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Randomized Controlled Trial
. 2019 Feb 28;16(5):729.
doi: 10.3390/ijerph16050729.

Frailty Level Monitoring and Analysis After a Pilot Six-Week Randomized Controlled Clinical Trial Using the FRED Exergame Including Biofeedback Supervision in an Elderly Day Care Centre

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Randomized Controlled Trial

Frailty Level Monitoring and Analysis After a Pilot Six-Week Randomized Controlled Clinical Trial Using the FRED Exergame Including Biofeedback Supervision in an Elderly Day Care Centre

Iranzu Mugueta-Aguinaga et al. Int J Environ Res Public Health. .
Free PMC article

Abstract

Background: Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the individual to a higher risk of negative health-related outcomes. Exercise using interactive videos, known as exergames, is being increasingly used to increase physical activity by improving health and the physical function in elderly adults. The purpose of this study is to ascertain the reduction in the degree of frailty, the degree of independence in activities of daily living, the perception of one's state of health, safety and cardiac healthiness by the exercise done using FRED over a 6-week period in elderly day care centre. Material and Methods: Frail volunteers >65 years of age, with a score of <10 points (SPPB), took part in the study. A study group and a control group of 20 participants respectively were obtained. Following randomisation, the study group (20) took part in 18 sessions in total over 6 months, and biofeedback was recorded in each session. Results: After 6 weeks, 100% of patients from the control group continued evidencing frailty risk, whereas only 5% of patients from the study group did so, with p < 0.001 statistical significance. In the case of the EQ-VAS, the control group worsened (-12.63 points) whereas the study group improved (12.05 points). The Barthel Index showed an improvement in the study group after 6 weeks, with statistically significant evidence and a value of p < 0.003906. Safety compliance with the physical activity exceeded 87% and even improved as the days went by. Discussion: Our results stand out from those obtained by other authors in that FRED is an ad hoc-designed exergame, significantly reduced the presence and severity of frailty in a sample of sedentary elders, thus potentially modifying their risk profile. It in turn improves the degree of independence in activities of daily living and the perception of one's state of health, proving to be a safe and cardiac healthy exercise. Conclusions: The study undertaken confirms the fact that the FRED game proves to be a valid technological solution for reducing frailty risk. Based on the study conducted, the exergame may be considered an effective, safe and entertaining alternative.

Keywords: biofeedback; elderly people; exergame; frailty; kinect; physical activity.

Conflict of interest statement

No competing interests need to be declared.

Figures

Figure 1
Figure 1
Classification of intensity of physical activity. Examples of absolute and relative levels of intensity. Source: Modified from Howley [29]. MET= metabolic equivalent); RPE = rating of perceived exertion) (*20 value Borg score) (**10 value Borg score). % HRmax = percentage of measured or estimated maximum heart rate (220-age). Heart rate (HR): <76% Maximum heart rate (%HRMAX)(*); Systolic blood pressure (SBP): <150 mmHg; Diastolic blood pressure (DBP): <90 mmHg; Blood oxygen saturation (SpO2): Variations <5%SpO2. (*)Modified Borg scale: a 5 score on the Borg scale is included together with the maximum heart rate percentage in order to ascertain that the perceived exertion is correctly related to heart rate.
Figure 2
Figure 2
FRED game overview: structure and contents.
Figure 3
Figure 3
CONSORT Flow diagram of the progress through the phases of a parallel randomised trial of two groups [32].
Figure 4
Figure 4
Description of sample features. DM: Diabetes Mellitus; HT: Hypertension; DL: Dyslipidaemia; EQ 5D-5L y EQVAS.
Figure 5
Figure 5
Statistical description of SPPB results in the first and sixth weeks of the study.
Figure 6
Figure 6
(A) Score obtained in the SPPB in week 1 and week 6. (B) Percentage frailty and number of participants in control and study group at the end of week 6. (C) SPPB score evolution. (D) Distribution of SPPB score obtained according to age and gender.
Figure 7
Figure 7
(A) Statistical description of the EQ-5D-5L Index and EQ-5D-5L Index differences for control and study groups. (B) Statistical description of EQ-VAS and EQ-VAS differences for control and study groups.
Figure 8
Figure 8
(A) Results obtained from the EQ-5D-5L Index in week 1 and week 6 for control and study groups. (B) Results of EQ-5D-5L Index differences in week 1 and week 6 for control and study groups. (C) Results of EQ-VAS in week 1 and week 6 for control and study groups. (D) Result of EQ-5D-5L Index differences in week 1 and week 6 for control and study groups.
Figure 9
Figure 9
(A) Statistical description of the Barthel Index for control and study groups. (B) Results of Barthel Index In week 1 and week 6 for control and study groups.
Figure 10
Figure 10
(A) Results of the maximum heart rate percentage for the study group during exercise, grouped together into 6-day intervals. (B) Number of % heart rate measurements (% FCmaximun) which were above the cut-off point per day. (C) Results of the intensity of perceived exertion according to the Borg scale for the study group during exercise, grouped together into 6-day intervals. (D) Number of perceived exertion measurements (Borg) which were above the cut-off point per day.
Figure 11
Figure 11
(A) Results of systolic blood pressure (SBP) for the study group during exercise, grouped together into 6-day intervals. (B) Number of systolic blood pressure (SBP) measurements which were above the cut-off point per day. (C) Results of diastolic blood pressure (DBP) for the study group during exercise, grouped together into 6-day intervals. (D) Number of diastolic blood pressure (DBP) measurements which were above the cut-off point per day.
Figure 12
Figure 12
(A)Results of daily variations in blood oxygen saturation (SpO2) for the study group during exercise, grouped together into 6-day intervals. (B) Number of blood oxygen saturation measurements which were above the cut-off point per day.
Figure 13
Figure 13
Measurement percentage within the parameters established as being safe for the following physiological constants grouped together into 6-day intervals.
Figure 14
Figure 14
(A) Statistical description of the software usability scale (SUS) for study group. Figure 14B. Histogram of results obtained using the software usability scale (SUS); red line: mean; blue line represents cut-off point. (B) Histogram of results obtained using the software usability scale (SUS); red line: mean; blue line represents cut-off point.
Figure 15
Figure 15
Daily response percentages by the study group to the questions: “Do you like the game?” and Do you find it motivating for the purpose of improving your physical condition?”.

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