Effects of Nintendo Ring Fit Adventure Exergame on Pain and Psychological Factors in Patients with Chronic Low Back Pain

Effects of exergames on rehabilitation outcomes in patients with osteoarthritis. A systematic review

PURPOSE

To analyze the effects of exergames on rehabilitation outcomes in osteoarthritis (OA) patients.

MATERIALS AND METHODS

A systematic review was reported according to the PRISMA statement. Randomized controlled trials (RCTs) were searched in Pubmed, Scopus, WoS, CINAHL, and PEDro (inception to November 2023). Studies that applied non-immersive exergames and assessed physical, functional, cognitive, pain, and psychosocial outcomes were included. Comparisons were other exercise modalities and non-intervention. Methodological quality was assessed with PEDro scale, and risk of bias (RoB) was assessed with Cochrane RoB-2 tool.

RESULTS

Eight studies were included (total of participants = 401). The mean PEDro score was 6.1, and seven studies had high RoB. Seven studies involved knee OA and one cervical OA. The most frequent duration for interventions was four weeks. Exergames were more effective than controls in at least one outcome in all studies. The outcomes for which exergames were most effective were functional disability, postural balance, muscle strength, proprioception, gait, range of motion, pain, quality of life, depression, and kinesiophobia.

CONCLUSION

Non-immersive exergames constitute an effective strategy for optimizing several relevant outcomes in rehabilitation. However, more RCTs with high methodological quality are required to deepen the knowledge about the multidimensional effects of exergames in OA patients.

Short-term effects of exergaming on patients with chronic low back pain: A single-blind randomized controlled trial

BACKGROUND

Exergaming is increasingly popular, but its impact on chronic low back pain (CLBP) remain unclear.

OBJECTIVES

To evaluate the effectiveness of exergaming versus traditional exercise for managing CLBP using the International Classification of Functioning, Disability and Health (ICF) framework.

METHODS

This single-blind, randomized controlled trial included 70 participants with CLBP, who were assigned to either the exergaming or traditional exercise group. Both groups received 2 weeks of treatment with six sessions. Assessments included the Oswestry Disability Index (ODI), range of motion, Hospital Anxiety and Depression Scale (HADS), balance (Biodex Stability System), Fear-Avoidance Beliefs Questionnaire (FABQ), and physical performance tests.

RESULTS

After six sessions over 2 weeks, the exergaming group showed significant improvements over the exercise group in ODI (p < 0.001), chair-rising time (p = 0.001), stair ascent (p = 0.025) and descent times (p < 0.001), flexion (p = 0.005), extension (p = 0.001), balance (p = 0.012), and FABQ subscales (physical activity: p = 0.003; work: p < 0.001) at the 3-month follow-up. Group × time interaction effects favored exergaming for ODI (p = 0.012), chair-rising (p = 0.045), stair ascent (p = 0.010), and descent (p = 0.002) times. While these changes did not meet clinical significance, exergaming was not inferior to traditional exercise in improving spinal motion, physical performance, fear-avoidance beliefs, and disability.

CONCLUSION

Exergaming appears to be a viable supplementary therapy for patients with CLBP, offering benefits across all ICF domains. Future studies with longer intervention durations are needed to assess its long-term effects.

Effects of active video games on mental health among college students: a systematic review

BACKGROUND

Mental health significantly impacts college students' academic performance and overall happiness. Active video games (AVGs) have gained popularity among college students due to their ample entertainment, and there is growing interest in utilizing them to address mental health issues. However, there has not been a comprehensive summary and systematic review of research on the effects of AVGs on college students' mental health.

METHODS

As of October 18th, 2024, searches were conducted in six internationally renowned databases (PubMed, SCOPUS, Web of Science, CINAHL Plus, EBSCOhost, Cochrane Library). Inclusion and exclusion criteria were developed based on the PICOS principles. A systematic review was conducted following the PRISMA guidelines, and compliant studies using randomised controlled trial design (RCT) were included. The methodological quality of the included studies was evaluated using the PEDro scale.

RESULTS

A total of 3471 articles were retrieved, of which 17 met the criteria inclusion. The PEDro scores of the 17 studies ranged from four to nine. The results indicate that AVGs can effectively improve college students' poor mental health, such as stress, anxiety, and depression, as well as increase their happiness and psychological satisfaction. Moreover, AVGs have been shown to increase motivation for exercise, improve college students' attitudes toward other forms of exercise, and promote sustained physical activity. Additionally, AVGs have demonstrated efficacy in improving sleep quality.

