Abstract
BackgroundImplementing exercises in the form of video games, otherwise known as exergaming, has gained recent attention as a way to combat health issues resulting from sedentary lifestyles. However, these exergaming apps have not been developed for exercises that can be performed in wheelchairs, and they tend to rely on whole-body movements.ObjectiveThis study aims to develop a mobile phone app that implements electromyography (EMG)-driven exergaming, to test the feasibility of using this app to enable people in wheelchairs to perform exergames independently and flexibly in their own home, and to assess the perceived usefulness and usability of this mobile health system.MethodsWe developed an Android mobile phone app (Workout on Wheels, WOW-Mobile) that senses upper limb muscle activity (EMG) from wireless body-worn sensors to drive 3 different video games that implement upper limb exercises designed for people in wheelchairs. Cloud server recordings of EMG enabled long-term monitoring and feedback as well as multiplayer gaming. Bench testing of data transmission and power consumption were tested. Pilot testing was conducted on 4 individuals with spinal cord injury. Each had a WOW-Mobile system at home for 8 weeks. We measured the minutes for which the app was used and the exergames were played, and we integrated EMG as a measure of energy expended. We also conducted a perceived usefulness and usability questionnaire.ResultsBench test results revealed that the app meets performance specifications to enable real-time gaming, cloud storage of data, and live cloud server transmission for multiplayer gaming. The EMG sampling rate of 64 samples per second, in combination with zero-loss data communication with the cloud server within a 10-m range, provided seamless control over the app exergames and allowed for offline data analysis. Each participant successfully used the WOW-Mobile system at home for 8 weeks, using the app for an average of 146 (range 89-267) minutes per week with the system, actively exergaming for an average of 53% of that time (39%-59%). Energy expenditure, as measured by integrated EMG, was found to be directly proportional to the time spent on the app (Pearson correlation coefficient, r=0.57-0.86, depending on the game). Of the 4 participants, 2 did not exercise regularly before the study; these 2 participants increased from reportedly exercising close to 0 minutes per week to exergaming 58 and 158 minutes on average using the WOW-Mobile fitness system. The perceived usefulness of WOW-Mobile in motivating participants to exercise averaged 4.5 on a 5-point Likert scale and averaged 5 for the 3 participants with thoracic level injuries. The mean overall ease of use score was 4.25 out of 5.ConclusionsMobile app exergames driven by EMG have promising potential for encouraging and facilitating fitness for individuals in wheelchairs who have maintained arm and hand mobility.
Highlights
Individuals with paraplegia are at a greater risk for many secondary health problems associated with sedentary behavior [1,2,3]
By analyzing the acquired EMG signals, we measured the number of detected muscle contractions, the integrated EMG levels, and peak EMG levels during each game session using custom-written MATLAB code (Mathworks, Inc)
From the EMG collected on the cloud server, we measured the total integrated EMG, which is linearly related to energy expenditure [37]. integrated EMG levels (iEMG) and inferred energy expenditure increased in proportion to the time spent on the app (Figure 9; r=0.86); that is, the more they used the app, the more energy they expended
Summary
Individuals with paraplegia are at a greater risk for many secondary health problems associated with sedentary behavior [1,2,3]. Exergaming is beginning to appear on mobile platforms (namely, smartphones and tablets) [16,26,27], which could help in overcoming transportation challenges and inaccessible gym environments for people using wheelchairs Among those that have been implemented, there are none to the authors’ knowledge that are tailored to exergaming in wheelchairs. Implementing exercises in the form of video games, otherwise known as exergaming, has gained recent attention as a way to combat health issues resulting from sedentary lifestyles. These exergaming apps have not been developed for exercises that can be performed in wheelchairs, and they tend to rely on whole-body movements
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