Earticle

Purpose: This study aimed to verify the effectiveness of virtual reality (VR) exercise programs and evaluate their practical applicability through systematic research on Ring Fit Adventure, a VR-based fitness game that includes various exercises such as aerobic and muscle strengthening activities. The subjects were randomly divided into two groups, with 15 individuals assigned to each group; due to dropouts, 11 people were ultimately assigned to each group. The experimental group performed three types of exercises using a Ring-Fit Adventure program. Methods: This study measured forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and dynamic balance ability improvement by conducting Parachute, Balance Walk, Hurray GET, Coin Run, Disc Hit, and Twist Bat, which are exercise programs of Ring Fit Adventure. Measurements were taken using BioRescue and MicroQuark systems. Results: The Coin Run exercise significantly improved stability limits in balance ability, specifically in right, and forward, and backward directions. It also significantly increased the average value of FEV1, indicating enhanced breathing ability. The Parachute exercise resulted in an increase in average stability limits for balance ability and improvements in FVC and FEV1, although these changes were not statisticallysignificant. Conclusion: VR exercise programs are effective for improving balance ability and breathing capacity. Ring-Fit Adventure exercise programs such as Coin Run, Disc Hit, and Twist Bat demonstrated greater improvements in balance ability, making them suitable choices for enhancing stability and balance in VR fitness programs.

Purpose: In this study, we investigated the effectiveness of a 12-week virtual reality exercise program using the Nintendo Wii console (Wii) in improving balance, emotion, and quality of life among patients with cognitive decline. Methods: The study included 30 patients with cognitive decline (12 female, 18 male) who were randomly assigned to an experimental (n=15) and control groups (n=15). All subjects performed a traditional cognitive rehabilitation program and the experimental group performed additional three 40-minute virtual reality based video game (Wii) sessions per week for 12 weeks. The berg balance scale (BBS) was used to assess balance abilities. The short form geriatric depression scale-Korean (GDS-K) and the Korean version of quality of life-Alzheimer's disease (KQOL-AD) scale were both used to assess life quality in patients. Statistical significance was tested within and between groups before and after treatment, using Wilcoxon signed rank and Mann-Whitney u-tests. Results: After 36 training sessions, there were significant beneficial effects of the virtual reality game exercise on balance (BBS), GDS-K, and KQOL-AD in the experimental group when compared to the control group. No significant difference was observed within the control group. Conclusion: These findings demonstrate that a virtual reality-training program could improve the outcomes in terms of balance, depression, and quality of life in patients with cognitive decline. Long-term follow-ups and further studies of more efficient virtual reality training programs are needed.

Purpose: This study was conducted in order to investigate the effectiveness of an 8-week virtual reality exercise program designed around the Nintendo Wii (Wii), in improving balance among patients with Multiple Sclerosis (MS). Methods: The study included 16 patients with MS (10 female, 6 male) who were assigned randomly to experimental (n=8) or control group (n=8). Experimental group performed three 40-minute Wii balance-training sessions per week, for 8 weeks. The control group did not perform any of the training programs. A computerized dynamic posturography (Sensory Organizing Test, SOT) was used to evaluate all patients at baseline and at the end of the treatment protocol. Statistical significance was tested in between the patients before and after treatment by t-test. Results: After 24 training sessions, SOT showed significant difference on condition 5, 6, and vestibular ratios within the experimental group from baseline to post-intervention. By contrast, no significant difference was observed within the control groups. Conclusion: These findings demonstrated that the virtual reality training program could improve the outcomes in terms of balance in the MS population. Long term follow ups and the development of more efficient virtual reality training programs are needed.

