Researchers from Berlin, Germany found that exercising with a Wii game console was feasible and beneficial for patients with rheumatoid arthritis (RA), and achieved comparable improvements in muscle strength and the 6 minute walk test as standard home physical exercises. This suggests that exercising with an animated program may be an alternative exercise option for patients with RA. The results were published in BMC Musculoskeletal Disorders.

“[Patients with RA] should be encouraged to be as physically active as possible. Even high-intensity exercises have been described as safe and effective for RA patients without increasing disease activity,” wrote Jan Zernicke from the Department of Rheumatology and Clinical Immunology at Charité University Medicine in Berlin and colleagues. “However, many patients [with RA] report about a lack of access to physical therapy and supervised community-based exercises.”

High Yield Data Summary

  • Use of a game console to encourage physical activity was found to be both feasible and beneficial for patients with RA

To investigate whether the Wii console could be an effective and feasible method of exercise, the researchers conducted a single-center, cross-over trial over 24 weeks (NCT02658370). 


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The researchers recruited 30 participants (mean age 56 ± 9 years, 25 women) with RA who had achieved low disease activity using biological disease modifying anti-rheumatic drug (bDMARD) therapy.

For 12 weeks, 15 patients participated in a predefined exercise program on the Wii, and 15 patients participated in a conventional exercise program at home. After 12 weeks, the patients crossed over to the other treatment arm for another 12 weeks.

The researchers found that after 12 weeks, both the Wii exercise program and the conventional exercise program showed improvements in functional tests without a significant difference between the groups. Overall muscle strength improved 12% for a mean value of 10 Newton, and the 6-minute walk test increased 5% to 28 meters.

Interviews with the participants showed that the animated exercise program was feasible and useful. Disabilities of the forefoot were identified as a main limiting factor for some of the exercises on the Wii Balance-Board. 

Advantages and criticism of both the Wii group and the conventional exercise group are found in the tables 1 and 2, respectively. 

Table 1. Advantages and Criticism of the Wii Exercise Group. 

Wii Exercise Group
Reported Advantages Reported Criticisms
  • More fun (66%)
  • Motivation increased due to animation (57%)
  • Ambition increased due to ranking results (53%)
  • Option of a wide variety of exercises (33%)
  • Individual exercises too difficult (33%)
  • Explanation of exercises was time-consuming (27%)
  • Forefoot disabilities limited use of the Wii Balance Board (37%)

Table 2. Advantages and Criticism of the Conventional Exercise Group.

Conventional Exercise Group
Reported Advantages Reported Criticisms
  • Specific and personalized exercises (40%)
  • Independence from devices (33%)
  • Increased effectiveness (27%)
  • Less motivation (50%)
  • Performing exercises alone (20%)
  • Insufficient variety of exercises (13%)
  • Individual painful exercises (20%)

“It is important to keep in mind the mean age of the participants (56 years) as well as the relatively long mean duration of their RA (13 years). In this context, an exercise time of up to 6 hours per week by using the game console seems to be a striking and impressive result,” the authors wrote.

The researchers noted that the Wii game console may open new perspectives in exercise opportunities for RA patients, including in younger and early patients.

Summary and Clinical Applicability

In the first study evaluating the efficacy of the Wii game console to encourage physical activity in patients with RA, researchers found that exercising with a Wii was feasible and beneficial for patients with RA, and achieved comparable results to standard home physical exercises.

“The recorded long exercising time and the high frequency using the game console by the high-responders can be interpreted as definite indicators for feasibility and acceptability,” the authors wrote. “Therefore such an animated program may be an alternative or additional option for RA patients depending on their individual preferences.”

The criticism of both exercise methods indicates a need to further examine the best approach to implementing the Wii exercises in daily life.

Limitations and Disclosures

  • The predefined alternating enrollment mode placed all 5 men in the Wii exercise treatment arm at the start, resulting in a higher baseline level of the functional tests in this group
  • The exercises in the Wii exercise group were not completely identical

The authors declare no competing interests. 

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References

Zernicke J, Kedor C, Müller A, Burmester G, Reißhauer A, Feist E. A prospective pilot study to evaluate an animated home-based physical exercise program as a treatment option for patients with rheumatoid arthritis. BMC Musculoskeletal Disorders. 2016;17:351.  doi:10.1186/s12891-016-1208-3.

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