Effects of virtual exercise on cardio‐pulmonary performance and depression in cardiac rehabilitation phase I: A randomized control trial

Abstract

BackgroundCardiac rehabilitation is recommended for patients undergoing open‐heart surgery (OHS). During the hospital admission, these patients suffer from reduced cardiopulmonary performance and decreased psychological health, leading to poor physical function, depression, and morbidity. To prevent post‐operative pulmonary complications, a pre and post‐operative physical therapy intervention is recommended for patients undergoing heart surgery. Virtual reality (VR) promotes the health status of healthy individuals and those with health conditions. However, few studies have reported the beneficial effects of VR exercise programs on the pulmonary performance and mental health status of patients undergoing OHS.ObjectivesTo determine whether by using training enhanced by VR, patients who have undergone OHS can more effectively attain cardiopulmonary performance and improve depression than through conventional physical therapy.Method60 participants were randomly assigned to a conventional physical therapy and VR exercise program. Each session was conducted once daily until discharge from the hospital. Cardiorespiratory performance and depression were evaluated before surgery and at the time of discharge from the hospital. A two‐way mixed ANOVA was performed to compare within (i.e., pre and post‐operation) and between (i.e., VR and conventional physical therapy) groups.ResultsNo significant cardiopulmonary performance gains were detected in patients receiving the VR exercise program when compared with those who participated in conventional physical therapy prior to post‐operative OHS (p > 0.05). However, the conventional physical therapy group showed significantly higher depression scores than the VR group (∆4.00 ± 0.98 vs. ∆1.68 ± 0.92). However, cardiopulmonary performance did not differ in both VR exercise and conventional physical therapy.

Non-Immersive Virtual Reality-Based Therapy Applied in Cardiac Rehabilitation: A Systematic Review with Meta-Analysis

“…Figure 2 shows the risk of bias in individual studies assessed with the CRoB. Four RCT included in this meta-analysis showed low risk of bias [61,63,65,66], and in five RCTs, the risk of bias was unclear [62,64,[67][68][69]. The mean risk of bias score was 72% ± 6.8% (Supplementary Table S1 that provides the mean risk of bias of each study included [61][62][63][64][65][66][67][68][69]).…”

“…Of these, 169 references were excluded by title/abstract and 16 for not meeting the inclusion criteria (reasons in Figure 1). In the end, nine RCTs [61][62][63][64][65][66][67][68][69] were included in the present systematic review with meta-analysis of interventions, and three of these nine studies [64,66,67] were included in the proportional meta-analysis to estimate the proportion of adverse events during niVR exposition. The PRISMA flow diagram, in Figure 1, summarizes this process.…”

“…The RCTs included, carried out between 2013 and 2023, provided data from 848 patients with CVD from Brazil [61,62,67], Spain [63], United States [64], Portugal [68], Ireland [66], Thailand [69], and one multicentre RCT from Sweden, Italy, Israel, Netherlands, Germany, and the United States [65]. The mean age of the included patients was 60.2 ± 5.8 years old (67% males).…”

“…The mean age of the included patients was 60.2 ± 5.8 years old (67% males). The studies included reported data from patients diagnosed with arterial hypertension [61], heart failure [63,65], valve failure, or coronary artery bypass [62,66,69] and mixed CVD [64,67,68] in phase I [62,66,69], II [61,63,64], and III [65,68]. Four hundred fourteen patients received niVR active videogames (mean age of 58.7 ± 6.4 years old), and 434 patients comprised the comparison group, receiving other interventions such as physical therapy, exercise, or usual care.…”

“…All RCTs included provided data from post-immediate assessment (after finishing the intervention). Finally, six studies received external funding to conduct the study [61,62,64,65,67,69]. Table 2 shows the main characteristics of the studies included in the meta-analysis.…”