Physio findings: virtual reality exercise, TENS benefits for pain relief

Active virtual reality games can entice sedentary people into taking exercise. But can this make a real difference to serious health conditions? 

 

Physios in Jamaica investigated whether active gaming could help patients with heart disease to improve their functional endurance. And an Irish team tested its effects on people with balance problems.

 

Both teams used Nintendo Wii Fit Plus, with which players’ real-life movements animate an onscreen version of themselves playing sports or doing exercises.

 

Dara Meldrum, of the school of physiotherapy at the Royal College of Surgeons in Ireland, and colleagues recruited 71 patients with unilateral peripheral vestibular loss, causing vertigo and problems with walking or balance.

 

Participants were divided into two groups and given either a gaming device or just an exercise mat. They were asked to do daily exercise at home for six weeks and have a weekly appointment with a physio. 

 

Tested after six weeks, and again six months later, both groups of patients had made similar progress. But the gamers reported significantly more enjoyment, less difficulty in exercising and less tiredness afterwards.

 

‘Virtual reality–based balance exercises performed during vestibular rehabilitation were not superior to conventional balance exercises, the authors concluded, ‘but may provide a more enjoyable method of retraining balance after unilateral peripheral vestibular loss.’

 

Meanwhile, Gail Nelson of the University of the West Indies and colleagues recruited a group of cardiac patients, referred by their specialists. They excluded anyone with a condition that could make exercise dangerous or painful. 

 

The team began by giving each patient a six-minute walk test. After that, the 28 participants did three individual gaming sessions a week for six weeks, alone in a room.

 

A range of virtual activities included rhythm boxing, hula hoop, running, stepping and completing an obstacle course. Players started with a 10-minute warm-up followed by 20 minutes’ exercise working large muscle groups, then a 10-minute cooldown. 

 

The patients, whose average age was62, reported greatly enjoying the programme. And after six weeks, they had significantly increased the average distance they could walk in six minutes, from 461 metres to 498 metres. 

 

The authors admit the study’s value was limited by its design and call for further research to include randomised trials with a control group. 

 

‘All participants, however, were at least in the subacute stage of their condition and medically stable,’ they said. ‘So, significant changes in their functional exercise capacity over a six-week period without intervention would be unlikely to occur.’ Meldrum D et al. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomised controlled trial, Archives of Physical Medicine and Rehabilitation 2015; 96:1319-1328.e1. Nelson GA et al. Wii Fit Plus exercise training for persons with cardiac disease, Cardiopulmonary Physical Therapy Journal 2015; 26: 73-77 - open access.

Pain relief should not be the only measure of success in using electrical stimulation, say physiotherapists who asked patients for their own observations. 

 

Although transcutaneous electrical nerve stimulation (TENS) is widely used, there hasn’t been much high-quality evidence published about its effects on chronic musculoskeletal pain. Researchers trying to evaluate its effectiveness need more information to help them select appropriate ‘patient-reported outcome measures’. 

 

So Peter Gladwell, based at North Bristol NHS Trust’s pain management service, and colleagues set out to discover what made TENS work for successful users.

 

They studied and interviewed a group of patients who found the machines helpful in managing their chronic musculoskeletal pain.

 

‘Distraction from pain and a reduction in the sensations associated with muscle tension or spasm should be considered as separate outcomes from pain relief. These direct benefits led to a wide range of indirect benefits dependent on patient decision making,’ Dr Gladwell’s team reports. 

 

As a result, patients reported psychological benefits, cut down their use of medicines, functioned more effectively and enjoyed better rest.

 

‘Evaluating TENS using a unidimensional pain scale is likely to overlook potential benefits,’ the team concludes. ‘The complex pattern of TENS usage, as well as multiple direct and indirect outcomes, indicates that TENS could be considered as a complex intervention.’Gladwell PW et al. Direct and Indirect Benefits Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews, Physical Therapy 2015.