Leisure time physical activity participation in individuals with spinal cord injury in Malaysia: barriers to exercise.

STUDY DESIGN: Cross-sectional. OBJECTIVES: An epidemiological study describing leisure time physical activities (LTPA) and the associations of barriers, sociodemographic and injury characteristics to moderate-vigorous aerobic exercise participation among individuals with spinal cord injury (SCI) in a developing Southeast Asian country. SETTING: SCI community in Malaysia. METHODS: The study sample consisted of 70 participants with SCI. Questionnaires were distributed containing an abbreviated Physical Activity Scale for Individuals with Physical Disabilities (items 2-6) and the Barriers to Exercise Scale using a 5-tier Likert format. Statistical analyses were χ2 tests, odds ratios, and binary forward stepwise logistic regression to assess the association and to predict factors related to participation in moderate-vigorous intensity aerobic exercise (items 4 and 5). RESULTS: Seventy-three percent of the study sample did not participate in any form of moderate or vigorous LTPA. The top three barriers to undertaking LTPA (strongly agree and agree descriptors) were expensive exercise equipment (54%), pain (37%) and inaccessible facilities (36%). Participants over the age of 35 years, ethnicity, health concerns, perceiving exercise as difficult and indicating lack of transport were significantly different (p < 0.05) between participation and non-participation in moderate-vigorous aerobic exercise type of LTPA. Age, ethnicity, indicated health concerns and lack of transport were the significant predictors in likelihood of participating in moderate-vigorous LTPA (p < 0.1). CONCLUSION: The issues raised depicted barriers within the intrapersonal (health concerns, exercising is too difficult, pain while exercising, age more than 35), interpersonal (different ethnicity), community (expensive exercise equipment), and policy levels (lack of or poor access to transportation, inaccessible facilities) that prevent LTPA participation.

Are Malaysians Exercising? A Psychometric Analysis of Their Physical Activity Habits, Physical Literacy and Exercise Participation Rates among Adults with and without Disability.

BACKGROUND: Physical activity levels of adults worldwide have reported a rising trend in sedentarism. This study's main objective is to analyze and understand the current tendency in this field and in physical literacy among Malaysian adults in order to improve physical performance. METHODS: The sample from which the data were collected corresponded to 352 Malaysian participants (N = 176 non-disabled, N = 176 physical disability) using The Physical Activity Scale for Individuals with Physical Disabilities questionnaire. RESULTS: Four factors were extracted, consisting of leisure activities, home maintenance, household chores, and career. The group with physical disability reported higher physical activity levels (14.30 MET h/day) compared to non-disabled (12.77 MET h/day), performing higher in leisure activities and light exercise. The compliance rate to health-beneficial exercise was 12.8% and was significantly higher among those with physical disability. Self-reported physical activity level correlated moderately well to overall MET performed p < 0.000, (r = 0.57). Only 2.8% of the respondents were aware of the recommendations outlined by health guidelines. CONCLUSION: The results indicated that the population surveyed was moderately active but had low compliance to exercise habits as recommended by international health guidelines. Non-participation in prescribed exercises was linked to higher education, urban dwellers, and higher income. The study also highlighted very low physical literacy among respondents in health recommended exercise guidelines.

Home-based exergaming training effects for two individuals with spinal cord injury: A case report.

INTRODUCTION: Exergaming is a type of serious game that requires active bodily movements for video gameplay. This game-based exercise is gaining interest as a form of leisure activity of moderate-vigorous dose intensity. OBJECTIVE: This case report sought to assess the effects of exergaming training (i.e. Move Boxing, Move Tennis, and Move Gladiator Duel) on aerobic capacity, feasibility, enjoyment and motivation in two individuals with spinal cord injury (SCI). CASE DESCRIPTIONS: Two males with SCI at the level of L4 and T10, aged 32 and 39, respectively, underwent home-based exergaming training sessions over a period of 12-18 weeks, conducted within moderate-vigorous intensity training zones for health improvements as recommended by health guidelines. Their peak oxygen consumption (VO2), physical activity levels and perceived enjoyment were evaluated before, during and after the completion of the training. OUTCOMES: Participant peak VO2 improved (effect size g = 2.7) from their baseline values (Participant A: 16.0 ± 0.7 mL/kg/min to 41.7 ± 8.1 mL/kg/min; Participant B: 13.5 ± 0.8 mL/kg/min to 32.7 ± 5.2 mL/kg/min), with an increase in overall weekly physical activity levels. Both participants maintained a relatively high level of enjoyment scores throughout their training period (mean: 31.9 ± 3.2, p = .56, 95% CI 0.22-1.0). CONCLUSION: A home-based exergaming training program improved aerobic capacity and level of physical activity, while maintaining adherence to the exercise within a relatively high perception of enjoyment for these two participants. The relatively high enjoyment scores maintained throughout the duration of the exergaming training period suggested its feasibility as a home-based exercise program and perceived as enjoyable by these individuals.

Children's Physiological and Perceptual Responses to Sports Exergames When Played in Different Positions.