Background: Ankle sprain is one of the most common musculoskeletal injuries in the sports population or during usual daily life activities. The sprain can cause functional ankle instability (FAI), and it is very important to treat FAI. However, the optimum intervention method for FAI has yet to be determined. Objects: This study investigated the impact that virtual reality (VR) training program on balance with ankle kinesio taping for FAI. Methods: Twenty-two people were selected for the study and randomly divided into the experimental (n = 11) and the control group (n = 11). The experimental group had attached kinesio taping on the ankle and then implemented a virtual reality exercise program for 30 minutes a day. Nintendo Wii Fit Plus was used for the VR intervention three times a week for four weeks. The control group performed only two measurements without intervention. Results: There were no statistically significant differences in overall, anterior-posterior (AP), medial-lateral (ML) index of the static balance, and significant differences in overall, AP, ML index of the dynamic balance when taping and VR exercise were applied at the same time (p < 0.05). There were no significant differences in overall and ML index of static and dynamic balance compared with before and after assessment between the experimental and the control group, and found differences in AP index of static and dynamic balance (p < 0.05). Conclusion: Kinesio taping may not influence the balance of FAI as great as people expected. VR approach does not affect the static balance of FAI, but it influences dynamic balance in overall, AP, ML index. The authors suggest that VR-based exercises can be used as an additional concept in clinicians for FAI or as part of a home program because the exercises still have limitations.

Objective: The purpose of this study was to evaluate the effect of virtual reality (VR)-based core stabilization exercise on upper extremity function, postural control, and depression among persons with stroke with hemiplegia. Design: Randomized controlled trial. Methods: This study was conducted with the inclusion of 24 participants and were randomly assigned to either the VR-based trunk stability exercise group (n=12) or control group (n=12). The VR-based trunk stability exercise group performed core stabilization exercises in a VR environment for 30 minutes. Meanwhile, the control group conducted general core stabilization exercises for 30 minutes. The participants trained 3 times a week for 4 weeks. The manual functional test (MFT), Box and Block Test (BBT), Berg Balance Scale (BBS), Trunk Impairment Scale (TIS), the Geriatric Depression Scale (GDS) were used to assess all participants before and after the intervention. Results: The VR-based core stabilization exercise group had a significant improvement in upper extremity function (MFT, BBT) and postural control (BBS) compared with the control group (p<0.05). The VR-based core stabilization exercise showed a significant difference after intervention in the TIS and GDS scores (p<0.05), but they did not significantly differ between the two groups. Conclusions: The result showed that VR-based core stabilization exercise can be effective in improving upper extremity function and postural control among patients with stroke more than the sole application of general physical therapy.

PURPOSE: This study examined the effects of posture improvement exercise using virtual reality programs on the posture and balance of patients with forward head postures. METHODS: Thirty men and women in their 20 s, who had a forward head posture, were divided randomly into a group with posture correction exercise and a group with posture correction exercise combined with virtual reality programs. The posture correction exercise was composed of squats, XCO training, and chin-tuck exercise. In contrast, exercise with virtual reality games involved the Hot Squat, Climbey, and Baskhead programs while wearing a headset. Both groups performed the exercises 15 min a day, three times per week, for four weeks. The balance ability, distance between the acromion and earlobe, and neck joint range of motion were assessed before and after the exercises. RESULTS: Both groups showed significant reductions in the distance between the acromion and the earlobe, along with significant improvements in the range of joint motion. The group that performed the virtual reality exercises showed a significant increase in the limit of stability. Both groups showed a significant decrease in the sway length. In contrast, the group given the virtual reality exercises showed a significant reduction in the sway speed while standing with their eyes closed. CONCLUSION: Exercise applying virtual reality programs can be used in clinical and home programs to correct the postures of individuals with a forward head posture because they can trigger interest in inducing active participation.

Purpose The purpose of this study was to develop a novel mouth contactless breathing exercise solution based on virtual reality (VR), and to test its feasibility. Methods We developed the Virtual Reality-based Breathing Exercise System (VR-BRES), a self-regulating biofeedback breathing exercise with gaming characteristics and a soft stretch sensor. The feasibility and efficacy of the VR-BRES prototype were investigated through a randomized crossover trial. Fifty healthy adults participated in the trial, and their respiratory parameters and user evaluation of the VR-BRES were compared with conventional deep breathing (CDB) exercises. Results The respiratory parameters, forced vital capacity (Z = 4.82, 4.95, p < .001), forced expiratory volume in one second (t = 6.02, 6.26, p < .001), and peak expiratory flow (t = 5.35, 5.68, p < .001) were significantly higher during breathing exercises using the VR-BRES. User evaluation was also significantly higher for the VR-BRES in terms of efficiency (Z = 3.86, p < .001), entertainingness (Z = 5.00, p < .001), and intention to use (Z = 3.22, p = .001) compared to CDB. However, there was no difference in convenience between the two methods (Z = ?0.90, p = .369). Conclusion The VR-BRES has the potential to be an efficient breathing exercise solution. We recommend a clinical study that evaluates the effects of the VR-BRES for a certain period of time for people who need breathing exercises.

