Department of Physiotherapy, São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Brazil.
Department of Physiotherapy, University of Brasilia, Brazil.
Phys Ther. 2021 May 4;101(5). doi: 10.1093/ptj/pzab071.
The purpose of this study was to investigate the effects of adding virtual reality (VR) to maintenance cardiac rehabilitation (CR); it was hypothesized VR would increase adherence, motivation, and engagement.
This study was a randomized, 1:1 concealed-allocation, single-blinded, 2 parallel-arm, crossover trial. Blinded assessments were undertaken at baseline (midprogram), 12 weeks, and 24 weeks after baseline. The setting was a single CR program of unlimited duration in Brazil. Participants were patients with cardiovascular diseases or risk factors who had been in the program for 3 months or longer. The CR program consisted of 3 supervised exercise sessions per week. In the VR arm, participants had 1 VR session of the 3 per week during the initial 12 weeks of the trial; this was withdrawn the subsequent 12 weeks. Measures were program adherence (% of 3 sessions/week over 12 weeks, ascertained in all participants), motivation (Behavioral Regulation in Exercise Questionnaire 3), and engagement (User Engagement Scale, adapted; vigor, dedication, and absorption subscales); all 3 were primary outcomes.
Sixty-one (83.6%) patients were randomly assigned (n = 30 to CR + VR); 54 (88.5%) were retained at 12 and 24 weeks. At baseline, participants had been in CR on average 7 years and had high engagement and motivation. CR + VR resulted in a significant increase in adherence at 12 weeks (baseline = 72.87%; 12 weeks = 82.80%), with significant reductions at 24 weeks when VR was withdrawn (65.48%); in the usual CR care arm, there were no changes over time. There was a significant effect for arm, with significantly higher adherence in the CR + VR arm than usual CR at 12 weeks (73.51%). Motivation decreased significantly from baseline to 12 weeks (4.32 [SD = 0.37] vs 4.02 [SD = 0.76]) and significantly increased from 12 to 24 weeks in the CR + VR arm (4.37 [SD = 0.36]). Absorption was significantly lower at 12 weeks in the CR + VR arm (6.79 [SD = 0.37] vs 6.20 [SD = 1.01]).
Although VR increased program adherence, interspersing it with usual CR sessions actually decreased patient motivation and absorption.
Supplementing a maintenance CR program with VR using "exergames" resulted in significantly greater adherence (8% increase or 3 of 36 sessions), and this was quite a robust effect given it was extinguished with the removal of VR. However, contrary to the hypotheses, offering 1 session of VR per week and 2 of usual CR exercise was related to lower motivation and absorption, which has implications for how clinicians design programs for this patient population.
本研究旨在探讨在维持性心脏康复（CR）中加入虚拟现实（VR）的效果；假设 VR 会增加依从性、动机和参与度。
这是一项随机、1:1 隐匿分组、单盲、2 平行臂、交叉试验。在基线（中期项目）、12 周和 24 周后进行盲法评估。该研究在巴西的一个单一 CR 项目中进行，该项目无时间限制。参与者为患有心血管疾病或危险因素的患者，他们已经参加该项目 3 个月或更长时间。CR 计划包括每周 3 次监督下的运动。在 VR 组中，参与者在试验的前 12 周内每周 3 次中的 1 次进行 VR 治疗；随后的 12 周内停止使用 VR。测量指标包括：（1）在 12 周内每周 3 次的比例，以确定所有参与者的方案依从性；（2）运动行为调节问卷 3 的动机得分；（3）用户参与量表，适应性；活力、专注和吸收分量表的参与度得分，以上 3 项均为主要结局。
61 名（83.6%）患者被随机分配（n=30 名接受 CR+VR 治疗）；54 名（88.5%）在 12 周和 24 周时保留。基线时，参与者在 CR 中的平均时间为 7 年，且参与度和动机较高。CR+VR 在 12 周时显著提高了依从性（基线=72.87%；12 周=82.80%），在 VR 停止使用的 24 周时显著降低（65.48%）；在常规 CR 护理组中，随时间无变化。组间存在显著差异，12 周时 CR+VR 组的依从性显著高于常规 CR 组（73.51%）。动机从基线到 12 周显著下降（4.32[SD=0.37]比 4.02[SD=0.76]），并在 CR+VR 组从 12 周到 24 周显著增加（4.37[SD=0.36]）。在 CR+VR 组，12 周时吸收度显著较低（6.79[SD=0.37]比 6.20[SD=1.01]）。
尽管 VR 提高了方案的依从性，但与常规 CR 治疗方案穿插使用实际上降低了患者的动机和吸收度。
使用“运动游戏”为维持性 CR 计划补充 VR，可显著提高依从性（增加 8%或 36 次治疗中的 3 次），这是一个相当显著的效果，因为在停止使用 VR 后，这种效果就消失了。然而，与假设相反的是，每周提供 1 次 VR 治疗和 2 次常规 CR 运动与较低的动机和吸收度相关，这对临床医生为该患者群体设计方案具有重要意义。