CONCLUSION

Overall, AVGs can serve as an effective intervention to reduce dysphoria and promote positive psychological states among college students, thus improving mental health. Using the theory-based design of AVGs will further increase the effect. However, the effects of AVGs vary depending on their type and initial design purpose. Therefore, when using AVGs to improve college students' mental health, it is necessary to carefully consider the students' original state, select AVGs with rich game content that can provide at least moderate-intensity physical activity, and adopt the correct intervention strategy to achieve good results. AVG can potentially become a valuable tool for improving college students' mental health.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero , identifier: CRD42024510488.

Early rehabilitation using virtual reality-based therapy can enhance hip function and self-perception of improvement following total hip arthroplasty: A systematic review and meta-analysis

OBJECTIVE

To investigate the effectiveness of virtual reality-based therapy (VRBT) after total hip arthroplasty (THA).

METHODS

PubMed, SCOPUS, WOS, PEDro and CINAHL were consulted for results up to April 2024. Randomized controlled trials (RCTs) that assessed the effectiveness of VRBT (physical and cognitive videogames) in patients after THA were included. Pooled effect was assessed using standardized mean difference (SMD).

RESULTS

This systematic review included 5 RCTs with 287 patients. Meta-analyses showed that VRBT, specifically non-immersive virtual reality (NIVR), combined with physiotherapy can be effective in reducing hip disability (SMD=-0.46; P = 0.018) and increasing hip function (SMD = 0.6;P = 0.002) after THA. The qualitative synthesis suggested that cognitive exercises using NIVR can improve disability, physical function, cognitive abilities and subjective perception of improvement. In contrast, passive immersive VRBT did not seem to have an impact on pain and hip function.

CONCLUSION

Combining VRBT (mainly NIVR) with physiotherapy could be effective in early rehabilitation after THA.

A randomised controlled pilot study of a Nintendo Ring Fit Adventure™ balance and strengthening exercise program in community-dwelling older adults with a history of falls

OBJECTIVES

This pilot study examined the feasibility, acceptability, and effects of a Nintendo Ring Fit Adventure™-based balance and muscle strengthening exercise program in community-dwelling older adults with a history of falls.

METHODS

Older adults who have had at least one fall in the past year were randomly assigned to an experimental (n = 21) or control group (n = 21). The experimental group performed 16 exercise sessions in total, lasting 60 min each, twice a week for 8 weeks, whereas the control group received usual care. Feasibility was evaluated based on the scores of participants in the exercises. Acceptance was evaluated using a customised questionnaire examining participants' self-perceived enjoyment, feasibility and improvements. Clinical outcomes including balance (Mini-BESTest), lower limb muscle strength (Five-Time Sit-to-Stand test), mobility (Timed-Up and Go test), dual-task ability (Timed-Up and Go test-Dual Task), fear of falling (Icon-FES) and executive function (Color Trails Test) were evaluated at baseline and 8 weeks.

RESULTS

Thirty-one participants (74%) finished the 8-week assessment. The experimental group significantly improved their scores in six out of eight exercises (all p < .031). The mean scores of the self-perceived enjoyment, feasibility and improvement domains of the acceptability questionnaire were 3.46 ± .53, 3.08 ± .59, and 3.47 ± .57 respectively. A significant improvement in the anticipatory subscore of the Mini-BESTest was found in the experimental group compared to the control group (p = .02; Partial eta squared = .14).

CONCLUSIONS

The Nintendo Ring Fit Adventure™-based exercise program was feasible, acceptable, and potentially effective in community-dwelling older adults with a history of falls.

Effects of Somatosensory Games on Heart Rate Variability and Sleep-Related Biomarkers in Menopausal Women With Poor Sleep Quality

Background and Objectives

The aim of this study was to investigate the effects of 12-week somatosensory games on heart rate variability and sleep-related biomarkers in middle-aged women with poor sleep quality.

Research Design and Methods

Twenty-nine women with poor sleep quality were recruited as participants randomly assigned into ring fit adventure exergame group (RFA, n = 15) and control group (CON, n = 14). The RFA group received ring fit adventure exergame for 60 min each time, 2 times a week, for 12 weeks. The CON group was not allowed to participate in intervention activities during the study period. Heart rate variability, sleep quality, cortisol, serotonin, and high-sensitive C-reactive protein were measured before and after the 12-week intervention.

