A Randomized, Controlled, Crossover Trial of Virtual Reality in Maintenance Cardiovascular Rehabilitation in a Low-Resource Setting: Impact on Adherence, Motivation, and Engagement

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dc.contributor.authorda Cruz, Mayara Moura Alves [UNESP]
dc.contributor.authorRicci-Vitor, Ana Laura [UNESP]
dc.contributor.authorBorges, Giovanna Lombardi Bonini [UNESP]
dc.contributor.authorda Silva, Paula Fernanda [UNESP]
dc.contributor.authorTurri-Silva, Natália
dc.contributor.authorTakahashi, Carolina [UNESP]
dc.contributor.authorGrace, Sherry L.
dc.contributor.authorVanderlei, Luiz Carlos Marques [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.contributor.institutionUniversity of Brasilia
dc.contributor.institutionYork University
dc.date.accessioned2021-06-25T11:18:14Z
dc.date.available2021-06-25T11:18:14Z
dc.date.issued2021-05-04
dc.description.abstractOBJECTIVE: 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. METHODS: 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 In the VR arm, participants had 1 VR session of the 3 per week during the initial 12 weeks of the trial; this was withdrawn the subsequent 12 weeks.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. RESULTS: 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in adherence at 12 weeks (baseline = 72.87%; 12 weeks = 82.80%), with significant reductions at 24 weeks when VR was withdrawn (65.48%); in the usual CR care arm, there were no changes over time.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]). CONCLUSION: Although VR increased program adherence, interspersing it with usual CR sessions actually decreased patient motivation and absorption. IMPACT: 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.en
dc.description.affiliationDepartment of Physiotherapy São Paulo State University (UNESP) School of Technology and Sciences
dc.description.affiliationDepartment of Physiotherapy University of Brasilia
dc.description.affiliationDepartment of Physiotherapy Faculty of Health York University
dc.description.affiliationUnespDepartment of Physiotherapy São Paulo State University (UNESP) School of Technology and Sciences
dc.identifierhttp://dx.doi.org/10.1093/ptj/pzab071
dc.identifier.citationPhysical therapy, v. 101, n. 5, 2021.
dc.identifier.doi10.1093/ptj/pzab071
dc.identifier.issn1538-6724
dc.identifier.scopus2-s2.0-85107319706
dc.identifier.urihttp://hdl.handle.net/11449/208739
dc.language.isoeng
dc.relation.ispartofPhysical therapy
dc.sourceScopus
dc.subjectCardiac Rehabilitation
dc.subjectCardiovascular Diseases
dc.subjectExercise
dc.subjectTreatment Adherence and Compliance
dc.subjectUser Engagement Virtual Reality Exposure Therapy
dc.titleA Randomized, Controlled, Crossover Trial of Virtual Reality in Maintenance Cardiovascular Rehabilitation in a Low-Resource Setting: Impact on Adherence, Motivation, and Engagementen
dc.typeArtigo
unesp.author.orcid0000-0002-3955-9149[1]
unesp.departmentFisioterapia - FCTpt

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