Date post: | 18-Dec-2014 |
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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