Nikoletou, D, Dudziec, M., Makris, D., Bloom, V., Papadakis, M. and Quinn, T. (2019) Health boxing for cardiac rehabilitation : evaluation of cardiorespiratory and balance responses to a non-contact boxing game. In: Human Motion Analysis for Healthcare Applications; 26 Jun 2019, London, U.K.. (Unpublished)
Abstract
Introduction: ‘Serious games for health’ are commercially available software games that are used in cardiac rehabilitation to promote activity. However, commercial games lack specificity for exercise prescription, especially in older people with cardiovascular disease and comorbidities that contribute to a risk of falls. The aim of the study was to evaluate cardiorespiratory and balance responses in each level of a novel non-contact boxing game (‘Health boxing’) designed by our team. ‘Health boxing’ operates in a Microsoft Kinect platform and creates an avatar of the player without a need to hold to a controller. A series of bubbles/balls appear in various directions which the player needs to burst to improve their score using boxing punches and kicks. Intensity of exercise is increased per level and progressively more complex movements are included. These represent similar balance-training activities to those often used in falls prevention rehabilitation programmes (see Fig. 1). The last 3 levels include sit to stand as well as arm movements. Figure 1: Screenshots from Health Boxing Game Clinical Methods: Our aim was to evaluate cardiorespiratory and balance responses in each level of the game and investigate whether these increased incrementally.12 healthy adults (5M), mean (SD) age (yrs) 43.0 (9.7), BMI 23.4 (1.6), Handgrip strength (kg) 39.4 (15.2), Quadriceps strength (kg) 28.5 (4.4), Timed up and go (TUG) test (sec) 5.8 (0.3) played the ‘health boxing’ game from beginning to end on a single session. We recorded heart rate (HR), oxygen saturation (SpO2), perception of breathlessness (BORG score) and perceived exertion (RPE) at baseline and at the beginning and end of each level. We also recorded Path velocity and Path Length (Force plate-AccuGait system) at baseline and at the end of each level. Results: There was an incremental increase in RPE per level with a reduced perception of exertion only in level 6 when the first sit-to-stand activity was introduced. HR increased per level but not uniformly (Table 1). Game levels that included diagonal movements (upper or lower limb) caused a drop in end HR (HR_end) increase from baseline dropped compared to the previous level while Path Length and Velocity continued to increase. The highest increase in HR and RPE was in the last 3 levels (sit-to-stand with arm raising at different stages) while Path Length and Velocity dropped in these levels close to baseline. SpO2 and BORG were generally preserved close to baseline levels throughout. Conclusion: There are differences in HR, RPE and balance responses to different levels. Sit-to-stand exercises produce the greater increases in HR and RPE and lowest increase in path length and velocity, making them more appropriate for cardiac patients at higher risk of falls. Diagonal movements train for balance but HR decreases, making them more appropriate for severe cardiac patients who may require balance training. The game levels need to be adjusted further for cardiac patients to enable more tailored exercise prescription for this patient group.
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