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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
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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
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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)
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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)
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Why Wii?
Easily available
Fun and engaging
Ongoing feedback
Choice of exercising at home
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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
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There is no difference between the effects of Virtual Reality (Wii) and traditional supervised exercise in
improving functional fitness
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Methodology100 subjects screened
1) Inclusion and exclusion criteria2) Patient information sheet
Informed consent
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Subjects
Methodology
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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
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Short Physical Performance Battery (SPPB):
Methodology
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Abbreviated Mental Test (AMT):
Methodology
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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
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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)
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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)
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Exercise Protocol
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Results (Wii vs Gym)•Normal Data
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10.2%
24.1%
Results (Pre-post values)
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Results (Pre-post values)
36.9% 59.7%
.00
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Results (Pre-post values)
29.8% 20.6%
0
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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
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Statistical Significance versus
Clinical Significance
Results (95% CI)
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Results (95% CI)
Wii: 18.70m
Gym: 43.30mClinical significance
Clinical significance
Improvement
MDC = 20mMDC = 20m
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Results (95% CI)
Clinical significance
Clinical significance
MDC = 0.1m/sMDC = 0.1m/s
Wii: 0.11m/s
Gym: 0.37m/s
Improvement
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Results (95% CI)
MDC = 16.67MDC = 16.67
Clinical significance
Clinical significance
Wii: 0.85
Gym: 19.00
Improvement
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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)
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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
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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)
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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
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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
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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
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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
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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
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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
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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