The purpose of this study was to examine the effects of virtual reality exercise (VRE) using Nintendo Wii-Fit on physical fitness of Korean adults with schizophrenia living in a mental health facility located in South Korea. Two male participants diagnosed with schizophrenia, ages 53 and 61, were recruited and selected for inclusion in this study. The intervention using the Nintendo Wii-Fit consisted of 35-min ses-sions, 3 times per week for 8 weeks and was facilitated by the primary researcher and two graduate students. The senior fitness test and 10-m walking test were used to measure the physical functioning, specifical-ly, physical fitness and mobility, of the participants. The study was divid-ed into three phases using an A-B-A single-subject design and involved multiple repeated measures of functional physical fitness. Both partici-pants were evaluated each week for the duration of 18 weeks. Both participants exhibited measureable improvement in some of the physi-cal fitness measures, but not in the mobility. These results thus provide preliminary evidence to support the use of VRE to improve physical function for Korean adults with schizophrenia as an alternative exercise regimen to the conventional exercise.

The purpose of this study is to find an optimal rehabilitation therapy intervention, especially in this study, by comparing the effects of applying both virtual reality (VR) programs and microwave diathermy (MWD) at the same time. The subjects of this study participated 19 college students in their 20s. The subjects were randomly divided into two groups. The first group received MWD (male:2 female:8) and VR ankle training, while the second group (male:2 female:7) received only the VR training. The interventions were conducted three times a week for four weeks. Biodex Balance System® is a tool to measure balance degree in this study. The MWD (PM-800S, ITO, Japan) intervention was conducted by setting the frequency of 2450㎒ and the output of 100W before the implementation of the VR exercise program. The exercise in this study was conducted using the Nintendo Wii Fit Plus program for VR exercise. Comparison of the results of the groups that implemented MWD and VR at the same time and those that implemented VR only are as follows. In the static balance, VR groups were significantly lower in all directions such as overall, anterior-posterior, and medial-lateral (p<.05). There was no statistically significant difference in dynamic balance (p>.05). If the therapist does not properly perform the examination when applying MWD for FAI, the effect might not be significant. VR exercise programs can also be used to improve the balance of FAI, although it has limitations.

This study explores the effect of proprioceptive neuromuscular facilita-tion (PNF) exercises combined with a virtual reality (VR) motion capture system and concurrent feedback (CF) on early shoulder muscle activa-tion in healthy individuals. Thirty healthy participants sequentially per-formed three PNF diagonal 2 shoulder exercises: PNF alone, PNF with VR (PNF+VR), and PNF with VR and CF (PNF+VR+CF), with the latter two exercises presented in randomized order. Using wireless surface elec-tromyography and 3-dimensonal (3D) inertial measurement units, the activation of the upper trapezius (UT), lower trapezius (LT), infraspinatus (INF), and serratus anterior (SA) muscles, as well as shoulder flexion, abduction, and external rotation range of motion, were recorded during three exercises. INF and LT muscles were activated earlier in abduction and flexion during PNF+VR and PNF+VR+CF exercises than in PNF alone (P<0.05). These muscles were also activated during the early external rotation phase during PNF alone (P<0.05). No statistically significant differences were observed in UT and SA muscle activation among PNF alone, PNF+VR, and PNF+VR+CF exercises (P>0.05). Integrating VR gaming elements and CF into PNF shoulder exercises may promote ear-ly muscle activation, offering a promising approach for advanced reha-bilitation strategies that can potentially improve patient outcomes. VR motion capture systems have the potential to transform traditional ther-apeutic approaches by increasing enjoyment and engage

