Exercise Intensity and Video Games: Persons Post-stroke

Study Overview
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Brief Summary
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Persons post stroke executed stepping activities under four conditions: standard of care, interacting with: an off-the-shelf Microsoft-Kinect game, with a self-paced repeated custom video game and a game-paced random custom video game. Exercise intensity (neuromuscular and cardiovascular), enjoyment and perceived effort were measured during and after each condition.

Detailed Description
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Persons post stroke were first familiarized with the four exercise conditions and then instrumented with a metabolic system and heart rate sensor. They played the games in two counter balanced blocks: repeated (standard of care and self-paced repeated custom) and random (Microsoft-Kinect game and game-paced random custom). Games were played for 8.5 minutes with ten minutes of rest in between so they could return to physiological baseline. During exercise they reported exertion and at the end of teach exercise trial they completed an enjoyment questionnaire. At the end of the first block, participants removed the metabolic system's mask and were assessed for motor recovery. Performances were video taped. At the end of data collection preferences for the activities were ranked and participants answered open ended questions. Data for neuromuscular and cardiovascular intensity, enjoyment and perceived effort were reduced and analyzed using a Repeated Measures Analysis of Variance (RMANOVA) with the appropriate post-hoc corrections. Where possible clinically meaningful changes were calculated.

Official Title
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Exercise Intensity During Interactive Video Games and Standard of Care of Individuals Post-Stroke

Conditions
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Stroke

Intervention / Treatment
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* Behavioral: Exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: men and women post-stroke at least six months T able to ambulate 100 feet without physical assistance but allowed to use assistive devices and orthotics, able to stand for 3 minutes. cleared for exercise with the PARQ. Exclusion Criteria: history of severe heart disease, heart attack, valve replacement or coronary artery bypass surgery, severe lung disease, uncontrolled diabetes, traumatic brain injury or neurological disorder other than stroke Are unable to follow directions. Do not have adequate vision and hearing ability (either aided or unaided with glasses, contacts or hearing aids Are unable to sign a consent form. Unstable medical condition or musculoskeletal disorder such as severe arthritis, knee surgery, hip surgery, or any other condition that the investigators determine would impair the ability to perform the required stepping for the games presented. Any other medical condition contraindications to exercise.

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 80 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: Repeated measures, counter-balanced
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Single<br>Participants exercised in two counter balanced blocks: repeated (standard of care and self-paced repeated custom game) and random (Kinect game and game-paced random custom game). Exercise bouts were for 8.5 minutes with ten minutes of rest in between so they could return to physiological baseline. Data were collected in a single session lasting two hours. | Behavioral: Exercise<br>* Participants performed stepping movements that were either cued by the investigator or interacted with a video game. There were three video game exercises that all involved stepping in either a repeated or a random pattern that was either self-paced or game paced.<br>* Other names: Standard of Care Stepping Activities;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neuromuscular intensity | movement repetitions (stepping and marching) measured through video tape measured continuously during each exercise bout | collected continuously during each of the four conditions. Collected in a single 2 hour session | 
| Cardiovascular intensity (metabolic Units) | metabolic units measured continuously during each exercise bout | collected continuously during each of the four conditions. Collected in a single 2 hour session | 
| Cardiovascular intensity (Percent of maximum heart rate) | the percent of the maximum heart rate | collected continuously during each of the four conditions. Collected in a single 2 hour session | 
| Enjoyment | measured with the PACES questionnaire after each exercise bout | four times collected in a single 2 hour session (once at the completion of each the four conditions). | 
| Borg Rate if Perceived Exertion Scale | Measures perception of effort on a scale of 6-20 | Collected three times (at the beginning, middle and end) of each of the four exercise bouts during a single two hour session | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preference ranking | ranking exercise preference from highest (1) to lowest (4) | collected once at the end of the completed data collection of a 2 hour session | 
| Fugl Meyer Motor Assessment Scale_ Lower Extremity Section | measure of lower extremity motor recovery | collected once during the single 2 hour data collection session | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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active video games, virtual reality, exercise intensity, Parkinson Disease