SPMRJ. Volume 3 No. 1 February 2021 DOI: 10.20473/spmrj.v1i3.21550 SINTA 5 (Decree No: 200/M/KPT/2020) Available online at https://e-journal.unair.ac.id/SPMRJ Original Research Upper Limb Muscles Activity during Punches in Virtual Reality Exergame on Standing and Sitting Position Bayu Aji Mayogya Putra1*, Reni Hendrarati Masduchi2, Damayanti Tinduh2, I Putu Alit pawana2 1Department of Physical Medicine and Rehabilitation, Mardi Waluyo 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, Department of Physical Medicine and Rehabilitation, Mardi Waluyo General Hospital, Jl. Kalimantan No. 113, Blitar, East Java, Indonesia Email: [email protected] ABSTRACT Background: Physical activity (PA) provides various health benefits. Article info: Received: August 24th, Unfortunately, individuals with disabilities may experience health 2020 problems and greater obstacles to PA participation. Boxing exergame Received in revised: (EXG) based on virtual reality (VR) can be an alternative option to February 3rd, 2021 increase physical activity level because it is fun, relatively affordable Accepted: February and accessible. Punching in boxing requires complex movements, 3rd, 2021 wherein the lower limbs are contributor for effective punches. An understanding of muscles activity is important to uncover the potential This is an open access benefits of VR EXG. article under the CC- Aim: To evaluate the differences in upper limb muscles activity of the BY license dominant side in standing compared to sitting position during punches. (http://creativecommon Material and methods: This was a cross-sectional study involving 15 s.org/license/by/4.0/) healthy adult men. Surface electromyography examinations was Cite this as: performed on four upper limb muscles of the dominant side (upper Putra BAM, Masduchi trapezius, anterior deltoid, biceps, triceps) when delivering straight, RH, Tinduh D, Pawana hook and uppercut punches while playing VR EXG "Fitness Boxing" IPA. Upper limb Nintendo Switch™ in standing and sitting position. muscles activity during Results: Fifteen healthy men (age 31.87±3.14 years old, BMI punches in virtual 23.77±2.47 kg.m-2) were participated in this study. No significant reality exergame on difference found in the percentage of maximum voluntary isometric standing and sitting contraction (%MVIC) values of the upper trapezius, anterior deltoid, position. SPMRJ. biceps and triceps muscles of the dominant sides when the subjects 2020;3(1):14-22 delivered straight, hook and uppercut punches (p>0.05), except for upper trapezius muscle during uppercut punch in standing compared to sitting position (p=0.041). Conclusion: The VR EXG "Fitness Boxing" Nintendo Switch™ can be done in a standing or sitting position to get similar effect on the upper limb muscles. Keywords: boxing, electromyography, exergame, muscle activity, nintendo switch, playing position, virtual reality 14 Surabaya Physical Medicine and Rehabilitation Journal, February 2021, Vol. 3 No. 1 Introduction punching movements in Boxing VR EXG activates the upper limb muscles. Physical activity provides benefits Electromyography (EMG) measures such as improving physical function, mental electrical signals related to muscle-neural health, cognition, sleep quality, quality of life, activity and provides real-time information reducing risk of various diseases, obesity, about what happens in nerves and muscles in depression and anxiety.1-3 Unfortunately, general, also muscle activity sequence or individuals with disabilities are twice timing, which also allows us to examine skill physically inactive and may experience health related parameters during exercise and problems and greater barriers to physical learning process.22 A complete and activity participation compared to general comprehensive understanding of muscle population.4 They also may have difficulty in activity involved is important to assess the maintaining work skills, recreational activities potential benefits of VR EXG.23 In boxing participation, self-care and various social punches, the muscles recruitment order gives activities. These problems require efforts to us hints regarding the importance of lower facilitate individuals with disabilities to have body/lower limbs, which begin from lower greater participation in all aspects and obtain body to upper body and sequentially to upper better life satisfaction.5 Regarding disabled extremity.24Using EMG, we try to objectively person with lower limb problems, activation describe the upper limb muscle activations in of upper limb muscles is crucial to meet the sitting, diminishing lower limb movement and needs of daily physical activity. thus, lower limb