Results

The Pittsburgh Sleep Quality Index total score in the RFA group was significantly lower compared with the CON group. The value of the standard deviation of normal NN intervals and the root mean square of the successive RR Differences were significantly increased in the RFA group, when compared with the CON group. The change in the logarithm of high frequency (log HF) was significantly higher and change in the logarithm of low frequency to high frequency ratio (log LF/HF) was significantly lower in the RFA group, when compared to the CON group. The change level of serotonin in the RFA group was significantly higher compared with the CON group.

Discussion and Implications

The results suggest that somatosensory games might improve sleep quality, increase serotonin level, and decrease sympathetic nerve activities in middle-aged women with poor sleep quality.

Augmented future: tracing the trajectory of location-based augmented reality gaming for the next ten years

Location-based games are a highly technology-dependent game genre that has witnessed an exponential increase in popularity with the democratisation of smartphones as well as ubiquitous mobile data and access to satellite navigation. Moving forward into the future, location-based games can be expected to evolve as the technologies underlying the genre improve. In this conceptual work, we review the current state of the art in location-based games, and identify key trajectories and trends. We discovered 12 trends, based on which we jump ten years into the future and evaluate how current technology trends may end up influencing location-based gaming. For example, we propose that in the year 2035 through improvements in map data services and sensor data coverage, we will see locative games that are increasingly connected to elements in the physical world. We also expect to see gameplay that moves away from solely taking place on a smartphone screen to the adoption of multiple forms of interactions with location-based game worlds, especially as head-mounted displays and other wearables become more commonplace.

Effect of Elastic Resistance on Exercise Intensity and User Satisfaction While Playing the Active Video Game BoxVR in Immersive Virtual Reality: Empirical Study

Background

One of the main contemporary forms of physical activity (PA) involves exercises and games in an immersive virtual reality (VR) environment, which allows the user to practice various forms of PA in a small space. Unfortunately, most of the currently available VR games and workout applications are mostly based on upper body movements, especially the arms, which do not guarantee sufficiently high exercise intensity and health benefits. Therefore, it is worth seeking solutions to help increase the exercise load during PA in VR.

Objective

The main aim of this study was to evaluate the effect of elastic arm resistance in the form of latex resistance bands of different elasticity levels on the intensity of students' PA while playing the BoxVR game. We further assessed the satisfaction of this form of exercise and its associations with PA intensity.

Methods

A total of 21 healthy and physically fit men (mean age 22.5, SD 2.0 years) were included in the study. The tests consisted of 3 10-minute games. One game was run with no load and the other two were run with 1.5-meter latex resistance bands (low and high resistance). The order of the tests was randomized and the participants rested for 20 minutes after each exercise. Exercise intensity was estimated using objective (heart rate monitoring) and subjective (Borg scale) methods. The Physical Activity Enjoyment Scale was used to assess satisfaction with the PA. The effect of elastic resistance on exercise intensity and user enjoyment was estimated using ANOVA for repeated measures.

Results

The ANOVA results indicated that incorporation of elastic resistance caused a significant change (F2,40=20.235, P<.001; η²p=0.503) in the intensity of PA in VR, which was low while playing without resistance and then increased to a moderate level with additional resistance. The use of elastic bands also changed participants' perceptions of the enjoyment of exercise in VR (F2,40=9.259, P<.001; η²p=0.316). The students rated their satisfaction with PA in VR on a 7-point scale highly and similarly when exercising without an upper limb load (mean 6.19, SD 0.61) and with slight elastic resistance (mean 6.17, SD 0.66), whereas their satisfaction declined significantly (mean 5.66, SD 0.94) when incorporating a higher load.

Conclusions

The intensity of PA among students playing the BoxVR game is at a relatively low level. With the added resistance of elastic bands attached to the upper limbs, the intensity of the exercise increased to a moderate level, as recommended for obtaining health benefits. Participants rated the enjoyment of PA in VR highly. The use of slight elastic resistance did not negatively affect satisfaction with the BoxVR game, although user satisfaction declined with a higher load. Further research should be undertaken to increase the effectiveness of exercise in VR so that regular users can enjoy the health benefits.

