# Exercise as it relates to Disease/Effectiveness of physical fitness through virtual reality in individuals with intellectual and developmental disability

This wikibook's page is a critique of the research article "Improving physical fitness of individuals with intellectual and developmental disability through a Virtual Reality Intervention Program" by Meir Lotan Shira Yalon-Chamovitz and Patrice Weiss 2009.

## What is the background to this research?

The aim of the research was to investigate the effectiveness of video capture virtual reality (VR) to enhance the physical fitness levels of individuals with intellectual and developmental disability (IDD). Individuals with IDD have been shown to have lower levels of physical fitness when compared to peers without IDD. This commonly occurs due to the passive lifestyle, low motivational levels exhibited, psychological and/or physiological factors.
Previous case studies relating to VR devices stated that motivational levels were high due to participant enjoyment leading to more engagement. This research takes a broader approach to other factors such as social, emotional and cognitive development, as well as the individual’s interests. For this to occur it requires the intervention to be highly motivational. As some fitness tests require supplementary requirements such as specialised equipment and/or trained individuals, these complexities may be exchanged for alternative fitness tests more favourable to the setting such as VR.

## Where is the research from?

Meir Lotan is an expert professor in the physical therapy field, with numerous published papers on a variety of health subjects including medicine, neuroscience, biochemistry and genetics. Lotan has completed similar studies across the years and this research is just one into those concerned with IDD. His 2006 study began researching how to improve physical activity in adolescents with intellectual disability, followed by the currently analysed study with an additional follow up study published in 2010 as ‘Virtual reality as means to improve physical fitness of individuals at a severe level of intellectual and developmental disability’ with the same team.

## What kind of research was this?

Researchers undertook an observational study to monitor how individuals with IDD responded to physical fitness with the use of VR in comparison to a control group. This study also had an additional goal to determine whether the motivational effect found in previous studies could be achieved with a reduced number of trained staff and specialised equipment, so more of these individuals can increase their level of physical fitness in the comfort of their own space. Other studies differ due to methodology however a large portion support evidence of a positive correlation between the use of VR in improving physical fitness in those with IDD.

## What did the research involve?

The participants were divided into two, thirty person groups both with approximately half that utilise wheelchairs and half that are utilising walker aids. One of these were a control group while the other group was the experimental group. Participants of each group were then enrolled into three, thirty-minute sessions per week over a span of 5-6-week for the length of the program. A preintervention test was performed a week before commencing the program. An included 10 min break was done before the start of the program once the participant arrived at the room. After the second session, the participants could choose their favourite games for the remainder of the program. The methodology was an acceptable approach due to limiting the factors of external stimuli. This was shown by the designated room of the participants resident which they would feel less anxious about and with the same 2 occupational therapy students and physiotherapist supervisor. The choice of game was also set by the individual having their preference of game for most of the test period. The test also allowed for a pre and post intervention test with non-overloading three, thirty-minute sessions per week with breaks to regulate anxieties about testing. However, the recruitment of these individuals did not account for those that still are able bodies that do not rely upon mobility aids. The study also did not account for those who are under the age of 30 or 18 when the disability is most diagnosed.

## What were the basic results?

The results showed that the Modified Cooper test had the most growth. There was a significant difference in the pre-post measurements of the wheelchair users and those with walking aids when compared separately. The Total Heart Beat Index (THBI) also showed the post intervention of the research group walkers users dropped significantly from 53.5+/- 57.0 to 31.3 +/- 27.9, while those from the research group with a wheelchair aid dropped from 8.1+/-13.0 to 3.9+/-3 however still a significant result.
Results Table :
| | Ambulance Type | Cooper Test (m) (Pre) | Cooper Test (m) (Post) | Energy Expenditure Index (EEI) (Pre) | Energy Expenditure Index (EEI) (Post) | Total Heart Beat Index (HB/M) (Pre) | Total Heart Beat Index (HB/M) (Post) |
| Control | All | 175.6 | 183.9 | 2.1 | 2.3 | 15.2 | 14.8 |
| Research | All | 211.8 | 304.3 | 3.47 | 2.74 | 28.3 | 15.6 |
| Control | Walkers | 253.3 | 261.4 | 1.9 | 2.1 | 7.5 | 8.8 |
| Research | Walkers | 340.1 | 486.7 | 1.2 | 0.87 | 8.1 | 3.9 |
| Control | Wheelchair | 87.6 | 96.1 | 2.5 | 2.5 | 23.9 | 21.5 |
| Research | Wheelchair | 40.7 | 60.1 | 6.5 | 5.3 | 53.5 | 31.3 |
*These values are taken at the mean ± S.D.
The researchers interpreted the results as a positive increase in physical fitness from the research group in relation to the control group. This was evidently shown by the results in the Modified Cooper Test. The researchers did not over-emphasis their findings, though through their discussion the results were compared to the population that did not have IDD.

