VIENNA – When patients in a randomized study regularly include simulated sports activities with a video game console in their everyday lives, their overall self-esteem and functioning improves.
But not every patient with heart failure who has used the Wii Sports (Nintendo) gaming console has reaped the benefits. Some disagreed with expectations that high adherence would lead to greater profits.
Those assigned the game console showed better improvements in 6-minute running distance over 3 months compared to patients with "motivational support" to increase their activity. But there was no strong correlation between playtime and functional response.
That might say something about how an "exergaming" strategy in patients with heart failure could in practice complement traditional exercise approaches or not speculate on researchers.
The primary result of the HF-Wii study, published at the 201
Exergaming as done in the study "requires rigorous physical exercise" and consists of simulated sports activities li Ke Golfing, bowling or playing tennis with the patient, alone or with other participants, said Jaarsma during her presentation.
Jaarsma turned to viewers who were unfamiliar with Wii Sports and Exergaming in general, saying, "It does not do Sudoku on your phone, it's really physically active and intended as a workout."
Experience in patients with heart failure, she said, suggests that "it increases motivation, increases activity, promotes better health behavior and improves performance and health."
In 2010, the American Heart Association (AHA) controversially partnered with Nintendo in The company donated $ 1.5 million to the organization, which in turn issued its "Heart Check" emblem on the Wii's packaging. Display exergaming systems. The emblem was used to identify consumer products selected by the AHA as a healthy lifestyle.
Of course, the benefits of increased heart failure activity are well known; The challenges often include having patients participate in and hold a training program. Exergaming appears to be facing these challenges in a number of ways, Jaarsma pointed out theheart.org | Medscape Cardiology . Most patients enjoyed playing the simulated sports, which can be done comfortably at home.
Also, exergaming can be performed alone or as a family activity, the latter being a major attraction for some patients. "When we did a pilot study a few years ago, we saw that the time we were playing was related to grandchildren," Jaarsma said. Their support and participation, it was believed, helped the grandparents with heart failure to use the gaming device more frequently.
HF-Wii advised 605 heart failure patients to use the Wii Sport console for at least 30 minutes A day or to receive "only motivation support" and standard advice on exercise.
Wii consoles were made available to patients and installed in their homes for free. Patients were given introductory courses on their use and continued to have access to technical support, Jaarsma said.
There were no requirements for study entry based on NYHA functional class or left ventricular ejection fraction. The patients were mainly in Sweden, but also in the Netherlands, Germany, Italy, Israel and the United States.
Adherence to the exergaming time recommendation varied. Just over a third of patients, 34.8%, achieved more than 90% of the prescribed useful life. About half, 49.5%, fulfilled more than 60% of the exergaming regulation.
But a surprisingly large 17% of the exergaming group never used the console. They showed a significantly lower 6MWT improvement over 3 months compared to the control group or those who used the Wii console regardless of adherence.
Otherwise, no dose-response effect was observed; those who achieved all or nearly 100% of the recommended use showed about as much 6MWT improvement as lower adherence users.
"Those who were really very attached, of course, were the people who had already trained – younger, fitter – so they could easily reach 80% of the recommended level, said Jaarsma. In other words, patients using the Wii system those most used were those who profited the least.
In part, the 17% of patients in the exergaming group who did not use the system, Christopher M. O'Connor, MD, of the Inova Heart & Vascular Institute, Falls Church, Va., Said he had hoped compliance with the study "would be a little better because holding on to exercise is the big deal."
Patients in the RF-ACTION study Responding to their training protocol at about the same level as HF Wii patients following their exGaming recommendation, O'connor told theheart.org | Medscape Cardiology. That's "curious "because in the former St who "wanted to train on a treadmill for 200 minutes a week for two and a half years".
O'Connor is not involved in HF -Wii but co-chaired HF-ACTION, which randomly assigned about 2,300 heart failure patients to usual care with or without supervised exercise workouts plus a home-based exercise program , Patients in the intervention group showed dose-response relationships between exercise and functional capacity, quality of life, and 90-day survival.
If exergaming could be shown to produce gains such as those seen in HF-ACTION, he said it could be recommended because they offer similar benefits to conventional exercises. It could then serve as an exercise option among many for individual patients, and the election itself, O & Connor said, could improve compliance.
As an adjunct discussant after Jaarsmas presentation, Loreena M. Hill, PhD, from the Queen's University Belfast, UK, said the study "really shows very positive results" and shows that the exergaming option is acceptable for patients is. But it would be wise to examine its long-term effects, she said, before recommending exergaming in clinical practice.
The previously reported functional benefit of exergaming in the study included a 33 meter longer 6MWT distance ( P = 0.002) after 3 months compared to the control group
table. Average Current and Expected Prosperity Scores a After 3 Months in HF-Wii
|Endpoints||Exergame Group||Control Group||P|
|Current Wellbeing||6.6 Expected well-being||7.6||7.4||<. 05|
a. Cantril Ladder of Life scales from 1 to 10.
In the new HF-Wii secondary analysis, the patients in the exergaming group showed significantly better responses from baseline to 3 months on Cantril ladder of life scales for current and expected well-being compared to control subjects.
But there were no significant differences in answers based on the hospital's anxiety and depression scale or quality of life due to the Minnesota Living with Heart Failure Questionnaire
Jaarsma agreed that exergaming is likely to be among a training option among many for most Patients served, but has probably gained In patients with heart failure who are already active, no significant functional improvements are achieved. For example, if you walk with a dog three times a week or ride an hour or so, "Wii will not help."
Nintendo did not provide any Wii systems or other support for the trial. Jaarsma and Hill have not reported any relevant financial relationships. O & # 39; Connor disclose advisory fees from Novella and Amgen; Property or partnership or as principal in BisCardia; and research support from Otsuka, Roche Diagnostics, BG Medical, Critical Diagnostics, Astellas, Gilead, GE Healthcare and ResMed.