The goal of this research is to investigate the effectiveness of exercise administered via immersive virtual reality in patients with pulmonary hypertension, thereby contributing to the existing literature on this subject. The main question is whether exercises delivered via immersive virtual reality are effective to improve physical performance, functional capacity, dyspnea, muscle strength, fatigue, quality of life, depression and anxiety.
The number of studies examining the effects of exercise training in pulmonary hypertension (PH) is limited in the literature. Given the chronic nature of PH and the benefits of exercise in PH, the importance of exercise programs that include motivation as a factor becomes apparent. Therefore, the aim of this research is to investigate the effectiveness of exercise programs implemented via virtual reality under the supervision of a physiotherapist in PH patients. To investigators' knowledge, there are no studies in the literature examining the effectiveness of exercise training conducted via virtual reality in PH patients. Therefore, another aim of this research is to identify virtual reality (VR) applications that can be used to improve clinical outcomes in PH patients and to contribute to the literature on the effectiveness of using innovative technologies in rehabilitation programs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
32
Patients assigned to Group 2 are involved in supervised exercise sessions 3 times a week during 8 weeks. Exercise sessions includes aerobic and strengthed exercises delivered via virtual reality
Istanbul University-Cerrahpaşa/ Cardiology Institute
Istanbul, Fatih, Turkey (Türkiye)
Muscle Strength
Lower and upper extremity strength: Measurement is performed by having the person being tested exert maximum effort against the device during the measurement, and the person conducting the test respond with maximum force in the opposite direction to prevent movement. The tests are repeated three times, and the average of the values is recorded in Newtons (N).
Time frame: at the beginning of the study and at the end of 8 week,
Hand Grip Strength
The tests will be repeated three times, and the average of the values will be recorded in kilograms of force (kgF).
Time frame: at the beginning of the study and at the end of 8 weeks
Functional capacity of lower extremity
Six Minute Walking Test: Participants will be asked to walk as fast as possible at their own pace for 6 minutes on a 30-meter course. The distance walked by the patient will be recorded in meters.
Time frame: at the beginning of the study and at the end of 8 weeks
Functional capacity of upper extremity
Six Minute Pegboard and Ring Test: A wooden platform with bars will be used during the test. Two bars will be placed at shoulder level and the other two 20 cm above shoulder level. Ten rings, each weighing 14 grams, will be placed on the lower bars: ten on the right and ten on the left, for a total of 20 rings. Patients will be asked to place as many rings as possible from the lower bars to the upper bars and then back to the lower bars using both hands for 6 minutes. At the end of this time, the number of rings moved will be recorded as the the total score, and the resting time will be recorded in seconds.
Time frame: at the beginning of the study and at the end of 8 weeks
Physical performance
Short Physical Performance Battery: The test consists of 3 tests: walking 4 meters, standing up from a chair, and standing balance test. Each test is scored between 0-4. The scores obtained by the participants, ranging from 1-4, indicate the progressive performance required to complete the test according to the specified times. Walking test: Participants will be asked to walk 4 meters in a pre-marked corridor, and the time will be recorded and scored. The use of walking aids will be permitted, and saturation monitoring will be performed. Standing up from a chair test: Participants will be asked to stand up once from a seated position with their arms crossed over their chest. Patients who can do this will be asked to stand up and sit down five times as quickly as possible, and the time will be recorded. Standing balance test: 3 positions will be used; feet side-by-side and together, tandem, and half-tandem.
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Time frame: at the beginning of the study and at the end of 8 weeks
Dyspnea assessment
Modified Medical Research Council Dyspnea Scale: This scale was developed to assess the level of dyspnea in patients. The scale evaluates how much difficulty patients experience in daily life activities due to dyspnea. Individuals indicate the degree of shortness of breath with a score between 0 and 4. Higher scores indicate a greater perception of dyspnea.
Time frame: at the beginning of the study and at the end of the 8 weeks
Physical Activity Level Assessment
International Physical Activity Questionnaire - Short Form: This is a 7-question questionnaire developed to determine physical activity levels, covering the past week. The questionnaire examines activities under the headings of vigorous physical activity, moderate physical activity, and walking. All activities are recorded in terms of frequency (days/week) and duration (minutes/day). A score in MET-min/week is calculated for all categories using a defined metabolic equivalent (MET) per activity, and the sum of these scores gives the total IPAQ-SF score. Standard MET values are accepted as 3.3 for walking, 4.0 for moderate activity, and 8.0 for vigorous activity. Sitting is assessed with a separate question and is not included in the total IPAQ-SF score.
Time frame: at the beginning of the study and at the end of 8 weeks
Fatigue Assessment
Fatigue Severity Scale: The scale consists of 9 questions, each rated between 1 (strongly disagree) and 7 (strongly agree). The total value is divided by 9 to obtain the final score. An increased score indicates greater fatigue severity. A score of \<2.8 indicates no fatigue, while a score \>6.1 indicates chronic fatigue.
Time frame: at the beginning of the study and at the end of 8 weeks
Quality of life assessment
EmPHasis 10: Developed for assessing quality of life in patients diagnosed with pulmonary hypertension, the EmPHasis-10 includes inquiries about significant consequences of the disease, such as shortness of breath, fatigue, and lack of energy, which can also affect social life. The scale consists of 10 questions, each a Likert-type question scored between 0 and 5. The total score of the scale ranges from 0 to 50 points. A high score indicates a poor quality of life due to symptoms.
Time frame: at the beginning of the study and at the end of 8 weeks
Depression and anxiety assessment
Hospital Anxiety and Depression Scale: The scale consists of 14 questions in total. The Likert-type scale includes 7 questions to assess anxiety levels and 7 questions to assess depression levels. Scores for both sub-assessments range from 0 to 21. Higher scores indicate a worse level. For both sub-assessments, scores of 0-7 indicate a normal level, 8-10 indicate borderline mood disorder, and ≥11 indicate a mood disorder.
Time frame: at the beginning of the study and at the end of the 8 weeks
Virtual Reality Experience Assessment
Simulator Sickness Questionnaire: This is a scale that assesses the safety of experiences that alter the perception of reality, such as virtual reality, and the symptoms of motion sickness. It consists of 16 items grouped into 3 subscales (oculomotor symptoms, disorientation, nausea). Each item is rated on a four-point scale (0 = I feel nothing, 1 = somewhat, 2 = moderate, and 3 = very), and the total score is the sum of the scores of the three subscales.
Time frame: at the beginning of the study and at the end of the 8 weeks