Use of Wii Home Computer in Patients With Chronic Obstructive Pulmonary Disease: Effects on Quality of Life
Condition: COPD
Study type: Interventional

Summary: 
      This study was designed to evaluate the effectiveness of 12 weeks' home exercise training
      using the Nintendo ® Wii Fit system in patients with COPD. Following an initial pilot study
      at one institution to determine the physiological responses to exercise training using the
      home based interactive computer system, a longitudinal study was performed to evaluate
      outcomes across several areas. Outcomes were measured at baseline, after 6 weeks of standard
      care, and after 6 and 12 weeks of home exercise training. Three hospital based pulmonary
      rehabilitation centers in Connecticut participated in the longitudinal study.
    

Detailed description: 
      After an initial clinical assessment, which included spirometry or review of recent
      spirometric data, patients performed an ISWT, as described above. Those who required using
      supplemental oxygen carried their own tanks. For those who had participated in the pilot
      study, another ISWT was performed at this time.

      Following a 1-hour rest period, baseline outcome assessments were obtained. These included:

        1. The Endurance Shuttle Walk Test (ESWT) 9 After an initial warm-up at a slow walk speed,
           patients walked at an external pace set by an audio source at approximately 85% of their
           maximal determined by the ISWT. Time at this speed was recorded.

        2. Health status. This was measured using the self-reported Chronic Respiratory
           Questionnaire (CRQ-SR) which has domains of dyspnea, fatigue, emotion and mastery as
           well as a total score.

        3. Dyspnea. This was measured using the 5-point Medical Research Council (MRC) rating.

        4. The number of sit-to-stand repetitions in 30 seconds. The patient was seated on a chair
           without arms and instructed to stand up (without using his/her arms) and then return to
           the seated position as many times as possible in a 30-second period. This test was first
           demonstrated by an investigator and then performed by the patient.

        5. The number of arm lift repetitions in 60 seconds.11 The subject was instructed to stand
           and repetitively raise a wooden dowel, from a position resting against the thighs, up to
           eye level with the arms straight at the elbows, and the return to original position. The
           maximum number of completed repetitions in 60 s was recorded.

      Patients returned after a 6 week non-intervention period when the above-listed outcomes were
      repeated. They were then given instructions on how to use the Wii Fit unit to perform
      exercise at home and instructed to perform at least 30 minutes of specified exercises on most
      days of the week. The required exercises, in sequence, were 1) "Basic Run" (warm up
      exercise); 2) "Bird's Eye, Bull's-Eye" (mostly upper arm exercise); 3) "Free Step" (mostly
      lower extremity exercise); 4) "Obstacle Course" (upper and lower extremity exercise); and 5)
      "Basic Run" (cool down exercise). Additional, ad-lib exercises using this device were
      allowed. They were instructed to maintain a diary, recording the dates of each session and
      the total number of minutes devoted to this exercise. Other exercises not based on this
      system were allowed but not recorded.
    

Intervention name(s): Use of Home exercise computer program
Intervention type(s): Behavioral
Intervention description(s): After a 30-minute rest period the study patient performed a series of 4 representative exercises from the Wii under direct supervision by an investigator. Five minutes' rest was allotted between each exercise. The patient was instructed to exercise at his/her own pace, with a maximal duration of 5 minutes per exercise. The Oxycon Mobile was worn throughout this exercise, and the metabolic measurements listed above were recorded over the last 30 seconds of each exercise. The exercises included running in place, upper arm movements, stepping in place, and obstacle course.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: COPD; exercise endurance