Today's children are prone to becoming involved in exergames, but their positions during play have not been sufficiently investigated to determine whether the positions they adopt result in equal responses. The design of this study involved the collection of physiological and perceptual responses (i.e., heart rate (HR), rating of perceived exertion, and enjoyment score) during exergames in three different sports (bowling, tennis, and boxing) with players in different positions (sitting and standing). The participants played each game for 10 min while their HR was recorded. After the gameplay, each perceptual response was retrieved. The results revealed a significant increase in HR above rest during exergaming overall (p < 0.001). Standing gameplay resulted in a significantly higher HR (p < 0.001) than seated gameplay. Compared to tennis and bowling, boxing produced the highest physiological response (p < 0.001) and perceived exertion (p < 0.05) in both positions. The participants perceived all the sports exergames to be enjoyable, as their enjoyment scores did not significantly differ for each game (p > 0.5). For all the variables, no statistically significant differences between genders were identified (p > 0.5). This home-based intervention demonstrated that sports exergames are not only enjoyable; overall, they can provide at least moderately intense physical activity, whether played seated or standing.

Physiological Responses of Exergaming Boxing in Adults: A Systematic Review and Meta-Analysis.

Objective: Studies investigating the effects of exergaming in available platforms are still limited. This review aims to systematically identify available studies on physiological intensities of exergaming boxing in able-bodied adults and recategorize them based on different platforms or environments. The meta-analysis further analyzes the physiological responses during exergaming boxing into a set of pooled data for any evidence of outliers, heterogeneity, or publication bias. Materials and Methods: A systematic search was conducted by using databases from Google Scholar, PubMed, and Web of Science. Population, intervention, comparison, and outcomes (PICO) and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used in the study selection process for the review. Results: From the 1534 articles examined, 16 articles were included for further analyses. Results indicated that exergaming boxing exhibits a wide range of metabolic equivalent of task (MET) values and intensity, from very light to vigorous, with elements of heterogeneity and bias detected. The Xbox® Kinect boxing platform produced higher MET (mean = 5.3) compared with the Nintendo® Wii™ boxing (mean = 3.8). Conclusion: The results of this review suggest that boxing exergames can produce intensity-adequate physical activity among younger adults that are beneficial for cardiometabolic improvements, regardless of platforms used. Exergaming boxing may be employed as an effective exercise tool to increase energy expenditure and physical activity level in young adults.

Malaysian adaptation of the physical activity scale for individuals with physical disabilities in individuals with spinal cord injury.

Purpose: The Physical Activity Scale for Individuals with Physical Disabilities questionnaire provides an assessment of physical activity after spinal cord injury. This study sought to adapt, with cultural competence, the English questionnaire and translate it into Bahasa Malaysia, including evaluation of content and face validity, internal consistency and test-retest reliability, and completion of a factor analysis in order to validate the Malaysian version.Materials and methods: A total of 250 participants completed the questionnaire that was distributed via email, postal mail, the internet, physically and by word of mouth. Sixty-eight respondents were re-contacted to complete the questionnaire again.Results: The adapted PASIPD demonstrated adequate internal consistency Cronbach's α = 0.68 and acceptable test-retest reliability, intraclass correlation = 0.87. Factor analysis extracted four main dimensions for physical activity; factor 1 (heavy housework, home repair, lawn work and gardening), factor 2 (sports and recreation), factor 3 (light housework and caring for another person) and factor 4 (leisure and occupational activities) that accounted for 64% of the physical activities' total variance.Conclusion: The Malaysian-adapted English and translated Bahasa Malaysia versions of the questionnaires intended to measure physical activity levels in individuals with spinal cord injury, demonstrated good to acceptable validity and reliability. However, some individual items revealed weak reliability measures. Further work is needed to validate the questionnaire's criterion validity against other physical activity measures.Implications for rehabilitationThe Malaysian adaptation of the Physical Activity Scale for Individuals with Physical Disabilities questionnaire provided preliminary support for its use since it has demonstrated adequate construct validity and reliability.The Malaysian adaptation of the Physical Activity Scale for Individuals with Physical Disabilities questionnaire can quantify the physical activity level of community-dwelling individuals with spinal cord injury, whilst deriving descriptive information on their physical activities.Deploying the Physical Activity Scale for Individuals with Physical Disabilities questionnaire to a spinal cord injury population in Malaysia may provide the first data on activities of daily living in an Asian developing country.

Exergaming boxing versus heavy-bag boxing: are these equipotent for individuals with spinal cord injury?

