Using a virtual game system to innovate pulmonary rehabilitation: Safety, adherence and enjoyment in severe chronic obstructive pulmonary disease

OBJECTIVE: The present pilot study tested the use of a virtual game system (VGS) for exercise training in patients with moderate to very severe chronic obstructive pulmonary disease undergoing pulmonary rehabilitation (PR). Safety, feasibility, enjoyment and adherence were assessed. METHODS: VGS (Wii [2006], Nintendo, USA) games were prescreened and categorized into lower-and upper-body workouts. Patients admitted for a three-to four-week inpatient PR program exercised daily. They were provided an opportunity to individually engage in VGS sessions three times weekly, varying with length of stay. Dyspnea, oxygen saturation and heart rate were measured before, during and after game sessions. Patients were considered to be adherent if they attended at least 50% of VGS sessions. Adverse events and enjoyment were evaluated. RESULTS: Thirty-two patients with a mean (+/- SD) age of 66 +/- 9 years and a mean forced expiratory volume in 1 s of 0.72 +/- 0.40 L participated. Among the 25 patients completing the program, adherence was 76%, with a mean attendance rate of 64 +/- 35%. Mean dyspnea score was 1.5 +/- 1.1 before and 3.2 +/- 1.2 after exercise. Mean oxygen saturation changed from 94 +/- 3% to 91 +/- 5% (P<0.001), while heart rate increased from 88 +/- 15 beats/min to 102 +/- 18 beats/min (P<0.001). One patient reported chest pain requiring nitroglycerin spray and five experienced transient desaturation below 85% with play. Patients enjoyed the program (visual analogue score 8 +/- 2.6/10) and most would highly recommend it to others. CONCLUSIONS: Moderate exercise using a VGS was safe, feasible and enjoyed as an adjunct to inpatient PR. This modality may encourage patients to maintain physical activity after PR.