Does virtual reality-based Kinect dance training paradigm improve autonomic nervous system modulation in individuals with chronic stroke?

Background: Physical inactivity and low resting heart rate variability (HRV) are associated with increased cardiovascular deconditioning, risk of secondary stroke and mortality. Aerobic danceis a multidimensional physical activity and recent research supports its application as a valid alternative cardiovascular training. Furthermore, technological advances have facilitated the emergence of new approaches for exercise training holding promise, especially those methods that integrate rehabilitation with virtual gaming. Objective: The purpose of this study was to evaluate cardiac autonomic modulation in individuals with chronic stroke post-training using a virtual reality – based aerobic dancetraining paradigm. Methods: Eleven community-dwelling individuals with hemiparetic stroke [61.7(±4.3) years] received a virtual reality - based danceparadigm for 6-weeks using the commercially available Kinect dancevideo game “Just Dance3”. The training was delivered in a high-intensity tapering method with the first two weeks consisting of 5 sessions/week, next two weeks of 3 sessions/week and last two weeks of 2 sessions/week, with a total of 20 sessions. Data obtained for HRV analysis pre-and post-intervention consists of HRV for ten minutes in 1) supine resting position; 2) quiet standing. High-frequency (HF) power measures as indicators of cardiac parasympathetic activity, low-frequency (LF) power of parasympathetic-sympathetic balance and LF/HF of sympatho-vagal balance were calculated. YMCA Submaximal Cycle Ergometer Test was used to acquire VO2 maxpre- and post-intervention. Changes in physical activity during dancetraining were assessed using Omran HJ-321 Tri-Axis Pedometer. Results: After training, participants demonstrated a significant improvement in autonomic modulation in the supine position, indicating an improvement in LF=48.4 (±20.1) to 40.3 (±8.0), p=0.03; HF=51.5 (±19) to 59.7 (±8), p= 0.02 and LF/HF=1.6 (±1.9) to 0.8 (±0.26), p=0.05]. Post training the participants had significantly higher VO2max. Number of steps during danceintervention significantly increased from the 1st to the 20th session (p<0.05). Conclusion: The current study, is the first to assess the effect of a virtual reality – based aerobic dancetraining paradigm on HRV among individuals with chronic stroke. Given, that the paradigm used in this study improves cardiac autonomic control, future studies should incorporate danceas an adjuvant therapy into clinical treatment program and assess its long-term efficacy.