Modified Shuttle Walk Test Article Summary
Purpose: to determine if a home exercise program using active video games (AVG), which in this case is the Nintendo Wii, is effective in improving exercise capacity, quality of life, and muscular strength in younger patients with cystic fibrosis.
Study population: 39 clinically stable children with cystic fibrosis from ages 7-18 years. Children who were lung transplant patients or if they had pulmonary rehabilitation within the last 12 months were excluded. Children with osteoarticular, neuromuscular, or cardiovascular comorbidities were also excluded. A final reason for exclusion was the inability to attend at least 80% of the intervention sessions.
Methods: This was a single blind randomized control trial. To ensure randomization, someone not involved in the study placed each child into either the control group or the training group. The staff who administered all outcome measures and questionnaires were also blinded to which group each child was in. All children were provided with routine cystic fibrosis management including antibiotics, nutritional supplementation, and chest physical therapy. The children in the training group also were prescribed 30-60 minute exercise sessions 5 times per week for 6 weeks using the Nintendo Wii. Each group was followed for twelve months.
Outcome measures: The modified shuttle walk test (MSWT) was the primary outcome used, but they also used height, weight, spirometry, six minute walk test (6MWT), the horizontal jump test (HJT), medicine ball throw, hand grip, and the Cystic Fibrosis Questionnaire-Revised to assess health-related quality of life.
Intervention: The 6 weeks of the AVG training, as mentioned above, was 30-60 minutes per day 5 times per week using the Nintendo Wii. The game chosen was EA Sports Active 2 which involves a plethora of activities such as bicep curls, running, lunges, and squats. This package includes a heart rate monitor as well as a “virtual personal trainer.” The activities were adjusted for age level to ensure motivation, and the training load was increased weekly. Three initial training sessions were provided in the facilities to ensure proper form and to educate patients/caregivers on appropriate exercise responses. Further, to ensure patient adherence, a PT checked in weekly with the patient/caregiver to see how the training sessions were going during the 6 weeks of intervention.
Results: They found 95% adherence during the 6 week intervention; however, at the 12 month follow-up period there was only 35% adherence with the average patient playing the game for 20 minutes 2 days per week. There were statistically significant differences for both the 6 minute walk test and the modified shuttle walk test in which the children in the training group showed significant improvement. HJT, hand grip, medicine ball throw, and the Cystic Fibrosis Questionnaire-Revised all improved among the participants in the training group as well. At the 12 month follow-up period, the modified shuttle walk test distance and hand grip were the only two significant differences between the control group and the intervention group.
Strengths: This is the first study that shows training with AVGs can lead to significant and also sustainable improvement in muscle strength and exercise capacity in younger patients with cystic fibrosis.
Limitations: There was no supervision from the study between the 6 week intervention and the 12 month follow-up. An increase in adherence could have been observed if the PT called even just once a month to follow up with the patient after the weekly calls during the 6 week intervention. Another limitation is that this study is only using a Nintendo Wii and it would be beneficial to compare the Wii to an Xbox Kinect to see if there were any differences between those groups as well.
Conclusion: This study demonstrates that the use of an AVG home exercise program is a feasible and effective way in which young patients with cystic fibrosis can improve exercise capacity when using this specific training intensity, type of AVG, and training protocol.
Works Cited:
del Corral, T., Cebrià i Iranzo, M., López-de-Uralde-Villanueva, I., Martínez-Alejos, R., Blanco, I. and Vilaró, J. (2017). Effectiveness of a Home-Based Active Video Game Programme in Young Cystic Fibrosis Patients. Respiration, 95(2), pp.87-97.
3 responses to “Modified Shuttle Walk Test Article Summary”
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I like the idea of using an interactive tool, such as video games, to encourage exercise and ultimately increase strength. The follow through on continuing to utilize the wii after the initial six weeks is poor. I wonder if after the six weeks the child could be transitioned to an exercise class with peers or a cystic fibrosis focused exercise class so that the children get the social aspects of coming to a class. I would like to see a follow up study to compare adherence of the wii vs x box kinect to see if children prefer one over the other.
Yes, I agree the follow through is very poor and suggest that a PT could at least call them once a month rather once a week to increase adherence. I also like the idea of an exercise class or a CF focused class for both social support and accountability. I personally like the Kinect better because it looks at your entire body where the wii only looks at the hand(s) the remote is in and you can easily cheat the system! I too would like to see a study comparing both.
I agree with you both! Adherence and long-term outcomes with gaming have not been impressive!