본 연구는 가상 현실 운동이 기능적 발목 불안정성을 가진 성인 남성의 균형 능력, 발목 불안정성 및 운동공포증에 미치는 효과를 검증하는 데 있다. 연구 대상자는 기능적 발목 불안정성과 운동공포증을 가진 20대 성인 남성 24명으로, 가상 현실 운동 집단(VRG)과 전통적인 운동 집단(CEG)으로 각각 12명씩 무작위 배정하였다. 대상자는 8주간 균형 운동, 근력 운동, 신경근 운동이 포함된 운동 프로그램을 주 3회씩 실시하였으며, 균형 능력, 발목 불안정성, 그리고 운동공포증 을 측정하여 비교·분석하였다. 연구 결과, 정적 균형의 타원 면적, 변위, 평균 속도는 시기에 따른 차이가 나타났으며 (p<.001), 동적 균형의 타원 면적, 변위, 평균 속도, 상대 도달 거리의 후방내측에서 시기에 따른 차이가 나타났다(p<.05). 또한 상대 도달 거리의 전방과 후방외측, 종합 점수에서는 상호작용이 나타났다(p <.05). 발목 불안정성은 상호작용이 나타났으며(p=.021), 운동공포증은 시기에 따른 차이가 나타났다(p=.003). 결론적으로 정적 균형, 동적 균형의 타원 면 적, 변위, 평균 속도, 상대 도달 거리(PM), 그리고 운동공포증은 시기에 따라 긍정적인 변화를 보였으나, 두 집단-간 차이 는 확인되지 않았다. 반면, 동적 균형의 상대 도달 거리(ANT, PL)와 발목 불안정성은 VR 운동이 효과적인 것으로 나타났 다. 따라서 VR 운동은 기능적 발목 불안정성을 가진 사람의 발목 기능 향상과 운동공포증 완화에 효과적인 방법으로 판단 된다.

This study aimed to examine the effects of virtual reality exercise on balance ability, ankle instability, and kinesiophobia in adult males with functional ankle instability. 24 male participants in their 20s with FAI and kinesiophobia were randomly assigned to either the virtual reality exercise group(VRG) or the conventional exercise group(CEG), with 12 participants in each group. Participants performed an exercise program including balance, strength, and neuromuscular training three times per week for eight weeks and were assessed for balance ability, ankle instability, and kinesiophobia. The results showed significant time effects for the elliptical area, displacement, and mean velocity in static balance(p<.001), as well as for the elliptical area, displacement, mean velocity, and posteromedial reach distance in dynamic balance(p<.05). Additionally, significant interactions were found for anterior and posterolateral reach distances and the composite score(p<.05). Ankle instability exhibited a significant interaction effect(p =.021), while kinesiophobia showed a significant time effect(p =.003). In conclusion, static balance, dynamic balance parameters, and kinesiophobia improved over time, but no significant differences were found between the two groups. However, VR exercise was effective for improving anterior and posterolateral reach distances in dynamic balance and reducing ankle instability. Therefore, VR exercise may be an effective approach for enhancing ankle function and alleviating kinesiophobia in individuals with functional ankle instability.

Purpose: The aim of this study was to investigate the effects of an exercise program using a virtual reality game and a gait exercise program using a treadmill on % maximum voluntary isometric contraction (%MVIC) and static and dynamic balancing capabilities. Methods: A total of 26 elderly women were included in the study. 13 women were assigned to an exercise program using a virtual reality game, and 13 to a gait exercise program using a treadmill. The subjects performed the exercise for 40 min per session, three sessions per week, for eight weeks. Results: The %MVIC of the vastus medialis was significantly increased from $28.91{\pm}2.03%$ to $32.98{\pm}2.6%$ in the virtual reality game exercise group (p<0.00). The %MVIC of the vastus lateralis was significantly increased from $27.17{\pm}1.93%$ to $31.50{\pm}2.18%$ (p<0.00) in the gait exercise program group. The whole path length with both feet on the floor and eyes open was significantly decreased from $1570.92{\pm}820.6mm$ to $1343.62{\pm}242.41mm$ (p<0.00). The whole path length with both feet on the floor and eyes closed was significantly decreased from $1819.85{\pm}361.14mm$ to $1581.05{\pm}285.11mm$ (p<0.00). The length of a functional reach was significantly increased from $25.2{\pm}4.23cm$ to $27.68{\pm}4.04cm$ (p<0.00). Conclusion: The exercise program using a virtual reality game is effective for improving the %MVIC and static and dynamic balancing capabilities in elderly women aged 65 years and more.