Chronic pain, a narrative review for the internist in 2024

Chronic pain is a complex and pervasive condition that profoundly affects individuals physically, emotionally, and socially. This narrative review aims to provide internists and healthcare professionals with a comprehensive overview of chronic pain, its various types, pathophysiology, epidemiology, clinical presentation, evaluation tools, and the burden it imposes on patients. We discuss the importance of recognizing chronic pain as a legitimate condition and the need for a compassionate, individualized approach to management. The review highlights the role of both pharmacological and non-pharmacological interventions in treating chronic pain, emphasizing the value of reducing pain, improving function, enhancing quality of life, and minimizing medication dependence. Additionally, we touch upon the promising future of pain treatment, including advancements in technology and personalized medicine. While not a comprehensive systematic review, this article serves as a valuable resource for healthcare providers seeking to understand, manage, and treat chronic pain effectively in their daily practice.

Safety, feasibility, and acceptability of physiotherapy combined with strength training using active video games for older patients with musculoskeletal conditions

PURPOSE

This study aimed to determine the safety, feasibility, and acceptability of physiotherapy (PT) combined with strength training using active video games (AVG) for older patients with musculoskeletal conditions.

METHODS

Sixteen patients underwent AVG + PT on day 1 and only conventional physiotherapy (CPT) on day 2. The AVG was conducted in 6 upper- and lower-limb training performed in standing position using Ring Fit Adventure (RFA) on Nintendo Switch. Outcome measured adverse events and deviant movements associated with the AVG as safety, execution rate of each AVG programme as feasibility, and questionnaires (4-point Likert scale) regarding enjoyment, motivation to continue, and feeling of efficacy as acceptability.

RESULTS

The berg balance scale/functional independence measure indicated 45 ± 8/90 ± 16. No adverse events occurred. Some of deviant movements were observed that could be an injury risk, such as a slight forward movement during the stepping exercise. The execution rate for each AVG programme ranged from 81% to 100%. The categories of enjoyment, motivation to continue, and feeling of efficacy had >90% of positive responses (strongly agree, slightly agree) in AVG + PT, and enjoyment tended to be higher in AVG + PT than in CPT.

CONCLUSIONS

Strength training using RFA was considered to be a safe and feasible exercise tool enough to be applicable as part of a rehabilitation programme in older patients with musculoskeletal conditions. However, should be supervised, at least during the introductory phase. It was also positively accepted by older adults, suggesting enhanced enjoyment.IMPLICATIONS FOR REHABILITATIONActive video games (AVG) training with Ring Fit Adventure (RFA) was found to be safe enough to be considered for application as part of a rehabilitation programme for older patients with musculoskeletal conditions, but should be supervised, at least during the introductory phase.AVG training comprising strength training with RFA was found to be a highly feasible exercise tool for rehabilitation in older patients with musculoskeletal conditions.Physiotherapy combined with AVG training using RFA was also well received, suggesting enhanced enjoyment for older patients with musculoskeletal conditions.

Feasibility, safety, and effects of a Nintendo Ring Fit Adventure™ balance and strengthening exercise program in community-dwelling older adults with a history of falls: A feasibility randomized controlled trial

AIM

This pilot study examined the feasibility, safety, and effects of a Nintendo Ring Fit Adventure™-based exercise program to enhance balance and lower limb muscle strength in community-dwelling older adults with a history of falls.

METHODS

In total, 42 older adults who experienced at least one fall in the past year were randomly assigned to an experimental or control group. Participants in the experimental group performed 60-min sessions of the exercise program twice per week for 8 weeks. The control group received usual care. We assessed the feasibility (retention and adherence to the exercise program), safety (number of adverse events), and clinical outcomes: (1) balance (Mini-BESTest); (2) functional lower limb muscle strength (Five-Time Sit-to-Stand test); (3) mobility (Timed-Up and Go test); (4) dual-task ability (Timed-Up and Go test - Dual Task); (5) fear of falling (Icon-FES); and (6) executive function (Color Trails Test).

RESULTS

Thirty-one participants (74%) completed the 8-week assessment. No adverse event associated with the exercise program was reported. There was a significant interaction in the anticipatory domain score of the Mini-BESTest between the experimental and control groups over the 8 weeks (P = 0.019).

CONCLUSIONS

The Nintendo Ring Fit Adventure™-based exercise program was feasible, safe, and potentially effective in improving anticipatory balance in community-dwelling older fallers. Geriatr Gerontol Int 2024; 24: 334-341.

