Authors, (year) [reference] | Outcome measures | Adverse effect(s) | Limitation | Findings (mean ± SD) |
---|---|---|---|---|
Butler, Lee, Goldstein and Brooks (2019) [6] | HR, energy expenditure, dyspnea, health-related QoL | Not stated | Small number of studies with small sample size Risk of bias as hard to blind the participants | 4 studies used HR as an outcome measure. 3 showed significant improvement after intervention and 1 showed higher MHR compared to CG. 1 study showed no differences in HR comparing VRG to CG 4 studies used energy expenditure as an outcome measure. 1 showed significant improvement after intervention and 1 study showed no differences in energy expenditure comparing VRG to CG 5 studies used dyspnea score as outcome measure. 3 showed significant improvement after intervention and compared to CG. 1 study showed no differences in energy expenditure comparing VRG to CG 2 studies measured health-related QoL as an outcome measure and they all showed improvement after intervention |
Carbonera, Vendrusculo, and Donadio (2016) [26] | Primary: HR, Vo2 Secondary: Dyspnea and fatigue, SpO2, and energy expenditure | No adverse event | Small number of studies Great variance of type of exercise or test used as comparator Majority of studies used estimation of MHR, only one used objective measurement | No significant between-group difference in HR was found in 75% (n = 3) of included studies that compared HR between group (n = 4) VRGs achieved % of MHR recommended for training in 75% (n = 4) of the relevant included studies All VRGs achieved higher energy expenditure than the CGs in the relevant included studies (n = 2, 100%) Relevant included studies demonstrated a similar (n = 3, 75%) or higher (n = 1, 25%) between group SpO2 measurements Relevant included studies showed a lower level (n = 2, 50%) or similar level (n = 2, 50%) of dyspnea and fatigue in VRGs |
Del Corral, Cebrià I Iranzo, López-de-Uralde-Villanueva, MartÃnez-Alejos R, Blanco, and Vilaró (2018) [19] | 6MWT distance, MSWD, HJT, MBT, HG | Common muscle stiffness | Unsupervised and long follow-up period increases drop-out rate and nonadherence to exercise recommendations Using field tests instead of laboratory tests as assessments | VRG demonstrated improvement in all outcome measures (effect size: 0.25 to 0.85, p < 0.05) VRG demonstrated significantly greater improvement in all outcome measures (effect size: 0.99 to 1.96, p < 0.05) than CG |
12 months follow up: VRG showed a better MSWD than pre VRG (effect size: 0.29, p < 0.01) and a greater improvement than follow-up CG (effect size: 0.74, p < 0.05) VRG showed a better MBT, right HG, and left HG than pre VRG (effect size: 0.54, 1.08, and 0.88 respectively, all p < 0.01) VRG showed a better right and left HG improvements (effect size: 1.54 and 1.51, p < 0.01) than CG | ||||
de Corral, Percegona, Seborga, Rabinovich, and Vilaró (2014) [11] | HR, dyspnea, Fatigue, SpO2, | No adverse event | Lack of an incremental test to use as comparator Short duration of intervention session | Wii Active and Wii family Trainer VRGs achieved a higher % of predicted MHR (80.1 ± 7.4 and 82.1 ± 7.5 vs 79.8 ± 7.7 bpm, p < 0.01) than 6MWT No significant differences were found in SpO2 and dyspnea between all VRGs and CG Wii fit VRG showed a lower fatigue score (1.0 ± 1.3 vs 2.8 ± 2.5, p < 0.01) than CG |
Frade, Dos Reis, Basso-Vanelli, Brandão, and Jamami (2019) [24] | Dyspnea, fatigue, SpO2, MHR, VO2 peak, number of steps in STVR | Not stated | Convenience recruitment of sample Lack of representation of population group No screening of function impairment which may affect gait No measurement of participant’s step length | VRG has a higher SpO2 (88.5 vs 85%, p < 0.05) and VO2 peak (13.5 ± 3.3 vs 12.6 ± 3 mL/min/kg, p < 0.05) than CG No significant differences were found in MHR, dyspnea, and fatigue score between VRG and CG. Good intra- and inter-rater reliability in VO2 peak (0.80 and 0.57 ICC, p < 0.001) and number of steps in STVR (0.94 and 0.93, p < 0.001) |
Gomes, Carvalho, Peixoto-Souza, Teixeira-Carvalho, Mendonça, and Stirbulov (2015) [7] | HR, energy expenditure, treadmill distance and time, lung function | Not stated | Possible underestimation of energy expenditure with the chosen tool No individualized exercise intensity in the intervention group | VRG showed improvements in all outcome measures (size effect: 0.3 to 1.07, all p < 0.05), as well as CG (except for resting HR) VRG showed a higher predicted % of MHR than CG (103.2 ± 8.6 vs 96 ± 7.8, p < 0.05) VRG showed a higher total energy expenditure than CG (159 ± 41.6 vs 133.3 ± 32.1 calories, p < 0.05) CG showed a higher treadmill distance (895.8 ± 143.4 vs 703.3 ± 148.3 m, p < 0.05) than VRG |
Holmes, Wood, Jenkins, Winship, Lunt, and Bostock (2013) [9] | HR, SpO2, dyspnea, and RPE | No adverse event | No objective measures of exercise intensity Replacing a laboratory treadmill test with a cycle ergometer, i.e. invalid measurement Small sample size | Exercise with VR showed an 86% of MHR demonstrated in CPET Less desaturation (p < 0.05) was evident during exercise with VR, comparing to CPET Lower dyspnea and RPE score (p < 0.05) were evident during exercise with VR, comparing to CPET |
