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After consenting to participate in the study, participants completed a ‘pre-test’ to establish baseline measures of cardiovascular fitness. “Participants did a maximum arm cranking test, in which we measured VO2 max and their maximum heart rate. We needed these measurements to calculate their relative exercise intensity during exergaming,” explains Wouda. By measuring relative exercise intensity, the researchers were able to assess participants’ level of effort based on how hard they were working relative to their individual levels of fitness. This was important given the differences in participants’ gender, level of injury and degree of cardiovascular fitness.

The next day, participants had a practice playing session with three different exergames: Fruit Ninja on Xbox Kinect, Wii Sports Boxing on Nintendo Wii, and Thrill of the Fight, a virtual reality boxing game, on VR Oculus Rift. While Fruit Ninja is controlled by body motions, which are picked up and analyzed by a camera, Wii Sports Boxing and Thrill of the Fight are played by imitating boxing movements while holding movement sensitive game controllers. To ensure that participants remained within operating distance of the game consoles and provide a safe gaming environment, participants’ wheelchairs were strapped down on a platform in front of the game consoles to limit chair movement while the games were in play. In addition, some participants wore specialized gloves that helped them to grip the hand-held controllers.

The following day, participants played each exergame in a randomized order for 15 minutes, with a 5-minute rest between each. “Before they started, we told them, ‘you have to remember that when playing these games, that they are a form of exercise, so don’t hold back.’ You know, so they were eager to play and to sweat,” says Wouda.

In total, participants played the exergames for 45 minutes. While gaming, the research team measured participants VO2 (oxygen consumption) and heart rate. “And then we presented our results in percentage of their maximum heart rate and their VO2max,” says Wouda, referring to participants’ relative exercise intensity.

When considered in terms of the potential for health benefits, the results were compelling. Participants spent more than two-thirds of the 45 minutes they spent exergaming—about 31 minutes—at a moderate to high level of exercise intensity. The remaining time was spent at low intensity.

“What was interesting was that the people with higher-level injuries, they were at the same exercise intensity as the people with lower-level injuries,” notes Wouda. There were no differences in how much time participants spent at low, moderate or high exercise intensities while exergaming. It didn’t matter how fit the participant was coming into the study, or what level of injury they had.

The only difference the researchers observed was in the type of game console or exergame participants played. Participants spent slightly more time in the high intensity range while playing Oculus Rift compared to the other games.

But according to Wouda, all three games were hits with the study’s participants, and that’s what matters. “[The participants] were all very excited about all three games. There was only one person that did not want to play the virtual reality boxing. They found it too scary. But otherwise, we had a really nice mixture of people that had been playing before, but also those that had never played before. And they all liked it. And they were rather surprised at how exhausting it actually is,” he explains.

Most importantly, the findings suggest that people with SCI who use a wheelchair can use exergaming as a way to achieve the health benefits of aerobic exercise. The physical activity guidelines for adults with SCI recommend 20 minutes of aerobic exercise at a moderate or high intensity, twice a week, for basic fitness benefits. For additional benefits, such as lowering your risk of developing Type 2 diabetes and heart disease, the guidelines recommend 30 minutes of aerobic exercise at a moderate or high intensity, three times per week. So, through 45 minutes of exergaming at least twice per week, you can achieve the aerobic activity component of the physical activity guidelines. Add in resistance or weight training twice a week (3 sets of 10 reps for each major muscle group)— the strength training component of the guidelines—and you’re set!

That said, we’d be remiss if we didn’t acknowledge the limitations of this study. In particular, while this study demonstrates that exergaming can be performed at a sufficient intensity to achieve health benefits, it didn’t measure whether health benefits actually occurred.

“This was a cross sectional study so, of course, we don’t know if [exergaming] actually gives health benefits,” says Wouda. “And now we have applied for funding to do the whole protocol in a follow-up study in which participants will borrow the equipment, and they can do the exergaming at home over 12 weeks, and we will measure changes before and after. That’s the next step.”

The research team is also interested in understanding how psychological factors, such as participants’ interest and motivation, may influence their exercise intensity during exergaming, says Wouda. “In the longitudinal study that we are planning, we are also going to measure motivational aspects before, during and at the end of the intervention, because, of course, exergaming sounds much more interesting than arm cranking to most of us. But we are not sure how motivating it is after three weeks or six weeks, or if we should change the games during the intervention period,” he explains.

“Most of us know somebody that has an Xbox or Playstation, so it’s easy to give it a try. And if you have a heartrate monitor, put it on and see if you get out of breath,” says Wouda. “There are many different types of games. Plus, it’s cheap and it’s easy. So, it’s not the worst thing if you try it and don’t like it.”