Acceptability of Physical Therapy Combined with Nintendo Ring Fit Adventure Exergame for Geriatric Hospitalized Patients

Geriatric hospitalized patients often experience complications associated with frailty and impaired functioning in activities of daily living. To enhance their functional independence, repetitive and continuous high-frequency exercises are necessary. However, conventional physical therapy (PT) can be monotonous and lead to reduced adherence. The introduction of Nintendo Ring Fit Adventure exergame (EG) as a complement to PT for geriatric inpatients has the potential to improve exercise enjoyment and acceptability. This study aimed to evaluate the acceptability of combining EG with PT for geriatric inpatients. A total of 30 geriatric inpatients were included in the study, receiving EG+PT on day 1 and PT only on day 2. The rate of perceived exertion (RPE) was assessed using the Borg scale, whereas enjoyment, motivation to continue, and perceived effectiveness were evaluated through a questionnaire after each exercise session and subsequently compared. The RPE for the lower extremities and the sense of enjoyment (P = 0.06) were found to be higher after the EG+PT session. The results suggest that combining PT with EG can enhance the enjoyment of exercise sessions and facilitate an increase in the intensity and frequency of exercise therapy. Incorporating EGs into geriatric PT holds promise as an effective strategy to improve patient engagement and adherence to exercise regimens. Further research is warranted to explore the long-term benefits and potential applications of EGs in geriatric rehabilitation settings.

Non-Immersive Virtual Reality-Based Therapy Applied in Cardiac Rehabilitation: A Systematic Review with Meta-Analysis

BACKGROUND

The aim of this systematic review with meta-analysis was to assess the effectiveness of non-immersive virtual reality (niVR) active videogames in patients who underwent cardiac rehabilitation (CR).

METHODS

A systematic review with meta-analysis, according to the PRISMA guidelines and previously registered in PROSPERO (CRD42023485240), was performed through a literature search in PubMed (Medline), SCOPUS, WOS, and PEDro since inception to 21 November 2023. We included randomized controlled trials (RCTs) that assessed the effectiveness of an niVR intervention, in comparison with conventional CR and usual care, on aerobic capacity and cardiovascular endurance (physical function), anxiety, depression, and quality of life (QoL). The risk of bias in individual studies was assessed using the Cochrane risk of bias tool. Effect size was estimated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model.

RESULTS

Nine RCT that met the inclusion criteria were included in the meta-analysis. The meta-analysis showed a moderate-to-large effect favoring niVR active videogames included in CR in increasing aerobic capacity and cardiovascular endurance (SMD = 0.74; 95% CI 0.11 to 1.37; p = 0.021) and reducing anxiety (SMD = -0.66; 95% CI -1.13 to -0.2; p = 0.006). Only 4.8% of patients reported adverse events while performing niVR active videogames.

CONCLUSIONS

Inclusion of niVR active videogames in CR programs is more effective than conventional CR in improving aerobic capacity and cardiovascular endurance and in reducing anxiety.

Effectiveness of two different exergaming systems in addition to conventional treatment for physical therapy in patients with multiple sclerosis: A study protocol for a multicenter, assessor-blind, 24-week, randomized controlled trial

Objectives

The main aim is to evaluate and compare the effectiveness of two specific exergaming systems in addition to conventional treatment on improving physical functional capacity, balance, muscle strength, spasticity in lower limbs, and quality of life in patients with multiple sclerosis. The secondary aim is to compare the effectiveness of each exergaming system to isolated conventional treatment.

Design

A multicenter, assessor-blind, 24-week, randomized controlled trial.

Methods

39 patients diagnosed with multiple sclerosis will be allocated to three groups. A control group will perform a conventional treatment based on daily routine activities and/or combined training, whereas the experimental groups will be randomly divided to develop an active videogame-based exercise program through Nintendo Ring Fit Adventure© or Nintendo Wii Fit©, in addition to the conventional treatment. Study outcomes will be assessed at baseline and at 12 and 24 weeks. One-way ANOVA or Kruskal-Wallis tests will be used to analyze differences between groups at baseline and mixed ANOVA for differences between-within groups over time.

Discussion

The findings from this evidence-based trial, which includes both Nintendo© active videogames, could potentially establish exergame training as a valuable and reliable therapeutic tool for neurorehabilitation. It is essential to consider the customization, specifically in our case, on each multiple sclerosis condition, and ensure patients' adherence to the treatment.

