Effects of exergaming on exercise capacity in patients with heart failure: results of an international multicentre randomized controlled trial

Abstract

Aims Exergaming is a new tool to increase physical activity. This study aimed to determine the effects of access to a home‐based exergame (Nintendo Wii) in patients with heart failure (HF) on exercise capacity, self‐reported physical activity and patient‐reported outcome measures. Methods and results We enrolled 605 HF patients in New York Heart Association functional class I–IV, independent of ejection fraction, in an international multicentre randomized controlled trial. Patients were randomized to exergame (intervention) or motivational support (control). The primary endpoint was change in submaximal aerobic exercise capacity as measured by the distance walked in 6 min (6MWT) between baseline and 3 months. Secondary endpoints included long‐term submaximal aerobic exercise capacity, muscle function, self‐reported physical activity, exercise motivation, exercise self‐efficacy at 3, 6 and 12 months. At baseline, patients on average walked 403 ± 142 m on the 6MWT. Patients in the exergame group walked further compared to controls at 3 months (454 ± 123 vs. 420 ± 127 m, P = 0.005), at 6 months (452 ± 123 vs. 426 ± 133 m, P = 0.015) and 12 months (456 ± 122 vs. 420 ± 135 m, P = 0.004). However, correcting for baseline 6MWT values by means of a linear mixed‐effects model revealed no main effect for the intervention on 6MWT. Small significant effects on muscle function were found. Statistically significant treatment effects were found for muscle function but after correction for baseline and confounders, only the treatment effect for the heel‐rise left at 6 months was significant (P < 0.05). No treatment effect was found for exercise motivation, exercise self‐efficacy, or self‐reported physical activity. Conclusion Exergaming was safe and feasible in patients with HF with different profiles in different health care systems, cultures and climates. However, it was not effective in improving outcomes on submaximal aerobic exercise capacity. Subgroup analysis did not identify specific subgroups benefiting from the intervention. Clinical Trial Registration: http://ClinicalTrial.gov Identifier: NCT01785121.

Cardiac Rehabilitation During Quarantine in COVID-19 Pandemic: Challenges for Center-Based Programs

“…However, the authors underlined that this type of program is feasible and safe. 25 In addition, because 36% of the patients report being inactive at baseline and this proportion did not change after the follow-up, the authors emphasize the importance of remote coaching and the necessity to study specifically remote motivational strategies. 25 To summarize, compared with conventional center-based CR, recent studies and meta-analyses suggest that telerehabilitation could be (1) as effective on improving the _ VO 2 peak, (2) less costly, (3) safe, and (4) more effective in terms of maintenance of an active lifestyle in the medium-term.…”

“…25 In addition, because 36% of the patients report being inactive at baseline and this proportion did not change after the follow-up, the authors emphasize the importance of remote coaching and the necessity to study specifically remote motivational strategies. 25 To summarize, compared with conventional center-based CR, recent studies and meta-analyses suggest that telerehabilitation could be (1) as effective on improving the _ VO 2 peak, (2) less costly, (3) safe, and (4) more effective in terms of maintenance of an active lifestyle in the medium-term. 19,[26][27][28][29][30][31] Regarding mortality, cardiovascular risk factors, and physical activity volume, Dalal et al demonstrated in 1938 cardiac patients that there was no difference between home-based and center-based CR programs.…”

“…24 These tools combining physical exercises and video games called exergames are promising, but more studies are needed. The HF-Wii study 25 evaluated the effectiveness of this new type of CR in a multicenter and international RCT of 605 patients with chronic heart failure (67AE12y). At 1 year of follow-up the Wii intervention group reported mitigated results on the 6-minute walk test compared with the control group without intervention.…”

Utility of single‐item questions to assess physical inactivity in patients with chronic heart failure

“…The details and primary outcomes of that study have been published elsewhere. 23,24 The exclusion criteria were 'Unable to use the Nintendo Wii due to visual impairment (see a TV screen at a distance of 3 m), hearing impairment (the patient is not able to communicate by telephone), cognitive impairment (assessed by a HF nurse or cardiologist), or motor impairment (the patient should be able to swing his arm at least 10 times in a row)', 'Unable to fill in data collection material', and 'life expectancy shorter than 6 months'. This study used data collected from patients in the HF-Wii study who had provided accelerometer data measurements (n = 106).…”

The consequences of the COVID‐19 pandemic for self‐care in patients supported with a left ventricular assist device

“…A solution to promote physical activity for LVAD supported patients can be by telerehabilitation sessions, exergaming or by sending video instructions given by the local physiotherapist known to the group of LVAD supported patients (13,14). This can be preferred above 'standard online video instructions' since the patients see a familiar face, are familiar with his/her instructions and by that, not only improve their adherence to physical activity but also decrease their feeling of isolation.…”