## What conclusions can we take from this research?

This study has been a significant boost to the insight in how we can adapt modern technology to increase the physical fitness of those with IDD. With the ever-growing support for VR, there can be further refinements made to cater for higher levels of engagement, thus leading to a larger increase in the physical fitness levels of those with IDD. While the idea of VR is a great gateway to increasing physical fitness of those with IDD, more support is required for the types of activities readily available. Those with IDD could ascertain a much better level of physical fitness if the activities are engaging and cater to those utilising this system.

## Practical advice

Further research into the engagement of physical fitness for those with IDD is required to be completed more as an individual case study rather than grouped together based on having IDD. Other case studies regarding those with IDD and their levels of physical fitness have skewed towards more positive results with higher levels of engagement. Further focus on the enjoyment of these activities carried out by the individuals should correlate to higher engagement and physical fitness. To motivate these individuals with IDD, there must be more pre-screening questionnaires to gage the individual’s preference towards types of VR and or physical fitness to improve their engagement levels.

## Further information/resources

* Center For Disease Control And Prevention
* Virtual Reality Institute of Health and Exercise
* Oculus Game “Supernatural” Example
* Oculus Where to Purchase

## References

* 1 2 3 Lotan M, Yalon-Chamovitz L, Weiss P. Improving physical fitness of individuals with intellectual and developmental disability through a Virtual Reality Intervention Program. Research in Developmental Disabilities [Internet]. 2009 March [cited 2020 September 14];30(2):229-239. Available from: https://doi.org/10.1016/j.ridd.2008.03.005
* ↑ King D, Mace F. Acquisition and maintenance of exercise skills under normalized conditions by adults with moderate and severe mental retardation. Mental Retardation [Internet]. 1990 October [cited 14 September 2020];28(5):311-317. Available from: https://pubmed.ncbi.nlm.nih.gov/2147735/
* 1 2 3 Lotan M, Isakov E, Kessel S, Merrick J. Physical fitness and functional ability of children with intellectual disability: Effects of a short-term daily treadmill intervention. TheScientificWorldJOURNAL [Internet]. 2004 June [cited 2020 September 14];4:449-457 . Available from: https://doi.org/10.1100/tsw.2004.97
* 1 2 Pitetti K, Boneh S. Cardiovascular fitness as related to leg strength in adults with mental retardation. Medicine & Science in Sports & Exercise [Internet]. 1995 March [cited 2020 September 14];27(3):423-428. Available from: https://insights.ovid.com/mespex/199503000/00005768-199503000-00020
* ↑ Yalon-Chamovitz L, Weiss P. Virtual reality as a leisure activity for young adults with physical and intellectual disabilities. Research in Developmental Disabilities [Internet]. 2008 May [cited 2020 September 14];29(3)273-287. Available from: https://doi.org/10.1016/j.ridd.2007.05.004
* ↑ Lotan, M. Research Gate [Internet] [cited 2020 September 16]. Available from: https://www.researchgate.net/profile/Meir_Lotan
* ↑ Lotan M, Henderson C, Merrick J. Physical activity for adolescents with intellectual disability. Minerva pediatrica [Internet]. 2006 June [cited 2020 September 15];58(3):219-226. Available from: https://europepmc.org/article/med/16832327
* 1 2 Lotan M, Yalon-Chamovitz L, Weiss P. Virtual reality as means to improve physical fitness of individuals at a severe level of intellectual and developmental disability. Research in Developmental Disabilities [Internet]. 2010 July [cited 2020 September 15];31(4):869-874. Available from: https://doi.org/10.1016/j.ridd.2010.01.010
* ↑ Rowland J, Malone L, Fidopiastis C, Padalabalanarayanan S, Thirumalai M, Rimmer J. Perspectives on Active Video Gaming as a New Frontier in Accessible Physical Activity for Youth With Physical Disabilities. Physical Therapy [Internet]. 2016 April [cited 2020 September 15];96(4):521-532. Available from: https://doi.org/10.2522/ptj.20140258
* ↑ American Association on Intellectual and Developmental Disabilities (AAIDD). Frequently Asked Questions on Intellectual Disability [Internet]. Silver Spring: AAIDD; 2020 [cited 2020 September 15]. Available from: https://www.aaidd.org/intellectual-disability/definition/faqs-on-intellectual-disability
* ↑ Bertills K, Granlund M, Augustine L. Inclusive Teaching Skills and Student Engagement in Physical Education. Front. Educ [Internet]. 2019 August [cited 2020 September 16];4(74). Available from: https://doi.org/10.3389/feduc.2019.00074
* ↑ Smith B. Physical fitness in virtual worlds. Computer [Internet]. 2005 October [cited 2020 September 16];38(10):101-103. Available from: https://ieeexplore.ieee.org/abstract/document/1516067/authors#authors