title: Energy expenditure in chronic stroke patients playing Wii Sports: a pilot study.
abstract: BACKGROUND
  Stroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing.
  
  
  METHODS
  Ten chronic (≥6 months) stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2) during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs), calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs) or vigorous (>6 METs) according to the American College of Sports Medicine and the American Heart Association Guidelines.
  
  
  RESULTS
  Among the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean (±SD) energy expenditure during Wii Sports game play was 3.7 (±0.6) METs for tennis and 4.1 (±0.7) METs for boxing. All 8 participants who played boxing and 6 of the 7 who played tennis attained energy expenditures>3 METs.
  
  
  CONCLUSIONS
  With the exception of one patient in the tennis group, chronic stroke patients played Wii Sports tennis and boxing at moderate-intensity, sufficient for maintaining and improving health in this population.
authors.affiliation: Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. h.hurkmans@erasmusmc.nl
authors.forename: Henri L
authors.initials: HL
authors.lastname: Hurkmans
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Ribbers
authors.forename: Marjolein F
authors.initials: MF
authors.lastname: Streur-Kranenburg
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Stam
authors.forename: Rita J
authors.initials: RJ
authors.lastname: van den Berg-Emons
mesh_terms: D000328:Adult; D000368:Aged; D004734:Energy Metabolism / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013177:Sports / Q000502:physiology; D000071939:Stroke Rehabilitation; D018910:Video Games