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Effect of a Virtual Reality–Enhanced Exercise Protocol After Coronary Artery Bypass Grafting

TY Chuang, MD, is Attending Physician and Associate Professor, Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, No. 201, Shih-Pai Rd, Sec. 2, Taipei, 11217 Taiwan, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
WH Sung, PhD, is Assistant Professor, Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
HA Chang, PT, MS, is Physical Therapist and Research Associate, Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital
RY Wang, PT, PhD, is Professor and Acting Chairman, Institute and Faculty of Physical Therapy, National Yang-Ming University

Address all correspondence to Dr Chuang at: tychuang{at}vghtpe.gov.tw

Background and Purpose. Virtual reality (VR) technology has gained importance in many areas of medicine. Knowledge concerning the application and the influence of VR-enhanced exercise programs is limited for patients receiving coronary artery bypass grafting. The purpose of this study was to evaluate the effect of a virtual "country walk" on the number of sessions necessary to reach cardiac rehabilitation goals in patients undergoing coronary artery bypass grafting. Subjects. Twenty subjects who were seen for cardiac rehabilitation between January and June 2004 comprised the study sample. Methods. The protocol for this study included an initial maximum graded exercise tolerance test, given to determine the subsequent training goals for the subject, followed by biweekly submaximal endurance training sessions. All subjects were assigned by lot to 1 of 2 submaximal endurance training programs, one (group 2) with and the other (group 1) without the added VR environment. In all other respects, the 2 programs were identical. Each training session lasted for 30 minutes and was carried out twice per week for about 3 months. The primary outcome measures were maximum load during the work sessions, target oxygen consumption, target heart rate (beats per minute), and number of training sessions required to reach rehabilitation goals. Results. By the end of 20 training sessions, only 4 of the 10 control subjects had reached the heart rate target goal of 85% their maximum heart rate. In contrast, 9 of the 10 subjects in the VR program had attained this goal by 9 or fewer training sessions. When target metabolic cost (75% peak oxygen consumption) was used as the training goal, all 10 subjects in the VR program had reached this target after 2 training sessions (or, in some cases, 1 training session), but not until training session 15 did a cumulative number of 9 control subjects reach this goal. Discussion and Conclusion. These study outcomes clearly support the notion that incorporating a VR environment into cardiac rehabilitation programs will accelerate maximum recovery of patients' cardiovascular function.

Key Words: Cardiopulmonary test • Endurance exercise • Rehabilitation • Revascularization • Simulation