| Author: | Lam, Ngo Sheung |
| Title: | Effect of a 12-week virtual reality exercise training program on physical and cognitive function in older adults with type ii diabetes: a randomized controlled trial |
| Advisors: | Yu, Clare (RS) Tsang, Sharon (RS) Cheing, Gladys (RS) |
| Degree: | DHSc |
| Year: | 2025 |
| Department: | Faculty of Health and Social Sciences |
| Pages: | xiv, 151 pages : color illustrations |
| Language: | English |
| Abstract: | Background and Purpose Virtual reality (VR) has been used for rehabilitation in recent years, however, limited research has investigated its use to promote health in individuals with diabetes. This single-blinded randomized controlled trial aimed to evaluate the effectiveness of a 12-week combined VR-based exercise and home-based exercise program on glycemic control, physical fitness, cognitive function and exercise compliance in older adults with type 2 diabetes mellitus (T2DM). Methods Individuals with T2DM aged between 55 to 80 years were recruited from five randomly selected elderly community centres. Participants were randomized to the combined VR and home-based exercise group (VRE group) or home-based exercise control group. The study included a 12-week intervention period followed by a 3-month maintenance period. To achieve the physical fitness exercise recommendation of five days per week, participants allocated to the VRE group attended a one-hour VR-based group exercise training at the elderly centres three days per week, in addition to a home-based exercise program two days per week for 12 weeks. Participants in the home-based exercise control group were advised to perform the home-based exercise program five days per week for 12 weeks. The diet of the participants was not controlled or regulated. The primary outcome measure was the blood glucose level, measured by the glycated hemoglobin (HbA1c). Secondary outcome measures were assessed, including physical fitness (measured by the Mini-BESTest, 30s chair stand test, the 30s arm curl test, handgrip strength, and the six-minute walk test); cognitive function (evaluated using the WAIS Digit-Symbol-Coding test, and the digit span forward and backward tests); diabetes-related distress level (measured using the Chinese Diabetes Distress Scale, CDDS-17); self-efficacy for exercise (assessed using the Chinese version of self-efficacy for exercise, SEE-C); total physical activity level (measured by the Chinese version of the International Physical Activity Questionnaire-short form, IPAQ-C); and exercise compliance (calculated by the percentage of attending the training sessions at the community elderly centres for the intervention group and completing home exercises as recorded in the exercise diary for both groups). All the outcomes were assessed at baseline, week 6 and week 12 during the intervention program, and 3 months post-intervention. A linear mixed model (LMM) was used to test the effect of intervention (VRE versus control) over the 12-week intervention period and the 3-month maintenance period. The between-group difference in exercise compliance rate at completion of intervention (at the end of week 12) was tested by independent t-tests. For the post-hoc test, the pairwise comparisons of estimated marginal means with Bonferroni adjustment of p values were used. The significance level was set at p<0.05. Results A total of 109 participants (4 male, 105 female) with T2DM completed the program and the assessments. The participants included 58 females and 2 males in the virtual reality exercise (VRE) group (mean age: 73.8±7.1), as well as 47 females and 2 males in the home-based exercise control group (mean age: 73.9±7.0). After the 12-week training program, no significant difference was observed in the change of HbA1c levels between the VRE and control groups. The VRE group had significantly greater improvement in the Mini-BESTest score (p=0.005), the 30s chair stand test (p<0.001), the 30s arm-curl test (p=0.001), the total and correct response of the WAIS Digit-Symbol-Coding test, and the CDDS-17 after the 12-week intervention as compared to the home-based exercise control group. However, by the end of the 3-month maintenance period, the effects on the Mini-BESTest, 30s chair stand test, 30s arm curl test were no longer evident, and both groups showed similar results. No significant differences in the changes in handgrip strength, SEE-C, and total physical activity level were observed between the VRE and the control group (all p>0.05). The exercise compliance in the VRE group was over 90%, which was significantly higher than in the control group (p<0.01). Conclusion The blood glucose level of older adults with T2DM was maintained after a 12-week VR-based exercise combined with a home-based exercise program, similar to home-based exercise program alone. In addition, the VR-based exercise combined with a home-based exercise program resulted in immediate improvements in balance, and upper and lower limb muscle strength in older adults with T2DM compared to a home-based exercise program alone. However, the improvements induced by the training program were no longer evident by the end of the 3-month maintenance period. There were no reports of accidents or adverse effects during exercise sessions in elderly centres. |
| Rights: | All rights reserved |
| Access: | restricted access |
Files in This Item:
| File | Description | Size | Format | |
|---|---|---|---|---|
| 8645.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 3.39 MB | Adobe PDF | View/Open |
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