Active Video Game and Potential to Cause Post-exercise Hypotension
Condition: Hypertension
MeSH terms: Post-Exercise Hypotension; Hypotension
Study type: Interventional

Summary: 
      The aim of this study was to determine the energy demand and the potential to promote reduce
      blood pressure of an active video game (AVG). Fourteen hypertensive (56.4 ± 7.5 years) held a
      session AVG and traditional sedentary video game sessions (SVG) and walk (WAL), as negative
      and positive controls, in order determined randomly. During the sessions, they were observed
      oxygen consumption and energy expenditure (EE). Blood pressure (BP) and cardiac autonomic
      modulation (CAM) were measured at rest and every 15 minutes of a 60 minute period of recovery
      activities. It was also applied a rating scale of pleasure (enjoyment scale).
    

Detailed description: 
      Volunteers: In a previous pilot study, seven women who had systolic blood pressure (SBP) of
      resting 128.9 ± 9.4 mmHg obtained a reduction to 116.9 ± 7.0 mmHg 60 minutes after a workout
      with AVG. These data resulted in an effect size of 1.05. Adopting an α error of 0.05 and
      statistical power of 0.95, estimated a minimum sample size of 12 volunteers. effectively
      participated in the study 14 hypertensive women aged between 47 and 68 years (56.4 ± 7.5
      years). In addition to the diagnosis of hypertension, they should perform with pressure
      values of at least 130/90 mmHg and no greater than 160/110 mmHg in measurements made in the
      days before the study and on the day of data collection. They should still be postmenopausal
      women, being overweight or obesity grade I (BMI between 25 and 34.9 kg / m2), not be
      practicing systematic physical exercise for at least three months and not be suffering from
      labyrinthitis. They would be excluded from the study volunteers who initiate any
      antihypertensive treatment during the study period, presented difficulties to perform the AVG
      games or take him more than four weeks to complete all experimental procedures.

      The research project was approved by the Research Ethics Committee of the Health Science
      Center - UFPB under the nº0621 / 14 protocol. After informed about all the procedures, the
      volunteers signed a Consent and Informed (IC) according to the resolution 466/12 of the
      National Health Council of Brazil.

      Study design: the volunteers held an AVG session, an internal control session composed of
      sedentary video game (SVG) and an external control session consists of a walking exercise
      (WAL) with a minimum of 48 hours between sessions and order determined randomly. In all
      sessions, during activities, they were instrumented with portable gas analyzer for measuring
      energy expenditure (EE) accelerometer to quantify performed movements and heart rate monitor
      to evaluate the behavior of heart rate (HR). Blood pressure measurements (BP) and cardiac
      autonomic modulation (CAM) were performed at rest and every 15 minutes a period 60 minutes of
      recovery activities. In these same times it was applied a rating scale of pleasure in
      activities (enjoyment scale) (Figure 1).

      Pre experimental procedures: prior to the experimental sessions, blood pressure measurements,
      physical activity and blood collection were made to characterize the participants. Personal
      information on the drugs used and collected and they were given a list containing rich foods
      and medicines caffeine could not be ingested 24 before each experimental session.

      Adaptation activities: the participants underwent three sessions of adaptation and learning
      the handling of active and sedentary games and walking on a treadmill. The sessions lasted 10
      to 40 minutes, with an interval of 48 hours between sessions and at least 72 hours between
      the last session of adaptation and the first test session. The intensity adopted in these
      sessions was free, but participants were encouraged to achieve moderate intensity on the
      treadmill exercise (60% to 85% of maximum heart rate). They were also taught to respond to
      the subjective perception questionnaires effort and enjoyment scale.

      Video active game: the console was the Xbox 360 with Kinect sensor (Foxconn®, New Taipei,
      China) and the game used was Dance Central (Harmonix Music Systems - Microsoft Games
      Studios). The difficulty level of the game was adopted the beginner, since the participants
      had no previous experience with AVG. In the game used, bodily movements are similar to dance
      steps with the use of different songs from pop style referring to the 1970, 1980, 1990 and
      2000. The session lasted 40 minutes.

      Video game sedentary: we used the Dance Dance Revolution® (SSD Company Ltd., Shiga, Japan)
      for Playstation 2® (San Mateo, CA, USA), where the practitioner simulated synchronized dances
      of similar songs to those used in gyms, however using the joystick traditionally known, so
      that remained seated throughout the session. The duration of the game was 40 minutes.

      walking exercise: the participants performed a walking session on a treadmill (Moviment,
      Brudden Ltda, São Paulo, Brazil) lasting 40 minutes and previously prescribed intensity
      between 60% and 80% of maximum heart rate.