Exergames in Older Adult Community Centers and Nursing Homes to Improve Balance and Minimize the Risk of Falls in Older Adults: A Systematic Review and Meta-Analysis

There is a substantial gap in our knowledge regarding the efficacy of exergames on the reduction of fall risk in older adults. This systematic review analyzes the findings of clinical trials describing the efficacy of exergames to improve balance or reduce the risk of falls in individuals above 60 years of age who are residents in community centers or nursing homes. We searched Google Scholar, PubMed, and Embase up to January 2023. Initially, 52,294 records were screened. After applying the inclusion and exclusion criteria, 20 studies were included in this systematic review. Meta-analyses revealed statistically significant reductions in the risk of falls and improvements in balance. Exergaming tended to produce positive benefits according to the results obtained using different instruments (TUG, PPA, BBS, and others), control groups, and times of intervention. Nevertheless, a substantial proportion of studies exhibited a high risk of bias and only one had a long follow-up period. Although a large body of evidence supports the view that exergaming is suitable for reducing fall risk and improving balance in older adults, some gaps remain in our knowledge about such benefits.

The Effects of Interactive Virtual Reality in Patients with Chronic Musculoskeletal Disorders: A Systematic Review and Meta-Analysis

Objective: Interactive virtual reality (iVR) has been widely used for treatment purposes in patients with chronic musculoskeletal disorders. However, no consensus has been reached on the effects of iVR on pain, psychological distress, and functional disability. Therefore, this study aims to investigate the effects of iVR on pain, psychological distress, and functional disability in patients with chronic musculoskeletal disorders compared with no rehabilitation and conventional rehabilitation. Methods: Five electronic databases (PubMed, Cochrane CENTRAL, Scopus, EMBASE, and Web of Science) were searched from January 2016 to December 2021. All randomized controlled trials using iVR for treating pain, psychological distress, and functional disability in patients with chronic musculoskeletal disorders were included. A subgroup analysis was conducted to compare the effects of nonimmersive and immersive types of iVR on the outcomes of interest. Results: Our study provides good quality evidence that iVR reduced overall pain by 9.28 points as compared with no rehabilitation and by 8.09 points as compared with conventional rehabilitation. In the subgroup analysis, nonimmersive iVR showed a reduction in psychological distress (standardized mean differences = -0.35) as compared with no rehabilitation. However, no statistically significant difference in the outcomes existed between nonimmersive and immersive iVR. Furthermore, there were no statistically significant differences in the outcomes of functional disability. Conclusions: iVR is recommended for reducing pain intensity more than no rehabilitation or conventional rehabilitation. Meanwhile, nonimmersive iVR has been proposed for psychological distress improvement, with effects similar to those of conventional rehabilitation. However, iVR may not be an effective intervention in the case of functional disability.

Using exergame-based exercise to prevent and postpone the loss of muscle mass, muscle strength, cognition, and functional performance among elders in rural long-term care facilities: A protocol for a randomized controlled trial

Objective

Elderly individuals in long-term care facilities (LTCFs) have a higher prevalence of sarcopenia than those in the community. Exercise is the gold standard for preventing and treating sarcopenia. Regarding exercise, multicomponent exercises, including progressive resistance training (PRT), are beneficial. However, developing routine, structured exercise programs for the elderly in LTCFs is difficult because of a shortage of healthcare providers, particularly in rural regions. Exergame-based exercises can increase a player's motivation and reduce staff time for an intervention. Nintendo Switch RingFit Adventure (RFA) is a novel exergame that combines resistance, aerobic, and balance exercises. In this study, we aim to investigate the clinical effectiveness of RFA on muscle and functional performance parameters among the elderly in LTCFs.

Methods

The EXPPLORE (using EXergame to Prevent and Postpone the LOss of muscle mass, muscle strength, and functional performance in Rural Elders) trial is a single-center randomized controlled trial involving elderly individuals (≥60 years) living in LTCFs in rural southern Taiwan. The participants will be equally randomized to the intervention group (exergame-based exercise plus standard care) or the control group (standard care alone). Both groups will receive standard care except that the intervention group will receive exergame-based exercises at the time previously scheduled for sedentary activities in the LTCFs. The exergame-based exercise will be performed using RFA in the sitting position with a specialized design, including arm fit skills and knee assist mode. Each session of the exercise lasts 30 mins and will be performed two times per week for 12 weeks. The primary outcomes will be the osteoporotic fracture index, appendicular skeletal muscle mass index, dominant handgrip strength, and gait speed. Meanwhile, the secondary outcomes will be the dexterity and agility, muscle strength and thickness, range of motion of the joints of the dominant upper extremity, Kihon checklist, Medical Outcomes Study 36-Item Short-Form Health Survey, and Brain Health Test.

