Effectiveness of virtual reality cycling exercise towards the motoric and cardiorespiratory functions of post-stroke patients
More details
Hide details
Department of Information Technology, State Polytechnic of Jember, Jember, Indonesia
Department of Health, State Polytechnic of Jember, Jember, Indonesia
Department of Electrical and Electronic Engineering, Ahsanullah University of Science and Technology (AUST), Dhaka, Bangladesh
Submission date: 2022-10-17
Acceptance date: 2023-01-11
Publication date: 2023-05-10
Physiother Quart. 2024;32(2):107-114
Virtual reality (VR) cycling exercise was developed as a physical rehabilitation therapy to impair the deficit on motoric function and cardiorespiratory fitness on post-stroke patients with lower extremity disorder. This study aims to determine the effectiveness of VR cycling exercise towards the impairment of lower extremity motoric function and cardiorespiratory fitness on post-stroke patients.

This study engaged 15 people chosen through a purposive sampling method, who were divided into 8 intervention groups of post-stroke patients without comorbidities (post stroke ≥ 2 years) and 7 healthy people in a control group. The Fugl-Meyer assessment was used to decide the participation of the patients. To assess the lower extremity motoric functions, the timed up-and-go test (TUGT) was carried out, the 6-minute walking test (6-MWT) was conducted to assess the gait function and VO2max was tested to assess the cardiorespiratory fitness. VR cycling exercise was conducted for 3 months, twice a week.

Both groups performed significantly differently (p < 0.05) in terms of balance, gait ability, and cardiorespiratory fitness. The decrease in the TUGT score and increase in the 6-MWT and VO2max test scores of the intervention group obtained after undergoing VR cycling exercise was significantly bigger than it was before performing the exercise. The group of post-stroke patients was able to take the exercise in 40–60 min of each exercise period.

VR cycling exercise is a highly effective intervention to increase motoric function and cardiorespiratory fitness in chronic post-stroke patients. Therefore, taking VR cycling exercise is recommended for stroke rehabilitation and clinical practice purposes.

Feigin VL, Strak BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795–820; doi: 10.1016/S1474-4422(21)00252-0.
Lindsay MP, Norrving B, Sacco RL, Brainin M, Hacke W, Martins S, et al. World Stroke Organization (WSO): global stroke fact sheet 2019. Int J Stroke. 2019;14(8):806–817; doi: 10.1177/1747493019881353.
Ministry of Health. Ministry of Health of The Republic of Indonesia: Indonesia Health Profile 2020. Jakarta. 2020. Available 15.9.2022 from: https://pusdatin.kemkes.go.id/....
Coupland AP, Thapar A, Qureshi MI, Jenkins H, Da­vies AH. The definition of stroke. J R Soc Med. 2017;110(1):9–12; doi: 10.1177/0141076816680121.
Elliott KC, Bundy DT, Guggenmos DJ, Nudo RJ. Physiological basis of neuromotor recovery. In: Colombo R, Sanguineti V (eds.). Rehabilitation Robotics. Elsevier; 2018, pp. 1–13; doi: 10.1016/B978-0-12-811995-2.00001-1.
Gezer H, Karaahmet OZ, Gurcay E, Dulgeroglu D, Ca­kci A. The effect of aerobic exercise on stroke rehabilitation. Ir J Med Sci. 2019;188(2):469–73; doi: 10.1007/s11845-018-1848-4.
Katz DI, Bernick C, Dodick DW, Mez J, Mariani ML, Ad­ler CH, et al. National Institute of Neurological Disorders and Stroke consensus diagnostic criteria for traumatic encephalopathy syndrome. Neurology. 2021;96(18):848–63; doi: 10.1212/WNL.0000000000011850.
Whitehead S, Baalbergen E. Post-stroke rehabilitation. S Afr Med J. 2019;109(2):81–3; doi: 10.7196/SAMJ.2019.v109i2.00011.
