão. Arq BrasCardiol 2010;95:1---51.

errier-Melo RJ, Brito-Gomes JL, Fernandes S, Oliveira M, Costa C.Analisar as Respostas Da Frequência Cardíaca E Da Pressão Arte-rial Durante E Após Uma Sessão de Vídeo Games Ativos (VGA’s).Rev Ter Ocup Univ São Paulo 2013;24:259---66.

olito MD, Farinatti PTV. Respostas de Frequência Cardíaca PressãoArterial E Duplo-Produto Ao Exercício Contra-Resistência: UmaRevisão Da Literatura. Rev Port Ciênc Despòorto 2003;3:79---91.

tewart A, Marfell-Jones M, Olds T, de Hans Ridder. InternationalSociety For The Advancement of Kinantropometry. Australia:International Standards for Anthropometric Assessment; 2012.

aylor LM, Maddison R, Pfaeffli LA, Rawstorn JC, Gant N, Kerse NM.Activity and energy expenditure in older people playing activevideo games. Arch Phys Med Rehabil 2012;93:2281---6.

eixeira-Arroyo C, Rinaldi NM, Batistela RA, Barbieri FA, VitórioR, Gobbi LTB. Exercise and cognitive functions in Parkin-son’s disease: gender differences and disease severity.

Motriz 2014;20:461---9.

arburton DE, Bredin SS, Horita LT, Zbogar D, Scott JM, Esch BT,et al. The health benefits of interactive video game exercise.Appl Physiol Nutr Metab 2007;32:655---63.