Energy Metabolism During Activity-Promoting Video Games Practice in Subjects with Spinal Cord Injury: Evidences for Health Promotion
Abstract by: Kelsey Stamps
Gaffurini, P., Bissolotti, L., Calza, S., Calabretto, C., Orizio, C., Gobbo, M. (2012). Energy metabolism during activity-promoting video games practice in subjects with spinal cord injury: evidences for health promotion. European Journal of Physical and Rehabilitation Medicine, 48.
This study was performed in order to determine if activity-promoting video game (APVG) practice in subjects with spinal cord injury (SCI) affected energy metabolism through an increase in energy expenditure (EE). APVG practice is a new approach being integrated into rehabilitation and health promotion programs of individuals post spinal cord injury. Whether it is used to recover levels of motor function or to promote health through changes in daily energy metabolism profiles, APVG practice may be a useful component in rehabilitation and maintaining a healthy lifestyle. The aim of this study was to assess the inclusion of APVG practice into a more general strategy for health promotion and lifestyle weight management in subjects with spinal cord injury through the monitoring of cardio-pulmonary and metabolic adaptions related to energy expenditure increase above resting.
APVG in subjects with spinal cord injury utilizes exclusively the upper limbs and can achieve up to a metabolic rate equivalent to 3.2 standard metabolic equivalents of task (METs). This metabolic expenditure level is considered as being moderately intense and could have implications for weight management in subjects with spinal cord injury. Moderate to vigorous leisure time physical activity also has implications for decreasing the risk of Type 2 diabetes by 65 percent. Incorporation of APVG practice into one’s health promotion routine has the potential to accompany a more long-term adapted physical activity program improving cardiovascular health and the reduction of secondary conditions.
Participants consisted of 10 male subjects with spinal cord injury lesions from C7 to L1 and an age range from 26 to 55 years. Informed consent was obtained and the study was approved by the local ethics committee. All subjects were familiar with APVG practice and showed similar ability levels for playing virtual bowling, tennis, and boxing. Participant’s weight was calculated using an accessible scale and differentiating wheelchair weight with and without the subject’s body weight. Body mass index (BMI) was calculated based on the individual’s study weight and height derived from an identification card.
Instrumentation in the study included the metabolimeter Cosmed K4b, which is a portable system designed to measure breath by breath gas exchange providing an output data set of oxygen consumption, pulmonary ventilation, heart rate, and energy expenditure. Subjects began playing the games (Wii Sports bowling, tennis, boxing) in a randomized order for 10 minutes with five minutes of rest in between. Participants began at the easiest level of competition in each of the games and played against the console opponent. Bowling was self-paced, did not involve an opponent, and included a 10-lane game. Tennis was externally paced, doubles match against two console opponents, and a five game match. Boxing was externally paced, consisted of a three-round bout, and utilized both arms to throw punches towards the screen. The metabolic and functional parameters were recorded over the last 60 seconds of the 10-minute period of each activity.
Statistical significance was set at P<0.05; all functional parameters showed a significant positive linear trend while no higher order polynomials were significant. The findings in this study support the idea of a constant increase in metabolic rates from rest to bowling, bowling to tennis, and tennis to boxing. On average, METs exceeded 3 during Wii boxing.
The results of this study suggest that APVG practice in individuals with spinal cord injury significantly increases metabolic rate above resting levels thus resulting in improved cardiovascular fitness and lifestyle weight management. It is recommended to include one hour of APVG practice per day to notice increases in energy expenditure above resting levels. Increases derived from this study are equated to 6 percent in Wii bowling, 10 percent in Wii tennis, and 15 percent in Wii boxing. These levels of physical activity are said to promote health when performed according to the PAG of 30 minutes five days a week or 150 minutes a week. APVG practice should be used in conjunction with other forms of physical activity to meet the recommendations. The authors indicate future studies to include a larger sample size, use of female subjects with spinal cord injury, and monitoring of biomechanical and kinematic parameters.
Individuals with spinal cord injury can reap cardiovascular and health benefits from one hour per day (can be broken into several bouts) of APVG practice. Games to try are Wii bowling, tennis, and boxing with boxing resulting in the largest “bang for your buck.” This form of exercise can be achieved comfortably in the home and combined with other forms of physical activity to achieve the PAG recommendations of 150 minutes of physical activity per week.