Gunnes M, Indredavik B, Langhammer B, Lydersen S, Ihle-Hansen H, Dahl AE, Askim T; LAST Collaboration group associations between adherence to the physical activity and exercise program applied in the LAST study and functional recovery after stroke. Arch Phys Med Rehabil. 2019;100(12):2251–9; doi: 10.1016/j.apmr.2019.04.023.
Maier M, Ballester BR, Verschure PFM. Principles of neurorehabilitation after stroke based on motor learning and brain plasticity mechanisms. Front Syst Neurosci. 2019;13:74; doi: 10.3389/fnsys.2019.00074.
Weiss PL, Keshner EA, Levin MF (eds). Virtual Reality for Physical and Motor Rehabilitation. New York: Springer; 2014.
Laver KE, Lange B, George S, Deutch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2017;11(11):CD008349; doi: 10.1002/14651858.CD008349.pub4.
MacKay-Lyons MJ, Makrides L. Longitudinal changes in exercise capacity after stroke. Arch Phys Med Rehabil. 2004;85(10):1608–12; doi: 10.1016/j.apmr.2004.01.027.
Luo L, Zhu S, Shi L, Wang P, Li M, Yuan S. High intensity exercise for walking competency in individuals with stroke: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2019;28(12):104414; doi: 10.1016/j.jstrokecerebrovasdis.2019.104414.
Al Haris MF, Rini EM, Yusuf D, Lesmana IPD. Effect of exercise using virtual reality-based bicycle simulator on balance and gait in post stroke patients [in Indonesian]. J Teknol Inf Terapan. 2020;7(2):102–6; doi: 10.25047/jtit.v7i2.185.
Lesmana IPD, Widiawan B, Hartadi DR. Manipulation of virtual environment to examine perception and vision aspects of individuals post-stroke when driving VRAC simulator. J Phys Conf Ser. 2020;1569:022010; doi: 10.1088/1742-6596/1569/2/022010.
Lesmana IPD, Mukhlisoh NA. Visual cueing modulation of cycling speed for training person with stroke in a virtual cycling system. IOP Conf. Ser.: Earth Environ Sci. 2021;672:012086; doi: 10.1088/1755-1315/672/1/012086.
Deutsch JE, Myslinski MJ, Kafri M, Ranky R, Sivak M, Mavroidis C, Lewis JA. Feasibility of virtual reality augmented cycling for health promotion of people poststroke. J Neurol Phys Ther. 2013;37(3):118–24; doi: 10.1097/NPT.0b013e3182a0a078.
Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63(10):1606–10; doi: 10.1093/ptj/63.10.1606.
Sullivan KJ, Tilson JK, Cen SY, Rose DK, Hersberg J, Correa A, Gallichio J, McLeod M, Moore C, Wu SS, Dun­can PW. Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials. Stroke. 2011;42(2):427–32; doi: 10.1161/STROKEAHA.110.592766.
Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med. 1987;66(2):77–90.
Bashir S, Caipa A, Plow EB. Assessment of behavioral tasks performed by hemiplegic patients with impaired dexterity post stroke. Eur Rev Med Pharmacol Sci. 2017;21(10):2443–2451.
Witmer BG, Singer MJ. Measuring presence in virtual environments: a presence questionnaire. Presence. 1998;7(3):225–40; doi: 10.1162/105474698565686.
Lesmana IPD, Widiawan B, Suryana AL. Development of a virtual reality system based cycling training for health promotion of individuals post-stroke. In: 2022 International Seminar on Application for Technology of Information and Communication (iSemantic). 2022:232–237; doi: 10.1109/iSemantic55962.2022.9920389.
Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, Shephard T; American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation and Prevention; the Council on Cardiovascula Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Circulation. 2004;109(16):2031–41; doi: 10.1161/01.CIR.0000126280.65777.A4.
American College of Sports Medicine (ed.) ACSM’s Health-Related Physical Fitness Assessment Manual. Lippincott Williams and Wilkins; 2013.
NICE. Stroke rehabilitation in adults. Clinical guideline. 2013;12:1–43. Available 7.10.2022 from: https://www.nice.org.uk/guidan....
