SPMRJ. Volume 3 No. 2 August 2021 DOI: 10.20473/spmrj.v3i2.21549 SINTA 5 (Decree No: 200/M/KPT/2020) Available online at https://e-journal.unair.ac.id/SPMRJ Original Research Cardiovascular Responses, Physical Activity Intensity, and Enjoyment Level of Nintendo Switch™ Exergaming, Comparing Different Tempos and Playing Modes: A Pilot Study Bayu Aji Mayogya Putra1*, Reni Hendrarati Masduchi2, Martha Kurnia Kusumawardani2 1Rehabilitation Medicine Installation, Mardi Waluyo State General Hospital, Blitar, East Java, Indonesia 2Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, East Java, Indonesia *Corresponding Author: Bayu Aji Mayogya Putra, Rehabilitation Medicine Installation, Mardi Waluyo State General Hospital, Jl. Kalimantan number 113, Blitar, East Java, Indonesia Email: [email protected] Article info: ABSTRACT Received: August 24th, Background: Physical activity (PA) has been associated with 2020; multiple health benefits. However, the global population does not Received in revised: meet the PA recommendations. Virtual reality exergaming (VR January 30th, 2021; EXG) can become an option to increase PA because it is fun, Accepted: February 5th, relatively easy to access and affordable through popular 2021 commercial devices. st, Published: August 31 Aim: To investigate the immediate cardiovascular responses 2021 (blood pressure, heart rate), quantification of PA intensity This is an open access (percentage of maximum heart rate (%HRmax), Borg’s rating of article under the CC- perceived exertion (RPE), and the level of enjoyment using visual BY license analog scale (VAS) while playing VR EXG. (http://creativecommon Material and Methods: Fifteen healthy men (aged 31.87±3.14 s.org/license/by/4.0/) years old, body mass index 23.77±2.47 kg/m2) undergone three “Fitness Boxing” Nintendo Switch™ playing modes in the same Cite this as: order: (1) single player-normal tempo, (2) single player-fast tempo Putra BAM, Masduchi and (3) versus. During playing, participant’s HR was monitored RH, Kusumawardani using Polar H10 heart rate sensor. Blood pressure was measured MK. Cardiovascular before and after playing. Borg’s RPE and VAS were collected after responses, physical playing. activity intensity, and enjoyment level of Results: Our results showed significant heart rate and systolic Nintendo Switch™ blood pressure increase (p = 0.001) in all three playing conditions, exergaming, whereas diastolic blood pressure was relatively constant (p > 0.05). comparing different The Borg’s RPE were in 12-13 range (moderate) and %HRmax tempos and playing range between 72- 81% (vigorous). The enjoyment level was found modes: a pilot study. greatest in versus mode compared to other playing modes. SPMRJ. 2020;3(2):44- Conclusion: VR EXG Nintendo Switch™ “Fitness Boxing” can 52. elicit immediate cardiovascular responses and provides an enjoyable moderate to vigorous PA intensity in healthy male adults, and can be used to meet the weekly PA recommendations. Keywords: boxing, cardiovascular responses, enjoyment level, 44 Surabaya Physical Medicine and Rehabilitation Journal, Vol. 3 No. 2, August 2021 exergame, nintendo switch, physical activity intensity, virtual reality Introduction function, postural control, balance and gait, in various age groups and patient conditions Physical activity is associated with (stroke, cerebral palsy, traumatic brain improvement in physical functions, mental injury, spinal cord injuries, Parkinson's health, cognition, sleep quality, quality of disease, multiple sclerosis, life, as well as reducing the risk of diseases, burns).11,12,13,14,15,16,17,18 Kwan and Brayan19 obesity, depression, and anxiety.1,2,3 stated that pleasant feelings after doing However, 23% adult and 81% adolescent exercise can give positive affective (11-17 years old) worldwide, do not meet responses and cause an individual to be the defined physical activity physically active and maintain physical recommendations.3 Despite knowing the activity in longer period. The degree of potential for its preventive and therapeutic liking/enjoyment contributes to the effects, 31% of the total population remain compliance of the individual training sedentary4, not motivated to adopt a healthy regimen, therefore, VR EXG can increase lifestyle (including physical activity), 21% the likelihood of achieving general health of the population do not intend to start benefits through regular physical activity4. physical activity, while the other 36% have Various VR EXG studies around the the intention but face difficulty in changing world use popular commercial game the sedentary behavior.5 Therefore, other consoles such as the Nintendo Wii™, strategies are needed to make physical Xbox® Kinect®.4,6,7,11,13,14,16,18 