IJCS | Volume 31, Nº6, November / December 2018

622 Silva et al. Virtual rehabilitation for individuals with heart disease Int J Cardiovasc Sci. 2018;31(6)619-629 Original Article Waist circumference Waist circumference was measured with a non- distensible measuring tape (accuracy to the nearest 1 mm) and the subject standing, with parallel feet and arms hanging freely by the sides of the trunk. The measuring tape was placed in a horizontal plane around the abdomen, at the level of the umbilicus, just above the uppermost lateral border of the right iliac crest, not compressing the skin. Measurement (in centimeters) was taken three times, and the lowest value obtained was considered for analysis. 23 Food frequency The Food Frequency Questionnaire (FFQ) was used to assess the frequency of food consumption. The FFQ consists of a list of foods and beverages with response categories to indicate the frequency of consumption over the time queried. The frequency is registered in units of time (days, weeks, months or years) according to the need. 24 Functional capacity Functional capacity was assessed by use of the Six- Minute Walk Test (6MWT) performed according to the American Thoracic Society criteria. 25 The 6MWT was performed along a corridor of theUNOESTE gymnasium. Blood glucose level Postprandial capillary blood glucose level was assessed (milligram per deciliter) by use of an Optium Xceed ® blood glucose meter that reads glucose in fresh capillary blood obtained by pricking the ring finger skin with a sterilized lancet. The measurements were taken before and after training in an individualized way. Cardiovascular parameters Heart rate was measured by use of a Sigma ® cardiac frequency meter. Oxygen saturation was measured by use of a pulse oximeter (Choicemmed ® , model Md300c1). With the subject in the sitting position, blood pressure was measured from the dominant arm, using a Premium ® aneroid sphygmomanometer and a Littman ® stethoscope, following the recommendations of the Brazilian guidelines on arterial hypertension. 26 The subjective perception of exertion was assessed by use of the Borg scale of perceived exertion. 27 Training protocol Both groups underwent 60-minute training sessions twice a week for eight weeks at the UNOESTE physical therapy clinic, adding up to 16 sessions. Four physical therapy students conducted the sessions, two for each group, and each student was responsible for two participants per session. In the initial and final 5 minutes, the following parameters were assessed: blood pressure, blood glucose level, oxygen saturation, and subjective perception of exertion by use of the Borg scale. During the entire session, the Borg scale was used and heart rate was assessed to ensure that the training heart rate calculated individually with the Karvonen formula would not be exceeded (50% to 80% of the reserve heart rate). 27,28 The VRG training comprised the use of the Microsoft Kinect™ sensor for Xbox 360 ® , with a controller-free infrared camera that tracks user motion. Two games were used: Your Shape™ (Fitness Evolved) and Dance Central 3™. Your Shape™ (Fitness Evolved) is a program that allows users to exercise their upper and lower limbs in an isolated or combined way, and comprises mainly trunk rotation, diagonal flexion/adduction and extension/abduction movements, plantar flexion of ankle, hip flexion and squat. Dance Central 3™ is a music rhythm game involving performing given dance moves, which are tracked by Kinect. Both were performed for 25 minutes, the former in association with ankle Velcro weights and dumbbells as resistance. The increase in resistancewas individualized and based on the Borg scale of perceived exertion (13: somewhat hard). 27 The CRG training comprised the use of treadmills (Embreex ® ) for aerobic training for 30 minutes and free weights, with 1-4-kg dumbbells and 2-4-kg ankle Velcro weights, for resisted training, performed in three sets of 10 repetitions, with 1-minute recovery interval. The exercises comprised shoulder abduction, elbow flexion, knee extension and flexion, all performed in the sitting position, except for knee flexion, performed in the standing up position. 27 In the CRG training protocol, resistance was increased similarly to that in the VRG training protocol. Statistical analysis Data were assessed by use of the GraphPad Prism statistical software. Data normality of distribution was analyzed with Shapiro Wilk test. Proportion was compared by use of chi-square test. Paired analysis was carried out by use of paired Student t test in case