Exergaming Shows Promise for Dialysis Patients’ Activity Levels | Healio Nephrology News

The potential for “exergaming” – combining video games with physical exercise – to improve the well-being of children and adolescents undergoing hemodialysis is gaining traction, according to a recent pilot study published in Pediatric Nephrology. The research suggests that incorporating interactive, movement-based games during dialysis sessions is both feasible and generally safe, offering a novel approach to combatting the physical inactivity often associated with this life-sustaining treatment. This is particularly important as children and adolescents on dialysis frequently experience lower levels of physical activity than their peers, potentially leading to long-term health consequences.

A New Approach to Dialysis Treatment

Traditionally, hemodialysis sessions require patients to remain relatively still for several hours, limiting opportunities for physical activity. Researchers at the Institute of Cardiology and Sports Medicine at German Sport University Cologne, in collaboration with the exergaming company Icaros, sought to address this challenge by developing a specialized system designed for use during treatment. The system centers around the ICAROS Seated Trainer (I.S.T.), a wobble board-like device coupled with a mobile device that translates leg movements into digital actions within a video game. This allows patients to engage in active gameplay while remaining seated and connected to the dialysis machine.

The pilot study involved nine children and adolescents with an average age of 11.6 years, who participated in two 20-minute exergaming sessions per week over an eight-week period. The primary objective was to assess the feasibility, safety and acceptability of the system within a real-world clinical setting. Researchers carefully monitored participants for any adverse events and gathered feedback from patients, caregivers, and medical staff.

Safety and Acceptability: Initial Findings

The study yielded encouraging results regarding the safety of the exergaming intervention. No serious medical incidents, such as falls or dislodgement of the arteriovenous shunt needle, were reported during the 123 total training sessions. Minor adverse events were observed in a small number of participants, including pressure alarms, headaches, abdominal pain, and dizziness or nausea. However, these events typically occurred before gameplay and led to the early termination of the session, suggesting they were not directly caused by the exergaming itself. Exercise-based interventions during hemodialysis are often challenging to implement due to patient fatigue and the constraints of the treatment, making the positive reception of this system particularly noteworthy.

Feedback from participants, parents, and clinicians was overwhelmingly positive. The researchers noted a clear enthusiasm for continuing the exergaming program beyond the pilot study, indicating a high level of acceptability. The system appeared to successfully integrate into the routine clinical workflow, enhancing motivation and engagement during dialysis treatment.

How the System Works: Games and Movement

The I.S.T. System offers a diverse library of 23 different exercise games designed to target various physical and cognitive skills. Games range from those emphasizing strength and balance to those focusing on reaction time, coordination, and endurance. For example, one game involves “hunting” dinosaurs by moving the legs to propel a dinosaur forward on the screen, while another simulates boxing, requiring players to dodge virtual punches by shifting their weight. Virtual reality technology is as well being explored to further enhance the immersive experience.

To tailor the intensity of the exercise, additional elements can be incorporated, such as sitting on a pillow or using resistance bands around the knees. The system is designed for seated use, prioritizing patient safety and comfort during dialysis. The child sits on an adjustable chair with their arms supported and legs positioned on a board. A tablet attached to the board captures leg movements, translating them into actions within the game displayed on a television screen.

Expert Perspectives: Motivation and Clinical Integration

“Our approach was to use this time during dialysis to increase physical activity and enhance motivation to be physically active,” explained Marleen Kerstin and Lene Stegelmann, the lead researchers from German Sport University Cologne, in an interview with Healio. They highlighted the challenges of maintaining patient engagement in traditional exercise programs during dialysis and saw exergaming as a potential solution to minimize dropouts and promote long-term adherence.

Stegelmann emphasized the significant necessitate for increased physical activity among children and adolescents on hemodialysis, noting that their activity levels often fall below recommended guidelines, potentially leading to negative health outcomes. The researchers acknowledged initial concerns from some nursing staff regarding safety, particularly after fresh dialysis access punctures, but these concerns subsided as the study progressed and the system’s safety profile became apparent.

Looking Ahead: Future Developments and Research

The researchers are actively working on further refining the exergaming system, with plans to incorporate multiplayer functionality to foster social interaction and enhance motivation. They are also exploring the integration of virtual reality technology to create a more immersive and engaging gaming experience. Another development under consideration is the adaptation of the Icaros Guardian, which would allow patients to train in a standing position.

Future research will focus on conducting larger, multicenter studies to evaluate the system’s applicability across a wider range of dialysis centers. Researchers also plan to investigate the impact of exergaming on objective measures of physical exertion, such as heart rate and electromyography, as well as its effects on dialysis efficiency, motor performance, and health-related quality of life. Data quantifying physical activity differences between dialysis and non-dialysis days underscores the importance of finding ways to increase activity during treatment.

The ultimate goal is to establish exergaming as a standard component of care for children and adolescents undergoing hemodialysis, offering a fun, engaging, and effective way to improve their physical and mental well-being. The researchers emphasize the need for continued investigation to optimize the system’s design, assess its long-term benefits, and ensure its safe and widespread implementation.

Marleen Kerstin and Lene Stegelmann can be reached at [email protected].