Development of an Exergame to Deliver a Sustained Dose of High-Intensity Training
Condition: Metabolic Syndrome
MeSH terms: Metabolic Syndrome
Study type: Interventional

Summary: 
      Males from areas of social deprivation within the town of Middlesbrough (UK) were targetted
      and recruited on to a high-intensity, exergaming intervention over a 6-week period. Eligible
      participants were randomly allocated to an intervention group (weekly exergaming) or control
      group (normal habitual lifestyle). All participants completed baseline (week 0) and follow-up
      (week 7) measures of metabolic health. Participants in the intervention group were invited to
      three sessions a week of high-intensity exergaming performed against their peers on a
      developed boxing game.
    

Detailed description: 
      A 6-week exploratory controlled trial designed to assess the fidelity of the game in terms of
      delivering the intended training stimulus and to examine the effect of the intervention on
      selected health outcomes was conducted. As appropriate for an exploratory trial, the
      investigators did not conduct formal sample size estimation a priori, rather the CIs would be
      used to inform future trials. A targeted recruitment approach at locations predominantly
      attended by men may facilitate uptake of participants was used. Therefore, to maximize
      recruitment within the intended population, relevant gatekeepers were approached at
      institutions positioned within regions of social deprivation. Thus, two settings used for
      recruitment and the trials were a social club and mosque, both situated within deprived
      regions of Middlesbrough, United Kingdom (TS1 and TS4). A total of 24 males were recruited
      into the trial (Figure 4) using relevant gatekeepers at institutions positioned within
      regions of social deprivation. Two recruitment drives (October 2014 and February 2015) took
      place, and these involved live demonstrations of the technology followed by word-of-mouth and
      snowballing approaches. The exergaming system was important in this recruitment process
      because it provided something tangible and interesting to engage potential participants.

      A third-party minimization process using baseline measures of age, waist circumference, and
      predicted maximum oxygen consumption (VO2 max) was used to remove bias in group allocation.
      The control group was instructed to maintain their current physical activity levels and
      inform the researchers should any changes arise during the intervention period. Overall
      retention to the intervention that encompassed baseline and follow-up measures was 87.5%
      (21/24).

      To explore perceptions of the exergame and the HIT regime, semistructured interviews were
      conducted with 5 intervention participants following the 6-week training period, which were
      analyzed semantically. The study was approved by the ethics committee of Teesside University,
      United Kingdom, and written informed consent was obtained from all participants.

      Evidence recommends a minimum duration of 12 weeks for a HIT protocol to promote favorable
      changes in blood pressure and anthropometric measurements of obesity [35]. However, a 6-week
      intervention was selected, as a minimum of 13 sessions (0.16 work/rest ratio) is sufficient
      to elicit moderate improvements in VO2 max in sedentary individuals. Additionally, there is
      still ambiguity regarding the optimal work-to-rest ratio when designing HIT interventions,
      particularly in populations with varied age, baseline fitness, and training experience.
      Therefore, longer duration HIT models (1-4 min) were deemed unsuitable for the target
      population. Furthermore, minigames (such as the current exergame) have short life spans,
      where adherence to a longer intervention (eg, 12 weeks) may diminish over time and influence
      health outcomes. This was evident from a 12-week pilot study (unpublished data) using an
      exergame in the same population that saw attendance drop from 53% during week 2 to 16% during
      week 12.

      Participants allocated to the intervention group were invited to attend three sessions of
      exergaming per week. At the beginning of the exergaming session, participants were required
      to complete a 6-min structured warm-up consisting of a series of exercises on a 210 mm step
      until both participants reached >70% HRmax. Session workloads with volumetric progression
      were set automatically once the user's identifying information was entered. The session
      workloads were 120-s, 150-s, and 180-s of work during weeks 1 and 2, weeks 3 and 4, and weeks
      5 and 6, respectively.

      To avoid staleness, the repetition lengths (10, 20, or 30-s) were randomly selected at the
      beginning of each round. The investigators set the work-to-rest ratio at 1:4, and thus, the
      respective repetitions were followed by 40, 80, or 120-s of active recovery. Participants
      were instructed to perform the repetitions at an intensity ≥85% HRmax. Each exergaming
      session took approximately 30 to 40 min to complete, including equipment set-up, warm-up with
      additional enjoyment, and task immersion questionnaires upon completion of the HIT bouts (not
      reported here). Heart rate responses were taken within repetitions and therefore, did not
      include any of the recovery period. This, therefore, avoided an overestimation of
      physiological load, which can occur when heart rate continues to rise after exercise
      cessation.
    

Intervention name(s): High-intensity exergaming
Intervention type(s): Other
Intervention description(s): Perform high-intensity exercise whilst playing a developed exergame. A full warm-up performed prior to the session was performed (~70% HRmax). Periods of exercise were performed at an intensity >85% HRmax for periods of 10, 20 and 30s, interspersed with periods of rest, for a total of 2-3 minutes per session. Heart rate was monitored throughout the intervention.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Pilot, exploratory, randomized controlled trial
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: high-intensity interval training; video games; heart rate; boxing; metabolic syndrome