Exergame-Driven High-Intensity Interval Training in Untrained Community Dwelling Older Adults: A Formative One Group Quasi- Experimental Feasibility Trial

Abstract

Purpose To investigate the feasibility of an exergame-driven high-intensity interval training (HIIT) and its effects on cardiovascular fitness in untrained community dwelling older adults. Methods Twelve older participants [10 women, age 72.3 ( SD : 4.44) years] performed a high-intensity interval exergame intervention three times a week for 4 weeks. Data was acquired during two baseline and one final measurement. Feasibility outcomes included attrition, adherence, acceptability [Technology Acceptance Model Questionnaire (TAM)], usability [System Usability Scale (SUS)], and enjoyment of exergaming. Furthermore, participants’ physical activity levels pre and post intervention were compared to physical activity levels for similar types of training. The secondary outcome was exercise capacity [heart rate at rest (HRrest), heart rate variability (HRV), maximum heart rate (HRmax), and maximum workload (W, in watt)] evaluated through maximal exercise testing. Results Eleven participants completed the study (8% attrition), without any adverse events. Adherence to the HIIT intervention was 91% and participants showed high acceptance of the intervention with TAM scores between 5.8 and 6.7 points. User satisfaction was rated as excellent (SUS total score: 93.5 of 100) and the overall enjoyment of exergaming scored 4.5 of 5 possible points. Total exercise time ranged from 19 to 35 min with a mean of 30.8 ( SD : 3.6) min. Actual high-intensity exercise time showed consistency with the target exercise time in 98% percent of trainings. Eighty-six percent of high-intensity intervals met the targeted intensity range (>70–90% of HRmax). Thirty-six percent of the recovery periods were completed with a heart rate above the target range of 50–70% of HRmax. Maximum workload (W) during the incremental exercise test post-training increased significantly compared to the baseline measurements one and two ( p = 0.032, effect size r = 0.77 and p = 0.012, r = 0.87). Conclusion High-intensity interval training through exergaming is feasible, safe, and shows high usability and acceptance in community dwelling older people. Exergame-driven HIIT had a significant effect on maximum power output on an incremental exercise test. A more extensive exergame intervention period, higher work to recovery ratios as well as a higher-intensity activity should be considered in future projects.

Usability Issues of Clinical and Research Applications of Virtual Reality in Older People: A Systematic Review

“…Sessions lasted from nine to 90 min (mean time = 30 min ca. ), ranging from one to 36 sessions spread over the course of 1 single day to 4 years; indeed, usability along with effectiveness of training was tested for three , four Rebsamen et al, 2019;van Beek et al, 2019), six , eight , and 12 weeks Desteghe et al, 2017), and three and 4 years . Exergames (i.e., serious games used for balance and fall risk training) were used in most of the motor training Schwenk et al, 2014;Wüest et al, 2014;Kiselev et al, 2015;Sáenz-de-Urturi et al, 2015;Shubert et al, 2015;Brox et al, 2017;Trombetta et al, 2017;Money et al, 2019;Rebsamen et al, 2019;van Beek et al, 2019), physiotherapy exercise in others Im et al, 2015), cognitive-physical dual-task in Pedroli et al (2018), neuropsychological testing in three studies Corno et al, 2014;Plechatá et al, 2019;Valladares-Rodriguez et al, 2019), gesture therapy in Morán et al (2015) and Vanbellingen et al (2017), and psychosocial support/educational in four studies Castilla et al, 2013;Cook and Winkler, 2016;Desteghe et al, 2017).…”

“…Additionally, innovative quantitative techniques could be useful to track unexpected information about psychophysiological (e.g., eye-tracking, heart-rate, galvanic skin response, non-verbal communication) responses of the users to assess their affective and cognitive reactions to the VR system Sáenz-de-Urturi et al, 2015). VR can also be used for evaluating usability and adherence (good >80%) by using time spent, number of log-ins, or interaction modality, giving additional quantitative data (Cipresso, 2015;Rebsamen et al, 2019;van Beek et al, 2019). Importantly, when testing immersive VR, cybersickness should always be assessed because it may negatively influence clinical practice and its reduction is a key objective of pilot studies (Kober et al, 2013;Corno et al, 2014;Tuena et al, 2017;Plechatá et al, 2019) and virtual embodiment with questionnaires if avatars are used (Kilteni et al, 2012;Gonzalez-Franco and Tabitha, 2018).…”

“…Concerning quantitative data, system usability scale (SUS) Sáenz-de-Urturi et al, 2015;Shubert et al, 2015;Vanbellingen et al, 2017;Nikitina et al, 2018;Pedroli et al, 2018;Money et al, 2019;Rebsamen et al, 2019;van Beek et al, 2019), TAM-based questionnaires Wüest et al, 2014;Morán et al, 2015;Cook and Winkler, 2016;Rebsamen et al, 2019;Valladares-Rodriguez et al, 2019), UX questionnaires Sáenzde-Urturi et al, 2015;Brox et al, 2017;Desteghe et al, 2017;Rebsamen et al, 2019), UCD-based questionnaire , flow of experience scale , other usability questionnaires Epelde et al, 2014;Trombetta et al, 2017;Plechatá et al, 2019;Valladares-Rodriguez et al, 2019), adherence or motivation to training questionnaires Desteghe et al, 2017;Vanbellingen et al, 2017;Nikitina et al, 2018;Rebsamen et al, 2019;van Beek et al, 2019) or with VR data Kiselev et al, 2015;Desteghe et al, 2017;Vanbellingen et al, 2017;Nikitina et al, 2018;Rebsamen et al, 2019;van Beek et al, 2019), cybersickness assessment Im et al, 2015;Plechatá et al, 2019), technology expertise Rebsamen et al, 2019;Valladares-Rodriguez et al, 2019), and video analysis were used. Regarding qual...…”

“…Tsai et al (2012) showed that Sharetouch is a well-designed, easy, and usable system, independent of gender or age, and facilitates social interactions in OA. Importantly, significant effects of the rehabilitative training on different motor/physical measures were found in all the studies that tested efficacy and usability Wüest et al, 2014;Im et al, 2015;Vanbellingen et al, 2017;Rebsamen et al, 2019;van Beek et al, 2019). However, risk of bias (see Supplementary Figure 1) is high for most of the categories (randomization, allocation, blinding, missing data, and reporting bias), as the majority of the research is quasi or non-experimental.…”

“…Application exclusively for tablets were used inValladares- Rodriguez et al (2019) and multi-device (i.e., PC, tablet or mobile) apps inCastilla et al (2013),Desteghe et al (2017),. Semi-immersive VR (i.e., large TV or projector screens with sensors for interaction) systems were tested in some studiesEpelde et al, 2014;Schwenk et al, 2014;Im et al, 2015;Kiselev et al, 2015; Sáenzde-Urturi et al, 2015;Brox et al, 2017;Rebsamen et al, 2019), whereas full immersive VR (i.e., visors or CAVE with interaction devices) was tested only inFordell et al (2011, andPedroli et al (2018). Interestingly, Trombetta et al(2017) compared a semi-immersive vs. an immersive version of the training to evaluate their usability, whereas Plechatá et al (2019) tested a VR memory test with non-immersive vs. immersive VR.…”