      Accelerometry: an accelerometer used was brand Actigraph® GT3 X (Pensacola, USA) for
      evaluating the acceleration of the body, calibrated according to the manufacturer's
      specifications. The adopted time interval was 60 seconds and output data expressed as mean
      counts per minute. The unit was set at waist height, the right hand by a strap of elastic and
      adjustable buckle. At the end of the records, data were transferred to a computer and
      analyzed using the SAS 9.2 software (SAS Institute Inc., Cary, NC 25513). The adopted
      referêcia values were 0-99 counts / min-1, considered sedentary activity, 100-1951 counts /
      min-1, light activity, 1952-5724 counts / min-1 was moderate activity and from 5725 counts /
      min-1, seen vigorous activity, according Freedson et al (113) Energy demand: it was made by
      gas analysis through the analyzer portable lung gases K4b2 (Cosmed Copyritgh ©, Rome, Italy)
      validated the study by McLaughlin et al (114). This equipment enables verification in each
      breath, respiratory parameters, measuring the oxygen consumption (VO2) and carbon dioxide
      production during exercise. The device was calibrated according to the manufacturer's
      recommendations. The variables measured by this instrument were the DE and VO2. The
      measurements were performed at rest (for five minutes) and during experimental sessions.

      Heart rate and perceived exertion: HR was measured using a heart rate monitor brand Polar
      RS800CX model (Polar ElectroOy, Kempele, Finland). The measurements were made after 10
      minutes at rest and every 5 minutes Durantes exercises. In the same times that HR was
      measured, the Subjective Perception Scale of Borg effort (Noble and Borg et al, 1983), with
      scale 6-20 points, was presented to the participants and asked who said they had their
      feelings of stress.

      Enjoyment Scale: This scale has been validated for use in the adult population according to
      Graves et al. (2008). It consists of 18 items that assessed the level of pleasure / enjoyment
      from levels ranging from "I like" to "I hate" in that the higher the sum of these points,
      pleasure / enjoyment the activity performed provided. This scale was presented to
      participants at the beginning of each study session and the same to answer the end of each
      study session.

      Blood pressure: before the start of each session, participants were asked to stay 15 minutes
      at rest and sitting. After this period was found resting BP. Further measures were taken
      immediately at the end of the experimental session and every 15 minutes during a 60-minute
      recovery period, the volunteers seated throughout this period. These measurements were
      performed by the oscillometric method with the use of ambulatory monitoring apparatus PA
      (DYNAMAPA) following the V Brazilian Guidelines on BP ambulatory monitoring (ABPM) (ALESSI,
      A; BRANDÃO, A.;. PIERIN et al, 2005). three pressure taps were made for each measure and
      considered the two closest values.

      Cardiac Autonomic Modulation (CAM): Immediately after each measurement of BP, we evaluated
      the MAC through the HR variability, using a monitor brand Polar RS800CX (PolarElectroOy,
      Kempele, Finland). The volunteers were seated and the record was made for a minimum of 10
      minutes. Data were transferred to a computer provided with software of the same manufacturer
      and then transferred to the Kubios HRV software, version 2.0 (University of Kuopio, Finland).
      Data were analyzed in the time domain, being considered the average (RRM) and the standard
      deviation of the individual intervals RR (SDNN), the root mean square of successive
      differences between adjacent RR (RMSSD) and the percentage of successive differences between
      RR intervals greater than 50 ms (pNN50). In the frequency domain, they were considered low
      frequency bands (0:04 to 00:15 Hz) (LF) and high frequency (0.15 to 0.4 Hz) (AF). It was also
      adopted the low ratio frequency / high frequency as sympathetic-vagal balance (LF / HF).

      Statistical analysis: Data are mean and standard error of the mean. the Shapiro-Wilk tests
      were used to verify the normality and Levene to check homogeneity. One-way ANOVA was used to
      compare the resting values. For comparisons between measurements during and after the
      experimental sessions, it adopted the two-way ANOVA test. Data were analyzed using the
      GraphPad Prism 6.0 software (GraphPad, San Diego, CA, USA), a significance of p <0.05.
    

Intervention name(s): video game active; sedentary video game; walking
Intervention type(s): Other; Other; Other
Intervention description(s): The session lasted 40 minutes. The participants held an active video game session. At the end they were monitored for 60 minutes at rest.; The session lasted 40 minutes. The participants held an sedentary video game session, using the traditional joystick. At the end they were monitored for 60 minutes at rest.; The session lasted 40 minutes. The participants held a walk using the treadmill. At the end they were monitored for 60 minutes at rest.
Other intervention name(s): AVG; SVG; WAL
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: post exercise hypotension; exercise; video games