Barbosa D, Santos CP, Martins M. The application of cycling and cycling combined with feedback in the rehabilitation of stroke patients: a review. J Stroke Cerebrovasc Dis. 2015;24(2):253–73; doi: 10.1016/j.jstrokecerebrovasdis.2014.09.006.
Kuriakose D, Xiao Z, Pathophysiology and treatment of stroke: present status and future prespectives. Int J Mol Sci. 2020;21(20):7609; doi: 10.3390/ijms21207609.
Bacca O, Patiño-Segura MS, Herrera E. Circumferential pressure treatment reduces post-stroke spasticity: a pilot randomized controlled trial. Physiother Quart. 2020;30(1):39–45; doi: 10.5114/pq.2020.102165.
Girijala RL, Sohrabji F, Bush RL. Sex differences in stroke: review of current knowledge and evidence. Vasc Med. 2017;22(2):135–145; doi: 10.1177/1358863X16668263.
Murphy SJ, Werring DJ. Stroke: causes and clinical features. Medicine. 2020;48(9):561–6; doi: 10.1016/j.mpmed.2020.06.002.
Marlina T, Waluyo I, Hananto M, Harsodjo S, Isra A, Yani S. Effect of neuro developmental treatment intervention in post stroke patients with upper limb gross motor impairment based on Fugl-Meyer post stroke recovery test parameters at Bukittinggi National Stroke Referral Hospital [in Indonesian]. Ilm Fisioter. 2012;2(1):1–11.
Pranggono MH, Denafianti, Rahmayanti Y. The effect of static bicycle exercise on blood pressure changes in patients with obesity [in Indonesian]. J Med Malahayati. 2021;5(1):36–42.
Reimers AK, Knapp G, Reimers CD. Effects of exercise on the resting heart rate: a systematic review and meta-analysis of interventional studies. J Clin Med. 2018;7(12):503; doi: 10.3390/jcm7120503.
Simanjuntak RH, Engka JN, Marunduh SR. The effect of acute physical exercise on oxygen saturation in basketball players at the Unsrat Faculty of Medicine [in Indonesian]. eBm. 2016;4(1):20–4; doi: 10.35790/ebm.4.1.2016.10817.
Intercollegiate Stroke Working Party. National clinical guideline for stroke fifth edition. 2012.
Alghadir AH, Al-Eisa ES, Anwer S, Sarkar B. Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke. BMC Neurol. 2018;18(1):1–7; doi: 10.1186/s12883-018-1146-9.
Nusdwinuringtyas N, Alwi I, Yunus F. Validity and reliability of the 6-minutes walk test on the 15-meters track [in Indonesian]. Media Penelit Pengemb Kesehat. 2018;28(2):131–6; doi: 10.22435/mpk.v28i2.178.
Cazzoletti L, Zanolin ME, Dorelli G, Ferrari P, Carbonare DL, Crisafulli E, Alemayohu MA, Olivieri M, Verlato G, Ferrari M. Six-minute walk distance in healthy subjects: reference standards from a general population sample. Respir Res. 2022;23:83; doi: 10.1186/s12931-022-02003-y.
Casanova C, Celli BR, Barria P, Casas A, Cote C, de Tor­res JP, Jardim J, Lopez MV, Marin JM, Montes de Oca M, Pinto-Plata V, Aguirre-Jaime A. Six Minute Walk Distance Project (ALAT). The 6-min walk distance in healthy subjects: Reference standards from seven countries. Eur Respir J. 2011;37:150–6; doi: 10.1183/09031936.00194909.
Weinberg RS, Gould D. Foundations of Sport and Exercise Psychology. 7th ed. Champaign: Human Kinetics; 2019.
Mandolesi L, Polverino A, Montuori S, Foti F, Ferraioli G, Sorrentino P. Effects of physical exercise on cognitive functioning and wellbeing: biological and psychological benefits. Front Psychol. 2018;9:509; doi: 10.3389/fpsyg.2018.00509.
Journals System - logo
Scroll to top