Title : Effect of virtual reality resistance exercise in patients with Chronic Obstructive Pulmonary Disease: A randomized control trial
Exercise component in pulmonary rehabilitation benefits the Chronic Obstructive Pulmonary Disease (COPD) patients by improving the exercise capacity and health-related quality of life (HRQoL). However, patients with COPD were reported for their low motivation to participate in pulmonary rehabilitation programs. Muscle weakness is a common problem for patients with COPD. Compared to aerobic exercise, additional benefits were discovered on enhancing the muscle strength and respiratory muscle force in resistance exercise. Moreover, virtual reality (VR) as a technological device, has multiple advantages of rehabilitation that are suitable to improve the engagement of COPD patients. Therefore, the present study aims to investigate the effect of VR resistance exercise on patients with COPD. Eighteen patients with COPD whose aged between 40 to 85 were recruited and randomly allocated to the control group (n=11) and intervention group (n=7). Participants in control group received conventional treatment of health education of home exercise. Participants in the intervention group received health education of home exercise and physiotherapist supervised VR resistance exercise. The intervention was performed 3 times per week for 8 weeks (a total of 24 sessions) and the weight was gradually increased within sessions. The assessments of muscle strength, cardiopulmonary exercise test, health-related quality of life (HRQoL), perceived symptom severity, and program preference were used to evaluate the treatment effect. Eleven stage IV COPD patients were allocated to the control group, and 7 patients (4 stage III COPD patients and 3 stage IV COPD patients) were allocated to the intervention group. Baseline data of COPD stage (p=.011), forced vital capacity (p=0.017) and forced expiratory in one seconds/ forced vital capacity (p=.003) had significant differences between groups. Muscle strength of biceps (p=.001), triceps (p=.003) and anterior deltoid (p=.006) had significant improvement between groups. However, the change of characteristics of cardiopulmonary exercise test, HRQoL, perceived symptom severity and program preference showed no significant difference between groups. The present study suggested that improving the muscle strength of upper extremities shows insufficient contribution on exercise capacity, HRQoL and perceived symptom severity. In addition, the VR program designed by the research team also failed to improve the engagement of COPD participants. It is recommended that future studies investigated the resistance training should focused on the assessment of activity performance and daily participated level. As for the utilization of VR, close cooperation between physiotherapist and designer could surely reach the maximum benefits for COPD.