Home-Based Exercise Gaming for Physically Inactive Individuals

Study Overview
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Brief Summary
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Current guidelines recommend that adults undertake at least 150 minutes of moderate intensity physical activity or 75 minutes of vigorous physical activity per week. However, many adults fail to be physically active according to this definition of the World Health Organisation (WHO). This represents a large economic burden to healthcare systems and public health. A number of behavioural and environmental factors associated with modern lifestyles are largely responsible for the high levels of physical inactivity including; motorised transport and sedentary jobs, lack of time, limited access to adequate exercise facilities, lack of motivation, financial constraints and environmental factors including bad weather. In an attempt to overcome many of the common barriers to exercise, members of our research group developed a virtually-monitored exercise intervention that used simple on-the-spot bodyweight exercises to be performed in the participant's home without supervision or equipment. This home-based intervention was designed to be a practical and effective training strategy capable of producing metabolic and functional adaptions while removing many of the common barriers to exercise. Despite promising results, more engaging exercise strategies are needed to motivate sedentary individuals to increase their physical activity. Inspired by current trends in the fitness market, Sphery Ltd. developed an immersive and motivating fitness exercise game (exergame), the ExerCube. The ExerCube allows a full-body workout that concurrently challenges physical and cognitive functions and adapts to the fitness and skill level of the individual. The development of a home-based version of the ExerCube has the potential to make this system available to more individuals, reduce major barriers to exercise, and ultimately provide a strategy to improve cardio-metabolic health in the population. Innovative home-based exergames are particularly in demand given the increase in the number of people wanting to exercise at home due to the COVID-19 pandemic.

Detailed Description
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Current guidelines recommend that adults undertake at least 150 minutes of moderate intensity physical activity or 75 minutes of vigorous physical activity per week. Regular physical activity improves many cardiovascular and metabolic health makers including beneficial effects on body weight, insulin sensitivity, glycaemic control, lipid profile, endothelial function and aerobic capacity. Despite overwhelming evidence that an inactive lifestyle leads to chronic disease and premature death, many adults fail to meet physical activity guidelines. Physical inactivity, defined as physical activity levels less than those required for optimal health and prevention of premature death, is a public health crisis. More than 1.4 billion adults worldwide classed as physically inactive, representing a large economic burden to healthcare systems. Clearly, new strategies are urgently needed to increase physical activity participation in the increasingly inactive population. A number of behavioural and environmental factors associated with modern lifestyle including urbanisation, mechanisation and increased motorised transport are largely responsible for the high prevalence of physical inactivity, in addition to a number of common exercise barriers. Lack of time is cited as the main barrier to exercise as many individuals feel that increasing work hours and family commitments mean they cannot achieve the physical activity guidelines. Other common barriers within the general population include limited access to exercise facilities and appropriate equipment, difficulty with transportation, inadequate financial resources, bad weather and lack of motivation to engage in regular exercise. In an attempt to overcome many of the common barriers to exercise, members of our research group developed a virtually-monitored exercise intervention that used simple on-the-spot bodyweight exercises that could be performed in the participant's home without supervision or equipment. This home-based intervention was designed to be a practical and effective training strategy capable of producing metabolic and functional adaptions while removing many of the common barriers to exercise uptake and adherence such as intimidating gym environments, difficulty with access to facilities, travel time and financial constraints. Although these pilot studies successfully reduced common exercise barriers, more engaging exercise strategies are needed to increase levels of physical activity in the physically inactive population. Inspired by current trends in the fitness market, the Swiss company Sphery Ltd. developed an immersive and motivating fitness exercise game (exergame), the ExerCube. The ExerCube provides a full-body workout that concurrently challenges physical and cognitive functions as well as adapting to the individuals' fitness and skill level. Previous research has shown that the ExerCube is an effective training method that is more enjoyable than conventional exercise training. Development of a home-based version of the ExerCube has the potential to make this system available to more individuals, and to reduce major barriers to exercise, providing an attractive strategy to improve cardio-metabolic health of the population. Innovative home-based exergames are in demand given the increase in the number of people wanting to exercise at home due to the COVID-19 pandemic.