The purpose of this study is to identify the effects of virtual reality exercise program with Wii on balance, walking and upper extremity function in stroke patients. Eleven subjects with stroke (an average age of 70.81 years) were participated in this study. One of three virtual reality exercises (boxing, tennis, bowling) using the Wii is performed for 30 minutes 2 times a week for 8 weeks. This study measured Timed up and go test (TUG), Berg balance scale (BBS), cadence, walking velocity, stride length, gait symmetry and box and block test (BBT) before and after 8-weeks exercise. The collected data were analyzed by using paired t-test. There were significant differences in TUG, BBS, cadence, walking velocity, stride length in the left side, gait symmetry, and BBT scores (p<.05). These findings suggests that virtual reality exercise using Wii might be effective on balance, walking and upper extremity function in patients with stroke.

This study aimed to determine the effects of the virtual reality respiratory exercise and conventional respiratory exercise on diaphragm movement and pulmonary function in patients with stroke. Thirty subjects with stroke (an average age of 54.9 years) were randomly allocated to virtual reality respiratory exercise (n=15, VR group), and conventional respiratory exercise (n=15, control group). The two exercises were performed for 30 minutes 2 times a week for 4 weeks. This study measured diaphragm movement and pulmonary function before and after each 4-weeks exercise. Ultrasonography was used for measuring the diaphragm movement, and AVAD9 was used to measure the pulmonary function; forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF). The control group showed a significant increase in PEF (p<.05), but no significant different in diaphragm movement, FVC, FEV1. The VR group showed a significant increase in all dependent variables (p<.05), except the FEV1. In comparison of two group, the VR group showed significant increases in diaphragm movement, FVC, and PEF relative to the control group (p<.05). Based on the above results, it can be concluded that the virtual reality respiratory exercise is more effective than conventional respiratory exercise on diaphragm movement and pulmonary function for rehabilitation in patients with stroke.

The purpose of this study was to investigate the effect of virtual reality-based exercise program using a video game on functional mobility, visual perceptual ability, and balance ability in students with cerebral palsy. Fourteen students with cerebral palsy participated as subjects in this study, and they were divided into exercise group(n=7) and control group(n=7). The exercise group participated in Wii fit program(Nintendo Inc., Japan) for six weeks(60 min, 2 day per week). After six weeks virtual reality-based exercise program, functional mobility significantly was improved. In case of visual perceptual ability, visual discrimination, visual memory, visual-spatial relationships, sequential memory, and visual figure-ground were significantly improved. In addition, Weight distribution index, stability index, and fall index related in balance ability were increased. In conclusion, these findings suggest that commercially available virtual reality-based exercise program can be used to improve the functional mobility, visual perceptual ability, and balance ability in students with cerebral palsy

Purpose: This study examined the effects of a virtual reality-based exercise program on the functional recovery of balance and gait in chronic stroke subjects. Methods: A total of 42 chronic stroke patients were enrolled in this study. The participants were allocated randomly to 2 groups: a VR (n=22) and control group (n=20). Both groups received treadmill training for 3 sessions (10 minutes each), 30 minutes per week over a 6 week period. The VR group practiced additional virtual reality programs consisting of 3 programs for 10 minutes each. The data was analyzed using a paired t-test and independent t-test to determine the statistical significance. Results: The virtual reality-based exercise group showed significant increases in gait velocity, cadence and stride length compared to the control group (p<0.05). However, there were no significant differences in static balance. Conclusion: These results support the perceived benefits of exercise programs that incorporate virtual reality to augment the balance and ambulation of stroke patients. Therefore, virtual reality is feasible and suitable for stroke patients

This study was performed to investigate the effects of virtual reality exercise with video game on gross motor performance and balance in a child with spastic cerebral palsy. The subject of study was cerebral palsy with spastic diplegia presenting 4th level in gross motor function classification system. The subject received virtual reality video game exercise using Wii Fit system, which was performed for 35 minutes in each session, 2 sessions per week over a 5-week period (a total of 10 sessions). Assessment tools were made with the pediatric balance scale, the gross motor function measure, and balance evaluation in Wii Fit system in each session. After the training, gross motor performance and balance ability were improved. The exercise using virtual reality video game may be a beneficial tool to improve gross motor performance and balance in the spastic cerebral palsy at clinics and home-based setting.

