# Exercise as it relates to Disease/Clinical effects of active video game exercising on children with asthma

This is a student analysis of a study by Gomes et al. (2015). The topic of this research is "Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomised Controlled Trial".

## What is the background to this research?

Asthma is a lung condition whereby the airways in the lungs are narrowed down due to inflammation making it more difficult to breathe and inducing other symptoms such as wheezing, chest tightness and continuous coughing.
Because of its symptoms, asthmatic individuals often have concerns regarding participation in physical activity as it may trigger their symptoms. Moreover, lifestyle changes in recent years means that children are not meeting the recommended physical activity requirements and are leading a more sedentary lifestyle. Time spent on technology has affected this change in their lifestyle as it is time spent at the expense of physical activity. This research poses the question of whether aerobic exercising in the form of technology (active video game) can benefit children with moderate to severe cases of asthma in improving asthma control, airway inflammation and exercise capacity. The hypothesis of this study is that active video gaming is at the same parity in effectiveness as exercising by treadmill in improving clinical control of asthmatic symptoms in children, yet can be a more enjoyable option.

## Where is the research from?

This study was done collaboratively with the following 3 universities located in São Paulo, Brazil:
* Postgraduate Program in Rehabilitation Sciences, Nove de Julho University
* Physical Therapy Department, University of São Paulo
* Santa Casa School of Medical Sciences
The research was conducted in the (unspecified) University clinic specialising in pulmonary health. The authors reported no funding or support for the research.

## What kind of research was this?

This research was implemented using a randomised, controlled single-blinded clinical trial. A randomised controlled trial (RCT) ranks as level II evidence according to the National Health and Medical Research Council (NHMRC). Furthermore, it reduces bias in results and increases in its generalizability across another group or population providing strong evidence in the research.

## What did the research involve?

Participants and allocation:
36 eligible children with asthma from a tertiary centre specialising in childhood asthma were involved in this study. They were allocated randomly into one of the two groups that is a video game group (VGG, n=20) or the treadmill group (TG, n=16).
Brief summary of intervention: (in table form)
| - | Week 1 | Week 2-9 (8 weeks) | Week 2-9 (8 weeks) |
| VGG | Asthma Control Questions | 5 min treadmill warm up (2 km/h) 30 min XBOX Kinect game 5 min treadmill cool down | 40min training 2x/week Monitored heart rate, oxygen saturation and energy expenditure |
| TG | Asthma Control Questions | 5 min treadmill warm up (2 km/h) 30 min treadmill (70% of max effort) 5 min treadmill cool down | 40min training 2x/week Monitored heart rate, oxygen saturation and energy expenditure |

## What were the basic results?

* Both groups received significant results (p<0.05) in regards to improvement in asthma control.
* VGG group demonstrated significant decrease in exhaled FeNO levels (p<0.05), but not the TG group. Reduction of FeNO indicates reduction in airway inflammation.
* VGG group had a significantly higher maximum metabolic expenditure (p<0.05)
* VGG group also had significantly higher total energy expenditure.
* Overall, both groups demonstrated significant improvement in maximum aerobic capacity after training (p<0.05) with an effect size of 0.7.

## What conclusions should be taken away from this research?

This particular research is valuable in literature as there had been no study prior to this that tests active video gaming on asthmatic children. This study provides evidence that active video gaming can be used as an option to manage clinical symptoms of asthma in children. Based on the results, it can be concluded that active video gaming can be an effective way to improve asthmatic clinical control, lung inflammation and overall aerobic fitness in children. Energy expenditure was higher in the VGG as compared to those who trained in the TG suggesting that active video gaming be a fun and appealing option to children that can also contribute to improvements in health. The main limitation stated however was that the use of SenseWear Pro Active might underestimate energy expenditure during vigorous physical activity. As mentioned earlier, time spent on technology use is at the expense of time that could have otherwise been spent on physical activity. Therefore, this intervention is also a good option to potentially reduce sedentary time.
Future direction
It would be curious to see if the children have the motivation to continue adhering to this intervention of active video gaming and therefore a longitudinal study is warranted. It would have also been of best interest as to whether physical activity in the form of active video gaming can potentially substitute the use of pharmacological intervention in children with moderate asthma.

## Practical Advice

The fun factor is likely to be the “driving force” behind a child’s choice to participate in physical activity. Therefore, the XBOX Kinect game or other active video games can be a valuable option as a non-pharmacological intervention for asthma in children.
Aerobic exercises seem to be the most effective type of exercising in regards to benefiting individuals with asthma. Morever, each aerobic activity session is recommended to be carried for at least 20 minutes in order to produce beneficial outcomes for asthmatic patients. Safety caution should always be kept in mind as individuals with asthma usually experience exercise-induced asthmatic symptoms.

## Further reading

* Asthma Australia: https://www.asthmaaustralia.org.au/
* Tips for preventing exercise induced asthma: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/asthma-and-exercise
* Asthma handbook (recommendations and benefits of physical activity): http://www.asthmahandbook.org.au/clinical-issues/exercise/physical-activity

## References

* 1 2 3 4 Gomes, E. L., Carvalho, C. R., Peixoto-Souza, F. S., Teixeira-Carvalho, E. F., Mendonça, J. F. B., Stirbulov, R., ... & Costa, D. (2015). Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomized Controlled Trial. PloS one, 10(8), e0135433.
* ↑ https://www.asthmaaustralia.org.au/national/about-asthma/what-is-asthma
* ↑ Carson, K. V., Chandratilleke, M. G., Picot, J., Brinn, M. P., Esterman, A. J., & Smith, B. J. (2013). Physical training for asthma. The Cochrane Library
* ↑ Australian National Children's Nutrition and Physical Activity Survey (2007) http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-nutrition-childrens-survey
* 1 2 Carlson, S. A., Fulton, J. E., Lee, S. M., Foley, J. T., Heitzler, C., & Huhman, M. (2010). Influence of limit-setting and participation in physical activity on youth screen time. Pediatrics, 126(1), e89-e96.
* ↑ https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
* ↑ Biddiss, E., & Irwin, J. (2010). Active video games to promote physical activity in children and youth: a systematic review. Archives of pediatrics & adolescent medicine, 164(7), 664-672.
* ↑ American Association of Cardiovascular & Pulmonary Rehabilitation. (1998).Guidelines for pulmonary rehabilitation programs. Human Kinetics.