muscle activation, compared Virtual reality exergaming (VR EXG) to standing or normal playing position. is an alternative option to help individuals Various VR EXG studies around the with special conditions to increase their world use popular commercial video-game physical activity because the technology consoles such as the Nintendo Wii™, Xbox® needed is relatively easy to access and at an Kinect®.6,7,11,13,14,16,18 Nintendo Switch™ is affordable cost through popular commercial the latest generation video-game console from video-game devices (Nintendo Wii™, Xbox® Nintendo and "Fitness Boxing" is an exclusive Kinect).6-8 Virtual reality (VR) is an exergame for Nintendo Switch™.25-26 There interactive computer simulation that gives were still few studies that explored muscle users the opportunity to participate in activity while playing VR EXG and to the best environments that look and feel like real- of authors' knowledge, there has not been any world condition.9 Exergame is defined as a study based on the Nintendo Switch™ video-game that uses or requires the player’s console. physical movement beyond sedentary Several studies report differences in conditions which consist of strength, balance, energy expenditure during exergame in and flexibility components.10 VR EXG can be standing position compared to sitting, which used in various places (hospitals, homes, may be influenced by large lower limb muscle schools), for various age groups, conditions activity which is limited in sitting position. and goals.11-18 Boxing is known as empty- However, it is uncertain whether upper body handed martial arts and one of the most muscle activity will decline or increase as popular sports today, which requires strength, compensation for the lack of involvement of endurance, stamina, agility, speed, the lower body. This study aims to evaluate coordination and high concentration.19 the differences in upper limb muscle activity Punching is the main component and it of the dominant side in standing and sitting requires complex movements of the arms, position when delivering punches in VR EXG trunk, and legs, which the lower body is the "Fitness Boxing" Nintendo Switch™, which contributor of effective punch. There are could give us the idea of using the Boxing VR several basic types of punches in boxing, such EXG to individual who only could move as straight, hook and uppercut.20,21 Thus, using upper limb because of lower limb problems 15 Surabaya Physical Medicine and Rehabilitation Journal, February 2021, Vol. 3 No. 1 repeated measurement design. All participants played the VR EXG "Fitness Boxing" using Material and Method Nintendo Switch™ console with the same order of playing menu, position and punches. Fifteen healthy adult men were This console was chosen because it is one of recruited for this study using consecutive the latest video- game consoles and the sampling from the Department of Physical successor to the Nintendo Wii console which Medicine and Rehabilitation Dr. Soetomo has been used widely in various fields of Academic General Hospital, Surabaya, rehabilitation research. Output parameters through the broadcast message of instant were maximal isometric voluntary contraction messaging application. Inclusion criteria were: (MVIC) and muscle activity (% MVIC) of the (1) aged 21- 39 years old; (2) body mass index four upper body muscles (dominant side): (BMI) 18.5 - 29.9 kg/m2. Exclusion criteria upper trapezius, anterior deltoid, biceps and were: (1) "yes" responses to at least one item triceps (measured using a surface of Physical Activity Readiness Questionnaire electromyography (sEMG) MESPEC 4000 (PAR-Q)27; (2) suffering from a disease or HW-SYSTEM 8CH, Mega Electronics Ltd. condition that causes difficulty in playing or Finland) when delivering straight, hook and affects the safety of participants during data uppercut punches according to the examples collection. General health checks were and instructions of the virtual trainer in performed on all participants. This study was standing and sitting positions. Standing approved by the ethics committee of Dr. position is the normal playing position, while Soetomo Academic General hospital, the sitting position was used to eliminate or at Surabaya (1834/KEPK/II/ 2020) and all least minimize lower limb muscles activity participants have received an explanation and (see figure 1). The aim of sitting position was signed a written informed consent. to get a similar condition on individuals with This study used a pretest-posttest disorders or paralysis of the lower body/limbs. Figure 1. Participants delivering straight punches while playing “Fitness Boxing” using Nintendo