Kuys, Hall, Peasey, Wood, Cobb, and Bell (2011) [21] | HR, energy expenditure, SpO2, enjoyment, dyspnea, and fatigue | Not stated | No long-term effect examined Possible inaccurate measurement of energy expenditure with the armband design of energy expenditure measurement tool | VRG had a higher total energy expenditure (127 ± 55 vs 101 ± 55 kcal, p < 0.05) than CG VRG and CG showed a similar average HR (144 ± 13 vs 141 ± 15 bpm) during exercise VRG had a higher enjoyment score (7.3 ± 1.6 vs 4.7 ± 2, p < 0.05) than CG No significant difference in dyspnea (5.1 ± 2.1 vs 5.1 ± 2.2) and RPE (15.0 ± 2.6 vs 15.5 ± 2.6) were found between VRG and CG |
LeGear, LeGear, Preradovic, Wilson, Kirkham, and Camp (2016) [22] | Total energy expenditure, HR, RPE, dyspnea, and SpO2 | Not stated | Possible inaccurate measurement of energy expenditure with the armband design of energy expenditure measurement tool Small sample size | VRG showed a higher SpO2 (94.7 ± 2.5 vs 92.3 ± 3.3%, p < 0.0001) than CG No significant differences were found in total energy expenditure, HR, RPE, and dyspnea between VRG and CG |
Liu, Meijer, Delbressine, Willems, Franssen, and Wouters (2016) [17] | 6MWT distance, SpO2, HR, fatigue, and dyspnea | Not stated | CG performed one 6MWT and VRG performed two and the best attempt out of the two was chosen to analyze Time gap between GRAIL 6MWT and the post HR and SpO2 measurements Underrepresentation of GOLD stage 4 COPD patients and complex COPD patients in sample Monocentric study as limited access to the GRAIL Learning effect of GRAIL 6MWT was not established | Significant differences were found between VGS and CG in all outcome measures in over ground 6MWT (all p < 0.05) 6MWT distance: 511.0 ± 64.6 vs 668.8 ± 73.6 m Changes in pre- and post-SpO2: −7.1 ± 5.9 vs −1.2 ± 3.4% Changes in pre- and post-HR: 29.5 ± 11.8 vs 47.3 ± 15.7 bpm Changes in pre- and post-dyspnea: 4.0 ± 2.3 vs 1.1 ± 0.9 points Changes in pre- and post-fatigue: 3.7 ± 2.2 vs 1.1 ± 1.0 points Significant differences were found between VGS and CG in all outcome measures in GRAIL 6MWT (all p < 0.05) 6MWT distance: 483.7 ± 84.5 vs 692.3 ± 62.0 m Changes in pre- and post-SpO2: −2.0 ± 4.4 vs 0.0 ± 0.9% Changes in pre- and post-HR: 19.1 ± 10.5 vs 32.6 ± 15.1 bpm Changes in pre- and post-dyspnea: 3.4 ± 2.2 vs 1.0 ± 0.9 points Changes in pre- and post-fatigue: 3.2 ± 2.1 vs 1.1 ± 1.0 points |
O’Donovan, Greally, Canny, McNally, and Hussey (2014) [25] | MHR, energy expenditure, VO2 | No adverse event | Only recruited individuals with cystic fibrosis who were well and had a relatively good lung function Individuals require oxygen supplement were not recruited due to the requirement of wearing facemask during measurements | No significant differences were found in all outcome measures between VRGs and CG |
Salonini, Gambazza, Meneghelli, Tridello, Sanguanini, and Cazzarolli (2015) [23] | HR, SpO2, dyspnea, and fatigue | Not stated | Only one short session of intervention, not enough to prove active gaming provides a sufficient training effect | Less participants in the VRG reached 80% of MHR (40 vs 67%, p < 0.05) than CG No significant between-group difference was found in SpO2 VRG experiences less fatigue and dyspnea (p ≤ 0.001) than CG |
Sutanto, Makhabah, Aphridasari, Doewes, Suradi, and Ambrosino (2019) [20] | 6MWT distance, dyspnea, QoL | Stated that all adverse events (including pulse rate higher than the predicted maximum, respiratory rate above 30/min, SpO2 below 90%) were recorded, but did not specify the event | Small sample size, underpowered No measurement of exercise intensity in VRG Standard exercise training may have masked the effect of the additional virtual reality gaming exercise Only the exercise component of traditional pulmonary rehabilitation was included No blinding applied to participants and assessors | Both VRG and CG demonstrated within-group improvement in 6MWT distance (52.4 ± 20.6, p < 0.0001 and 66.8 ± 27.8, p < 0.0001), and no between-group difference was found VRG showed a lower dyspnea score (4.5 ± 1.3 vs 5.7 ± 1.3, p < 0.05) than CG at baseline, and no difference was found between group after intervention Both VRG and CG demonstrated within-group improvement in health-related QoL (27.0 ± 14.3, p < 0.0001 and 24.6 ± 17.3, p < 0.0001), and no between-group difference was found |
Simmich, Deacon, and Russell (2019) [13] | HR, SpO2, dyspnea, enjoyment | No studies reported the occurrence of adverse events linked to virtual reality gaming | Small number and significant heterogeneity of included studies Vulnerable to publication bias as only high-quality studies were included Possible language bias, only English search terms were used HKSJ estimation method may produce overestimation | No significant difference was found in HR, dyspnea, and SpO2 between VRGs and CGs after calculation of mean difference Large effect of enjoyment among VRGs was found comparing to CGs |
Sánchez, Salmerón, López, Rubio, Torres, and Valenza (2019) [15] | Lung function, knowledge of condition, QoL, exercise capacity | Not stated | Small number of studies Heterogeneity of included studies | Knowledge of asthma were significantly improved in all educational VRGs Increase in exercise capacity, QoL, and improvement of symptoms were found in VRGs |