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VR Series #9 Aerobic Stimulus

06 September 2018

Ian Slater discusses a clinical trial done with the aim of testing whether virtual reality games [VRG] increase the motivation to exercise and adherence to an exercise programme.

As regular readers will know I am a member of the American Congress of Rehabilitation Medicine (ACRM). Each month they publish their Archives of Physical Medicine and Rehabilitation dedicated to showcasing some of the latest research from anywhere in the world.

It was of interest to come across some original research from Brazil Aerobic Stimulus Induced by Virtual Reality Games in Stroke Survivors [de Sousa et al Archives of Physical Medicine and Rehabilitation 2018;99:927-33]

This was a relatively small clinical trial (n= 12) with the aim being to test whether virtual reality games [VRG] increase the motivation to exercise and adherence to an exercise programme: VRG's have been suggested as a method for increasing aerobic capacity in stroke survivors.

It was this last part which particularly interested me.

As those of you who know me will realise – I like to get on my bike occasionally… ;-) and I like to think that I have a passing knowledge of what is required to train the body's aerobic and VO2 systems so this kind of research article dealing with training load tends to automatically get my interest.

So here's what bothers me: there have been a couple of presentations which I have attended recently (restrictive blood flow training and FES cycling [more of those in subsequent articles]) which have started me thinking that I remain to be convinced about the value of low level intensity exercise.

This is going to make me really unpopular isn't it? Yes, I accept, it's better than nothing but what discernible physiological changes is it producing in the long term?

The aim of this particular Brazilian Study was to evaluate whether VRG's promote reproducible and adequate cardiovascular and metabolic stimuli characterized by an exercise intensity between anaerobic threshold [AT] and respiratory compensation point [RCP]. Participants underwent, in random order, two identical sessions of VRG's and one control session (38 mins watching a movie). The VRG sessions were composed of 4 sets (3 mins of tennis, 1 min changing the game, 4 mins of boxing) interspersed with 2 mins of rest.

Heart rate [HR] was always higher in the boxing VRG than the tennis and increased when compared with the pre-intervention or control group HR but here is where it begins to get a bit worrying for me: HR and VO2 were both assessed as being below the recommended range for aerobic training. To be fair to the authors of this Study they are up front about that and comment that strategies will be required to compensate for the low intensity.

Don't get me wrong: the VRG's will have benefits in terms of the motor, sensorial and cognitive demands placed on stroke patients but – if we are simply talking about aerobic training – I am struggling to see the benefit.

HR was raised – slightly – during exercise but the point is that it wasn't raised enough to have a training benefit. This is where the lifting of light weights (counter acted by blood flow restrictive training) and FES cycling come into the equation.

In the litigation sphere we are often met with expert reports recommending therapies and interventions but do we ever question (or question enough) the extent to which those interventions / equipment have a demonstrable physiological benefit?

In cycling we have this concept of 'junk miles'. On the day of writing this article I am tired (having done three different routes up the Montee du Semnoz yesterday) so my capacity for a structured session today is limited and I intend to just go out and ride easy for a couple of hours.

Will it benefit me physiologically? Probably not (although there is an argument that an easy active recovery session can clear the legs / body of toxins built up by training load) but, and here is where the strict science merges into shades of grey: it will almost certainly benefit me mentally as the enjoyment that I will get from being out in the mountains for a couple of hours will be significant :)

Exercise is good, on so many levels but do we need to be clearer about what benefit is being produced? Is it aerobic or the feel good factor from the release of endorphins after exercise… both are valuable but aren't the same…

Last but by no means least, a plea, if you have the opportunity please follow our Twitter page @BIRGarage

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