Discussion

This trial will provide valuable knowledge on whether exergames using RFA can counteract physical decline and improve quality of life and cognition among the elderly in LTCFs.

Clinical trial registration

[www.ClinicalTrials.gov], identifier [NCT05360667].

Comparative Effectiveness of Artificial Intelligence-Based Interactive Home Exercise Applications in Adolescents with Obesity

The rate of obesity in adolescents has increased due to social distancing measures and school closures caused by the COVID-19 pandemic. These issues have caused adolescents to change their lifestyles and eating habits. Furthermore, the growth in inactive behavior and computer screen or watching TV time, as well as the reduction in physical activity, could similarly be related with obesity. To overcome this problem, we recently developed an artificial intelligence (AI)-based gesture recognition game application called Super Kids Adventure (SUKIA, Funrehab, Daejeon, Korea), which provides inexpensive and motivational game applications. This research is designed to assess the effects of SUKIA and Nintendo Switch (NINS) on calorie consumption, VO2 max, 6-minute walking test (6MWT) as well as body mass index (BMI), and the Borg rating of perceived exertion scale (RPE) in adolescents with obesity. A convenience sample of 24 adolescents with obesity were randomized into either the NINS or SUKIA groups 5 days/week for 3 weeks. Analysis of variance (ANOVA) and independent t-tests were presented with significant level at p < 0.05, and the analysis indicated that SUKIA showed superior effects on calorie consumption, VO2 max, and RPE compared to NINS. Our results provide evidence that SUKIA can more effectively improve cardiopulmonary function and calorie consumption than NINS in adolescents with obesity during COVID-19.

A Mixed Comparison of Interventions for Kinesiophobia in Individuals With Musculoskeletal Pain: Systematic Review and Network Meta-Analysis

Objective

This systematic review aims to make a mixed comparison of interventions for kinesiophobia and individuals with musculoskeletal pain.

Methods

A comprehensive search strategy was conducted in the database of PubMed, MEDLINE, and Web of Science with the inclusion criteria: (1) randomized controlled design; (2) patients with musculoskeletal pain as participants; (3) treatments protocols of kinesiophobia as interventions or comparisons; (4) the score of Tampa Scale Kinesiophobia (TSK) as outcome measures. A network meta-analysis was used to synthesize the data after checking the model consistency. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Assessment Tool.

Results

Thirty-one studies were included in this review after a comprehensive search strategy with a low risk of bias and good consistency. According to the results of the network meta-analysis, a multi-modal treatment protocol had the highest probability to become the best choice in dealing with kinesiophobia caused by musculoskeletal pain, whereas psychological treatment protocols also showed a potentially positive effect on musculoskeletal pain-induced kinesiophobia.

Conclusion

Multi-modal protocols could be recommended as the preferred option when dealing with kinesiophobia caused by musculoskeletal pain. However, it is still worth mentioning that there are also potentially positive therapeutic effects of psychological interventions. Since the concept of kinesiophobia is based on the fear-avoidance model, the psychological mechanism should be paid enough attention to during treatment.

Registration Number

CRD42021286450.

Effects of Gaming on Pain-Related Fear, Pain Catastrophizing, Anxiety, and Depression in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis

The aim was to systematically review the effects of gaming on pain-related fear, pain catastrophizing, anxiety, and depression in patients with chronic musculoskeletal pain. Databases (Medline, EMBASE, PsycInfo, CINAHL, Cochrane Central Register for Controlled Trials [CENTRAL], Web of Science, and SCOPUS) were searched from inception up to October 2021. Two reviewers independently selected randomized controlled trials that compared the effects of any gaming modality with other interventions or no treatment on pain-related fear, pain catastrophizing, anxiety, and depression. For data synthesis, Standardized Mean Differences (SMDs) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model for meta-analysis according to the outcome of interest, comparison group, and follow-up period. The level of evidence was synthesized using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Thirteen studies were included with a total sample of 680 patients. Gaming was superior to other treatments and no treatment on reducing pain-related fear (SMD: -1.23; 95% CI: -2.02 to -0.44) and anxiety (SMD: -0.55; 95% CI: -1.01 to -0.09), respectively. Gaming was not superior to other treatments on reducing pain catastrophizing, anxiety, and depression, and it was not superior to no treatment on reducing pain-related fear, pain catastrophizing, and depression. Those findings were based on very low or low-quality evidence. In a conclusion, gaming modalities may have positive effects on some mental health outcomes. However, there were conflicting results with low-quality evidence, which indicates that more high-quality randomized controlled trials are needed.