Nintendo activity more attractive and motivating to Switch™20 is the latest generation game increase compliance and continuity that console from Nintendo and is a hybrid encourages individuals to become more video game console released to the public in active physically.4 March 2017. "Fitness Boxing"21 is an Virtual reality exergaming (VR exergame for the Nintendo Switch ™ and EXG) can be an alternative option to was commercially marketed in December increase physical activity level because it is 2018. To the best of author knowledge, there fun, the technology is relatively easy to has not been any study based on the access and at affordable costs through Nintendo Switch™ console. popular commercial device (Nintendo An understanding of physiological Wii™, Xbox® Kinect).4,6,7,8 Virtual reality responses during physical activity is (VR) is a term that describes interactive important to obtain training variables and computer simulations that give the user an produce strategies that can be used to opportunity to participate in environments increase compliance, prescribe that look and feel similar to real-world rehabilitation programs, and ensure patient events and objects.9 Exergame (exercise safety. This study aims to investigate the game; exertion game) is a VR based immediate responses of the cardiovascular exercise, and is defined as video games that system, quantification of the physical use or require the physical movement of activity intensity, and the level of enjoyment players beyond sedentary conditions with while playing VR EXG "Fitness Boxing" components of strength, balance, and Nintendo Switch™ in different tempos and flexibility.10 VR EXG can be used in playing modes in order to achieve various places (hospitals, homes, schools, standardize values of physiological elderly care institutions), and has been responses as training parameters for extensively studied for its use to increase unstandardized, limited customization of physical activity, prevent obesity, reduce commercial video game. pain, improve motor function, cognitive 45 Surabaya Physical Medicine and Rehabilitation Journal, Vol. 3 No. 2, August 2021 Material and Methods Familiarization period of 3-5 minutes playing the video-game was carried Fifteen healthy men were recruited out after brief explanation and for this study using consecutive sampling demonstration of gameplay. Participants from Department of Physical Medicine and were told to wear comfortable clothes and Rehabilitation of dr. Soetomo hospital via shoes while playing. Before each session, instant messenger broadcast message. The systolic and diastolic blood pressure and participants were included in following heart rate were recorded after 10 minute rest criteria: (1) aged 21-39 years; (2) Body in sitting position. Polar H10 sensors was Mass Index (BMI) 18.5 - 29.9 kg/m2; (3) used for heart rate measurement and low to moderate classification based on the monitoring. All Participants undergone 30 International Physical Activity minutes of three playing conditions in the Questionnaire (IPAQ) – Indonesian same order: (1) single player mode - normal version22; (4) did not smoke, did not tempo, (2) single player mode - fast tempo, consume alcohol; (5) did not consume and (3) versus mode (normal tempo) in two caffeine or energy drink, or drugs consecutive days. The first and second containing ephedrine 24 hours prior to data playing condition were done in first day of collection; (6) did not do strenuous data collection, whereas versus mode were activity/exercise 12 hours prior to data taken in the second day. In the first and collection. The exclusion criteria were: (1) second playing condition, participants "yes" response to one item of the Physical played by himself, started with warm-up and Activity Readiness Questionnaire (PAR- then encouraged to follow virtual trainer Q)23; (2) suffer from illness or conditions instruction in terms of stance, upper and that cause playing difficulties or affect the lower extremities movements (see figure 1). safety of the participants during data There were 6 exercise menu to choose collection. Participants completed general consisted of the most basic punches: health examination. The study was straight, hook and uppercut, which approved by Dr. Soetomo hospital ethic accumulated into 30 minutes total playing committee (1834/KEPK/II/2020) and all duration. Thirty minutes rest interval was participants signed written informed provided to reset the participant’s vital consent. signs (heart rate and blood pressure) back to This study was an experimental pre-playing condition. In the second day, series with repeated measure design. All after warmed-up, each participant played participants played