Official Title
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Effects of Home-based Exercise Gaming on Cardio-Metabolic and Cognitive Health Markers in Physically Inactive Individuals

Conditions
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Physical Inactivity

Intervention / Treatment
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* Behavioral: Home-based exergaming


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female Aged 18-55 Physically inactive, defined as not meeting the exercise guidelines of 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week BMI 18.5 kg/m2 - 30 kg/m2 No known cardiovascular disorders Able to provide written informed consent and understand instructions Exclusion Criteria: Overt diabetes mellitus (type 1, type 2, other forms of diabetes) Pregnant, planning on becoming pregnant during the study, or breast feeding Physical or psychological disease likely to interfere with the normal conduct of the study as judged by the investigator

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Interventional Model Description: A single-centre, single-armed, open label pilot study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: home-based exergaming<br>The home-based exergame intervention will take place in an unsupervised place of the participant's choosing. Participants will be provided with all of the equipment (including a television if required) and receive instructions on how to use the system. Participants will be provided with a stepped training plan with exergame session durations of 19 minutes (4x 3-minutes 45-seconds of exercise interspersed with 1 minute of rest) in weeks 1 and 2; 24-minutes (4x 5-minutes of exercise interspersed with 1 minute of rest) in week 3 and 4; and 30-minutes (5x 5-minutes of exercise interspersed with 1 minute of rest) in week 5 and 6. Sessions will be set at a vigorous intensity (≥80% heart rate maximum) and participants will be provided with individualised heart rate zones to achieve in line with heart rate maximum determined during a maximal exercise test in Visit 2. Participants will be asked to train 3 times per week. | Behavioral: Home-based exergaming<br>* Participants will undertake one of two 6-week training interventions. In both groups participants will be asked to train 3 times per week (18 sessions total), during which adherence to the training will be measured. To monitor adherence to training and training load (exercise completion, exercise duration and heart rate achieved during workouts) throughout the 6 weeks participants will be given a heart rate monitor.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| VO2max | Change in maximal aerobic capacity (VO2max) | Pre to post 6 weeks of home-based exergame training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Wmax | Change in maximal power output (Wmax) | Pre to post 6 weeks of home-based exergame training | 
| Adherence | Training adherence indicated by the number of training sessions performed over the 6 week period | 6 weeks of home-based exergame training | 
| Adherence | Training adherence indicated by the number of training sessions in which the desired exercise intensity was achieved over the 6 week period | 6 weeks of training | 
| Drop-out rate | Number of participants that drop out from the study | 6 weeks training | 
| Physical Activity Enjoyment Scale (PACES) score | Change in Physical Activity Enjoyment Scale (PACES) score (an 18-item scale designed to measure physical activity enjoyment) | Pre to post 6 weeks of home-based exergame training | 
| Situation Motivation Scale (SIMS) | Change in Situation Motivation Scale (SIMS) score | Pre to post 6 weeks of home-based exergame training | 
| Qualitative interviews | Overall experience determined through qualitative interviews | Following 6 weeks of training | 
| Immersive Experience Questionnaire (IEQ) | Immersive experience during home-based exergame sessions | Following 6 weeks of training | 
| Executive Functioning | Change in reaction time determined using Test for Attentional Performance | Pre to post 6 weeks of home-based exergame training | 
| Dynamic balance | Change in dynamic balance determined using Y-Balance Test | Pre to post 6 weeks of home-based exergame training | 
| Whole body adipose tissue | Change in whole body adipose tissue volume using InBody body composition analyser | Pre to post 6 weeks of home-based exergame training | 
| Visceral adipose tissue | Change in visceral adipose tissue mass using InBody body composition analyser | Pre to post 6 weeks of home-based exergame training | 
| Fat free mass | Change in fat free mass using InBody body composition analyser | Pre to post 6 weeks of home-based exergame training | 
| Blood pressure | Change in blood pressure (systolic, diastolic and mean) | Pre to post 6 weeks of home-based exergame training | 
| C-reactive protein | Change in C-reactive protein | Pre to post 6 weeks of home-based exergame training | 
| Total cholesterol | Change in total cholesterol | Pre to post 6 weeks of home-based exergame training | 
| Low Density Lipoprotein | Change in low density lipoprotein | Pre to post 6 weeks of home-based exergame training | 
| High Density Lipoprotein | Change in high density lipoprotein | Pre to post 6 weeks of home-based exergame training | 
| Triglycerides | Change in triglycerides | Pre to post 6 weeks of home-based exergame training | 
| HbA1c | Change in HbA1c | Pre to post 6 weeks of home-based exergame training | 
| Fasting glucose concentration | Change in fasting glucose concentration | Pre to post 6 weeks of home-based exergame training | 
| Fasting insulin concentration | Change in fasting insulin concentration | Pre to post 6 weeks of home-based exergame training | 
| Mean daily glucose concentration and area under the glucose curve | Change in mean daily glucose concentration and area under the glucose curve | Pre to post 6 weeks of home-based exergame training | 
| Coefficient of variation | Change in coefficient of variation in continuous glucose monitor | Pre to post 6 weeks of home-based exergame training | 
| Mean Daily steps | Change in daily steps monitored by an accelerometer in percent | Pre to post 6 weeks of home-based exergame training | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Home-based exercise gaming, Cardiovascular health, Neurocognitive health, Physical Inactivity, Exergame