Effect of the Nintendo Ring Fit Adventure Exergame on Running Completion Time and Psychological Factors among University Students Engaging in Distance Learning during the COVID-19 Pandemic: A Randomized Prospective Study (Preprint)

Background

The COVID-19 outbreak has not only changed the lifestyles of people globally but has also resulted in other challenges, such as the requirement of self-isolation and distance learning. Moreover, people are unable to venture out to exercise, leading to reduced movement, and therefore, the demand for exercise at home has increased.

Objective

We intended to investigate the relationships between a Nintendo Ring Fit Adventure (RFA) intervention and improvements in running time, cardiac force index (CFI), sleep quality (Chinese version of the Pittsburgh Sleep Quality Index score), and mood disorders (5-item Brief Symptom Rating Scale score).

Methods

This was a randomized prospective study and included 80 students who were required to complete a 1600-meter outdoor run before and after the intervention, the completion times of which were recorded in seconds. They were also required to fill out a lifestyle questionnaire. During the study, 40 participants (16 males and 24 females, with an average age of 23.75 years) were assigned to the RFA group and were required to exercise for 30 minutes 3 times per week (in the adventure mode) over 4 weeks. The exercise intensity was set according to the instructions given by the virtual coach during the first game. The remaining 40 participants (30 males and 10 females, with an average age of 22.65 years) were assigned to the control group and maintained their regular habits during the study period.

Results

The study was completed by 80 participants aged 20 to 36 years (mean 23.20, SD 2.96 years). The results showed that the running time in the RFA group was significantly reduced. After 4 weeks of physical training, it took females in the RFA group 19.79 seconds (P=.03) and males 22.56 seconds (P=.03) less than the baseline to complete the 1600-meter run. In contrast, there were no significant differences in the performance of the control group in the run before and after the fourth week of intervention. In terms of mood disorders, the average score of the RFA group increased from 1.81 to 3.31 for males (difference=1.50, P=.04) and from 3.17 to 4.54 for females (difference=1.38, P=.06). In addition, no significant differences between the RFA and control groups were observed for the CFI peak acceleration (CFIPA)_walk, CFIPA_run, or sleep quality.

Conclusions

RFA could either maintain or improve an individual’s physical fitness, thereby providing a good solution for people involved in distance learning or those who have not exercised for an extended period.

Trial Registration

ClinicalTrials.gov NCT05227040; https://clinicaltrials.gov/ct2/show/NCT05227040

Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.

Vitamin D inhibits TNF-α induced apoptosis of human nucleus pulposus cells through regulation of NF-kB signaling pathway

BACKGROUND

To observe the effects of vitamin D on the apoptotic human nucleus pulposus cells under tumor necrosis factor-α (TNF-α) treatment.

METHODS

The gene expression data was downloaded from the NCBI Gene Expression Omnibus (GEO) database ( https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE34095 ). Differentially expressed genes between degenerative disc and non-degenerative disc were performed by R software. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway enrichment analyses were performed using The Database for Annotation, Visualization and Integrated Discovery (DAVID). Then, the human nucleus pulposus tissue was harvested from 12 patients according to the modified Pfirrmann classification and human nucleus pulposus cells were obtained from digestion of herniated nucleus pulposus tissue. The collected nucleus pulposus cells were treated with different concentration of TNF-α, and cellular apoptosis was measured by flow cytometry. Then, human nucleus pulposus cells were divided into following groups: normal culture medium, TNF-α treated, TNF-α, and vitamin D-treated groups. Cellular apoptosis rate was quantified by flow cytometry. Protein expression of p-p65, p65, and IkBa was detected with western blot analysis.

RESULTS

A total of 536 differentially expressed genes were identified through bioinformatic analysis. KEGG pathway revealed that NF-kB signaling pathway was involved in the process of disc degeneration. In the NP cell cultures, vitamin D significantly increased cell proliferation potency. Furthermore, vitamin D inhibited TNF-α induced apoptosis of human nucleus pulposus cells. Vitamin D reduced the phospho-NF-κB/p65 expression in the TNF-α-treated NP cells.

CONCLUSION

Vitamin D can attenuate TNF-α-induced NP cells apoptosis through interfering with the NF-κB pathway.