BACKGROUND: Current strategies for increased physical activity and exercise in individuals with spinal cord injury (SCI) face many challenges with regards to maintaining their continuity of participation. Barriers cited often include problems with accessing facilities, mundane, monotonous or boring exercises and expensive equipment that is often not adapted for wheelchair users. AIM: To compare the physiological responses and user preferences between conventional heavy-bag boxing against a novel form of video game boxing, known as exergaming boxing. DESIGN: Cross-sectional study. SETTING: Exercise laboratory setting in a university medical center. POPULATION: Seventeen participants with SCI were recruited, of which sixteen were male and only one female. Their mean age was 35.6±10.2 years. METHODS: All of them performed a 15-minute physical exercise session of exergaming and heavy-bag boxing in a sitting position. The study assessed physiological responses in terms of oxygen consumption, metabolic equivalent (MET) and energy expenditure between exergaming and heavy-bag boxing derived from open-circuit spirometry. Participants also rated their perceived exertion using Borg's category-ratio ratings of perceived exertion. RESULTS: Both exergaming (MET: 4.3±1.0) and heavy-bag boxing (MET: 4.4±1.0) achieved moderate exercise intensities in these participants with SCI. Paired t-test revealed no significant differences (P>0.05, Cohen's d: 0.02-0.49) in the physiological or perceived exertional responses between the two modalities of boxing. Post session user survey reported all the participants found exergaming boxing more enjoyable. CONCLUSIONS: Exergaming boxing, was able to produce equipotent physiological responses as conventional heavy-bag boxing. The intensity of both exercise modalities achieved recommended intensities for health and fitness benefits. CLINICAL REHABILITATION IMPACT: Exergaming boxing have the potential to provide an enjoyable, self-competitive environment for moderate-vigorous exercise even at the comfort of their homes.

Exergaming for individuals with neurological disability: a systematic review.

INTRODUCTION: Exergames have the potential to enable persons with disabilities to take part in physical activities that are of appropriate "dose-potency" and enjoyable within a relatively safe home environment. It overcomes some of the challenges regarding transportation difficulties in getting to commercial gymnasium facilities, reducing physical activities perceived as "boring" or getting access into the built environment that may be "wheelchair unfriendly". OBJECTIVE: This systematic review assessed available evidence whether "exergaming" could be a feasible modality for contributing to a recommended exercise prescription according to current ACSM™ or WHO guidelines for physical activity. METHODS: Strategies used to search for published articles were conducted using separate search engines (Google Scholar™, PubMed™ and Web of Science™) on cardiometabolic responses and perceived exertion during exergaming among neurologically-disabled populations possessing similar physical disabilities. Each study was categorized using the SCIRE-Pedro evidence scale. RESULTS: Ten of the 144 articles assessed were identified and met specific inclusion criteria. Key outcome measures included responses, such as energy expenditure, heart rate and perceived exertion. Twelve out of the 17 types of exergaming interventions met the ACSM™ or WHO recommendations of "moderate intensity" physical activity. Exergames such as Wii Jogging, Bicycling, Boxing, DDR and GameCycle reported moderate physical activity intensities. While Wii Snowboarding, Skiing and Bowling only produced light intensities. CONCLUSION: Preliminary cross-sectional evidence in this review suggested that exergames have the potential to provide moderate intensity physical activity as recommended by ACSM™ or WHO in populations with neurological disabilities. However, more research is needed to document exergaming's efficacy from longitudinal observations before definitive conclusions can be drawn. Implications for Rehabilitation Exergaming can be deployed as physical activity or exercise using commercially available game consoles for neurologically disabled individuals in the convenience of their home environment and at a relatively inexpensive cost Moderate-to-vigorous intensity exercises can be achieved during exergaming in this population of persons with neurological disabilities. Exergaming can also be engaging and enjoyable, yet achieve the recommended physical activity guidelines proposed by ACSM™ or WHO for health and fitness benefits. Exergaming as physical activity in this population is feasible for individuals with profound disabilities, since it can be used even in sitting position for wheelchair-dependent users, thus providing variability in terms of exercise options. In the context of comprehensive rehabilitation, exergaming should be viewed by the clinician as "at least as good as" (and likely more enjoyable) than traditional arm-exercise modalities, with equivalent aerobic dose-potency as "traditional" exercise in clinic or home environments.

Exergaming for Individuals with Spinal Cord Injury: A Pilot Study.

OBJECTIVE: Commercially available exergames that are for wheelchair-bound individuals with spinal cord injury (SCI) are scarce. This study sought to identify exergames for individuals with SCI that are "dose-potent" for health benefits. MATERIALS AND METHODS: Six participants with SCI were recruited for a pilot study to investigate the exercise intensity of selected exergames (Move Tennis, Move Boxing, and Move Gladiator Duel) for the potential to improve health. Issues relating to exergaming for individuals with SCI were identified, and a Move Kayaking exergame was conceived using relevant design processes in an iterative manner. These processes included the following: participant needs and requirements, system requirements (hardware), system architecture (physical and operational views), and integration and verification of the finished system. Emphasis was given to operational and physical designs of the Move Kayaking exergame. RESULTS: Move Boxing, Move Gladiator Duel, and Move Kayaking achieved moderate intensity exercise, while Move Tennis only achieved exercise of low intensity based on participants' metabolic equivalent. However, all four exergames achieved at least moderate intensity based on individuals' ratings of perceived exertion (RPE). CONCLUSION: The intensity classification while playing Move Boxing, Move Tennis, Move Gladiator Duel, and Move Kayaking, using RPE, reported adequate exercise intensities prescribed by exercise guidelines.