Purpose : The purpose of this study was to identify effects of virtual reality-based closed kinetic chain (CKC) exercise on lower extremity muscle activity in chronic stroke patients Methods : Subjects were assigned randomly either to VR+CKC exercise group (n=15) or the CKC exercise group (n=15). When the study began, both groups received conventional physical therapy five times per week. The VR+CKC exercise group received virtual reality programs and the CKC exercise group received close kinetic chain exercises. Each exercise program was performed for six weeks (5 times per weeks; 20 minutes per time). Participants were measured on lower extremity muscle activity using EMG. Results : There was a significant increase of muscle activity (%RVC) in vastus lateralis and vastus medialis. Conclusion : In this study, the virtual reality-based closed kinetic chain exercise program was an effective exercise for improving lower extremity muscle activity in chronic stroke patients

연구목적: 닌텐도 위를 이용한 가상현실기반 비디오게임 프로그램을 만성기 뇌졸중 환자에게 적용하여 균형능력 및 일상생활동작에 어떠한 영향을 미치는지 알아보고, 뇌졸중 환자의 재활프로그램으로서 적용 가능성이 있는지 알아보고자 한다. 연구방법: 만성기 뇌졸중 환자를 무작위로 가상현실기반 비디오게임 프로그램을 적용한 실험군(n=7)과 적용하지 않은 대조군(n=10)으로 구분하여 연구를 진행하였다. 연구에 참여한 모든 대상자에게 30분의 Bobath therapy와 15분간의 FES 치료를 기본적으로 실시하였다. 이에 더하여 실험군은 가상현실기반 비디오게임 프로그램을 1일 30분이내, 주 5회, 3주간 실시하였다. 대조군은 자전거 운동과 보행훈련으로 30분간 시행하였다. 실험 전 후 눈뜨고 외발서기(OLST; open leg standing test), Timed Up and Go(TUG) 검사, 10m 걷기 검사, Functional Independence Measure(FIM)를 측정하였다. 실험 전과 실험 후 측정값의 차이를 비교하기 위해 Wilcoxon Signed Ranks Test를 실시하였다. 그리고 각 측정값의 변화량에 대한 실험군과 대조군 사이의 차이를 알아보기 위해 Mann-Whitney U Test를 실시하였다. 연구결과: 실험결과는 다음과 같다. 1) 실험군에서는 FIM의 유의한 증가와 TUG, 10m 걷기 검사의 유의한 감소를(p<.05) 보였다. 대조군에서는 OLST의 증가와 TUG, 10m walking test의 감소가 나타났지만 통계적으로 유의하지 않았다. 오직 FIM에서만 유의한 증가가 나타났다(p<.05). 2) 실험 전 후의 실험군과 대조군의 각 측정값들의 평균차를 비교한 결과 실험군은 대조군보다 실험 전 후 OLST, TUG, 10m walking test 차이의 평균은 컸지만 통계적으로 유의하지 않았다. 결론: 이상의 결과로부터 가상현실기반 비디오게임이 만성기 뇌졸중 환자의 동적균형능력 및 일상생활동작 향상에 효과가 있음을 알 수 있었다.

Background: This study aims to implement lumbar stabilization exercises by using gym ball s and mats and exercises by utilizing a virtual reality program to normal adults in their tw enties for four weeks and to identify effects on balance ability. Methods: Eighteen students (M:6, F:12) studying in H University in Gwangju were randoml y placed to three groups: six students in the control group, six students in the gym ball an d mat exercise group, and six students in the virtual reality program group. Lumbar stabilization exercises and the virtual reality program were implemented for thirty minutes a day and three times a week for four weeks in total. The control group carried o ut only daily activities. Limit of Stability (LOS) was measured before and after experiment s to check balance. In order to compare differences between values before and after experi ments, Wilcoxon Signed Ranks Test was carried out. In order to identify differences among groups for changes of values, Mann-Whitney U Test and Kruskal-Wallis Test were carrie d out. Results: The findings are as follows. 1) There was no significant difference among LOSes of the groups before exercises (p>.05). 2) After exercises for four weeks, LOS of the lu mbar stabilization exercise group increased even though the increase was not statistically si gnificant than that of the control group. The virtual reality program group showed a signific ant increase in LOS compared to that of the control group (p<.05)(Table 4). Conclusion: The above findings confirmed that the virtual reality program is effective in imp roving balance ability of normal adults.