Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population

BACKGROUND

Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system).

OBJECTIVE

This study aims to investigate the impact of physical exercise in a VR environment.

METHODS

A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence).

RESULTS

First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality-stimulation=1.90; hedonic quality-identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04).

CONCLUSIONS

These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine.

[Concerning: aging, the beginning of dialysis, the beginning of dependence: repercussions on the psychopathology of the very old dialysis patient]

The incidence of psychopathology, particularly depression, is high in dialysed elderly patients whereas their perceived level of health in the mental domain is similar to that of a non-dialysed and, even younger, population. Although the losses associated with advancing years, chronic disease and then entry into dialysis renders the psyche of elderly people frail, they do not strictly add in negative terms: their psychological reserve or resignation helps very elderly people to tolerate dialysis and its constraints. However, maintaining functional autonomy (ability to provide for one's fundamental needs and preserve leisure activities) while remaining independent to take decisions (particularly in controlling ways of receiving assistance) and preserving close relationships emerge as major determinant factors of the quality of life of very elderly dialysed patients. Added to the dependency due to dialysis, losses in these domains very often represent a turning point by changing the patient's identity, predisposing to the development of relationship problems, leading the patient to question his self-esteem or even resulting in psychological dependency, which itself adversely affects the quality of life. These mechanisms of psychopathology may not hide the possibility of an underlying dementia.

[Symptoms and quality of life of hemodialysis patients aged 75 and over]

BACKGROUND

The population of dialysed patients includes an increasing percentage of very elderly patients. Although their life expectancy continues to increase, there are few currently available data about their quality of life.

OBJECTIVES

descriptive analysis of the determinants of quality of life, perceptual level of health and quality of life, and estimation of symptomatic complaints in a population of very elderly haemodialysed patients.

METHOD

Study of 35 haemodialysed patients aged 75 years old and older, who answered a questionnaire divided into 7 parts, defining: the determinants of their quality of life by open-ended questions, the prevalence of complaints amongst 35 pre-determined symptoms, Folstein MMSE performance, scores on Katz (ADL) and Lawton (IADL) independence scales, SF-36 perceptual health scale, and score subjectively allocated by the patients to their quality of life.

RESULTS

Maintenance of functional autonomy, independence in the decision-making process and maintaining good relationships with friends and family were major determinants of quality of life. Asthenia, the major complaint, was well reflected the reduced physical capabilities of the patients (mean SF-36 physical score: -1.1 SD). Despite the high prevalence of incapacitating painful symptoms (42%) and psychological symptoms (23%), autonomy remained satisfactory (mean ADL score: 5.6 out of 6 and IADL: 58%). The levels of perceptual health and of quality of life remained satisfactory for the majority of patients (mean mental SF-36 score: -0.06 SD, and 84% of the patients scored their quality of life > 5 out of 10).

CONCLUSION

These figures indicate the considerable resources that these patients could mobilise. It also emerges as an additional argument against the exclusion, based only on the criteria of age and multiple pathologies, of the oldest patients from the access to dialysis.