Effects of Exergame vs. Traditional Aerobic Exercise in Patients at High Cardiovascular Risk

Introduction Cardiovascular (CV) disease is a major cause of premature death and morbidity worldwide. It is widely known that age, sex, hypertension, dyslipidemia, diabetes, and smoking are the main risk factors which can cause CV disease[1]. Many other CV risk factors and their markers have been identified in recent studies. Among these, cardiorespiratory fitness (CRF) and endothelial dysfunction are strong predictors of the risk of developing CV disease[2, 3]. In addition, epicardial adipose tissue is a visceral fat which accumulates in the epicardium of the heart, and has recently been considered as a new index of CV risk[4, 5].

It is well established that regular exercise (physical activity) is effective in preventing and treating CV risk factors by improving health-related fitness[6]. Despite the health benefits of regular exercise, many patients with CV risk factors often do not participate in regular exercise for reasons including lack of time, motivation, or interest.

In recent years, a new exercise program called exergame has been developed as a result of the technical advancements in gaming and virtual reality programs. Exergames are interactive video games which provide the opportunity to increase physical activity by requiring movement of the entire body[7] and are proving to be an alternative exercise modality. In addition, exergames are used to fight pediatric obesity[8], improve senior physical performance[9], and facilitate poststroke motor rehabilitation[10]. However, only a few studies have examined the effects of exergaming on CV or chronic disease related risk factors. Furthermore, in order for exergames to progress as a rehabilitation program for the prevention and treatment of CV disease in the future, it is necessary to compare it to traditional aerobic exercises.

Therefore, the aim of this study was to compare the effects of exergame versus treadmill exercises on cardiorespiratory fitness (CRF), endothelial function, epicardial fat, cardiometabolic, and anthropometric parameters in patients with high CV risk.

Methods Participants and Study Design This single-center study was approved by the Institutional Review Board of Kosin University Gospel Hospital (Protocol no. KUGH 2016-06-029). Sixty-four female patients with a Framingham CV disease 10-year risk score above 20% were enrolled in this study[11, 12]. All participants voluntarily participated in the study and signed a consent form agreeing to the study process. In order to reduce the margin of error due to sex differences and physiological responses to the greatest degree possible, only post-menopausal women were recruited considering the hormonal changes which occur during menstruation. The inclusion criteria were post-menopausal women aged ≤80 years who did not have a history of participating in regular exercise within the past 3 months. The exclusion criteria were resistant hypertension, any systemic disease including significant liver disease, neurologic disorders, malignant disease, renal failure, chronic obstructive pulmonary disease, valvular heart disease, a positive treadmill test, a history of acute coronary syndrome, myocardial infarction or any revascularization procedure, or musculoskeletal patients for whom exercise was impossible. Patients were randomized to the exergame (EG: n=22), treadmill (TM: n=22), or control (n=20) groups.