Effectiveness of a Home-Based Active Video Game Programme in Young Cystic Fibrosis Patients

Abstract

Background: Exercise-based rehabilitation is already a part of cystic fibrosis (CF) treatment; however, patient adherence is low. Objectives: To assess the effectiveness of a home exercise programme using active video games (AVGs) as a training modality for children and adolescents with CF. Methods: Thirty-nine children with CF were randomised to a control group (CG, n = 20, age 11 ± 6 years; FEV₁ 86.2 ± 20.5% of predicted) or a training group (AVGG, n = 19, age 13 ± 3 years; FEV₁ 82.7 ± 21.7% of predicted). The home training protocol consisted of 30- to 60-min sessions, 5 days/week, for 6 weeks using a Nintendo Wii™ platform. Exercise capacity was measured by the 6-min walk test (6MWT) and modified shuttle walk test (MSWT); muscular strength was estimated using the horizontal jump test (HJT), medicine ball throw (MBT), and hand grip strength (right [RHG]; left [LHG]); and quality of life was rated using the Cystic Fibrosis Questionnaire-Revised (CFQ-R). All the children were measured at baseline, after rehabilitation, and at 12 months. Results: For the group × time interaction ANOVAs, the AVGG showed significant between-group differences in exercise capacity: 6MWT farthest walking distance, 38.4 m (p < 0.01); MSWT farthest walking distance, 78.4 m (p < 0.05); and muscular strength: HJT 9.8 cm, MBT 30.8 cm, RHG 7 kg, and LHG 6.5 kg (p < 0.01), before versus after intervention. The CFQ-R reported significantly higher scores on respiratory symptoms after the intervention and favoured the AVGG, and there was an improvement in other domains after 12 months. Adherence to the home exercise programme was 95% during the 6- week intervention period. Conclusion: A home-based programme using AVGs can effectively improve exercise capacity, muscular strength and quality of life in the short-term in children and adolescents with CF. The effects of training on muscle performance and quality of life were sustained over 12 months.

Active Video Games for Rehabilitation in Respiratory Conditions: Systematic Review and Meta-Analysis (Preprint)

“…Four of 12 included studies reported randomised studies examining the longer-term effects of AVGs versus traditional training in respiratory conditions [55,57,61,63]. One examined the effect of AVGs versus treadmill training in asthma, with training sessions twice a week over eight weeks [61].…”

“…Due to the nature of the intervention, no study blinded participants to treatment and only three blinded those assessing all outcome measures [55,57,61]. Additionally, none attempted to demonstrate their participants were representative of the population or recruited their participants randomly.…”

“…Additionally, none attempted to demonstrate their participants were representative of the population or recruited their participants randomly. Only four studies reported concealing patient allocation until the experiment was complete [27,28,57,61]. Only six studies reported adequate statistical power [27,28,57,58,61,63], though one study did perform a power calculation but was underpowered due to dropouts [59].…”

“…Five studies examined adherence to unsupervised active video game treatments, and generally reported adherence was high and maintained throughout the intervention period [55,57,59,60,62]. In the only controlled trial with an active control group, Bingham et al [55] reported that, despite there being no difference in the number of days each intervention was used, their game intervention was used for significantly more minutes per day than the control.…”

“…In the only controlled trial with an active control group, Bingham et al [55] reported that, despite there being no difference in the number of days each intervention was used, their game intervention was used for significantly more minutes per day than the control. Another controlled trial by del Corral [57] reported the adherence to the home intervention was 95% during the 6 week trial, but adherence dropped in the 12-month followup with 65% no longer using the AVG at all. A single-arm study Hoffman week intervention.…”