SO067VIRTUAL REALITY EXERCISE INTRADIALYSIS IMPACT ON PHYSICAL FUNCTION AND PHYSICAL ACTIVITY LEVEL: RANDOMIZED CONTROLLED TRIAL WITH FOLLOW-UP
Authors: Segura-Ortí Eva , Martínez-Olmos Francisco José , Garcia-Testal Alicia , Garcia-Maset Rafael , Valtueña-Gimeno Noemi , Ortega-Perez de Villar Lucia , Piñón-Ruiz Jocelyne , Ferrer-Salva Ana , KARANDYSZ KATARZYNA , Lehtoviita Maari Elvi Amanda , Ferrer-Sargues Francisco José , Salvador-Coloma Pablo , Rico-Salvador Inmaculada , Royo-Maicas Pilar , Gil-Gómez José Antonio 
Published: June 2020

Abstract

BACKGROUND AND AIMS
Despite the benefits reported by the implementation of exercise during dialysis, currently it is not a clinical routine. Non-immersive virtual reality (VR) is a feasible option to exercise and in a short pilot study of intadialysis VR exercise improved physical function (PF), Health-related quality of life (HRQoL) and physical activity (PA). The objective of this research was to investigate if a 12-weeks non-immersive VR exercise program intradialysis improves PF and PA.

METHODS
This was a crossover randomized controlled trial. Participants were randomized in a control-VR group (CVR) or VR-control group (VRC). There were two consecutive periods of 12 weeks, one control and one exercise period. The CVR started with a control period and followed by the exercise period, and the VRC did the opposite. PF and PA were assessed at four time points: baseline, 12, 24 and 36 weeks. The functional tests administered included the Short Physical Performance Battery (SPPB), gait speed in 4 meters, Timed Up-and-Go (TUG), balance with the one-legged stance test (OLST), Sit-to-Stand 10 (STS10) and Sit-to-Stand 60 (STS-60), 6 minute walking test (6MWT). Human Activity Profile (HAP) was used to assess PA level. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive VR game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion (RPE). A mixed model of repeated measures were used to assess the effect of the intervention.

RESULTS
47 subjects were included in the study, 22 subjects (median age 73.5 years; 13 males) in the CVR and 25 subjects (median age 72 years, 15 males) in the VRC. At 24 weeks we tested 33 subjects and at 36 weeks 31 patients were tested. The results of all functional tests improved after the exercise program (Gait speed in 4 meters -0.16 seconds, 95% CI -0.1- -0.2 VRC and -0.12 seconds, 95% IC -0.06--0.17 CVR; TUG -1.8 seconds, 95% CI -1.2--2.5 VRC and -1.3 seconds, 95% CI 0.1--2.7 CVR; OLST 6.2 seconds, 95% CI 2.6-9.8 VRC and 8.1 seconds, 95% CI 4.2-12.0 CVR; STS-10 -5.6 seconds, 95% CI -3.5--7.8 VRC and -6.0 seconds, 95% CI -4.0--7.9 CVR; and 6MWT 105.4 meters, 95% CI 76.2-134.6 VRC and CVR 59.5 meters, 95% CI 34.5-84.5). The VRC showed a significant increase in HAP (9.2, 95% CI 6.4-12.0) after the 12 weeks of exercise program. The CVR did not change during the first 12 weeks of no exercise, but showed a significant increase at 24 weeks after the end of the exercise program in HAP (7.4, 95% CI 3.8-11.0). The follow-up of 12 weeks after the end of the program in the VRC showed a significant decrease in function in the following tests (Gait speed in 4 meters -0.13seconds, 95% CI 0.08--0.18; STS-10 -1.4 seconds, CI 95% 0.11-2.65; and 6MWT -66.4 meters, 95% CI 43.5-89.2). During the follow-up period, at 24 weeks, the VRC showed a significant decrease in HAP (-7.7, 95% CI -11.0--4.4), there was no further decrease at 36 weeks. At 36 weeks, after 12 weeks of follow-up, participants in the CVR presented a significant decrease in HAP (-7.2, 95% CI -10.5--4.0).

CONCLUSIONS
A non-immersive VR exercise program during intradialysis improves PF and PA and HRQoL. Exercise benefits are not maintained after 12 weeks of follow-up.