IJCS | Volume 31, Nº6, November / December 2018

DOI: 10.5935/2359-4802.20180082 558 EDITORIAL International Journal of Cardiovascular Sciences. 2018;31(6)558-559 Mailing Address: Ricardo Stein Hospital de Clínicas de Porto Alegre - Rua Ramiro Barcelos 2350 - Serviço de Fisiatria e Reabilitação - Térreo. Postal Code: 90035-903. Porto Alegre, RS - Brazil. E-mail: rstein@cardiol.br Digital Tools and Cardiovascular Rehabilitation Ricardo Stein and Leandro Tolfo Franzoni Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil Grupo de Pesquisa em Cardiologia do Exercício do Hospital de Clínicas de Porto Alegre (CardioEx - HCPA), Porto Alegre, RS - Brazil Manuscript received July 18, 2018; revised manuscript July 25, 2018; accepted July 25, 2018. Cardiovascular Diseases/physiopathology; Virtual Reality; Cardiac Rehabilitation; Exercise Movement Techniques/methods; Quality of Life. Keywords Cardiovascular diseases are the leading cause of death worldwide. The inclusion of patients with such diseases in cardiovascular rehabilitation (CR) programs is an evidence-based conduct, since it has the potential to improve the individual’s clinical condition and manage several risk factors associated with these diseases. 1 The association of aerobic and resistance exercises is a recommended combination in many CR programs. However, technological tools have been studied and used in order to increase the range of methods to optimize the results in the scenario of secondary prevention of cardiac diseases. In addition, combining modern strategies and conventional models can be a form of motivation for the patient by making CR interactive and funnier. In this case, virtual reality (VR) has also been used, including in our country. 2,3 A study published by Silva et al. 4 in this issue of the International Journal of Cardiovascular Sciences compares the effects of conventional rehabilitation with VR on body composition and functional capacity of patients with cardiac diseases. It is a randomized controlled trial (RCT) in which 27 patients with cardiac diseases were enrolled to participate in an eight-week CR program. The sample was divided into two groups: a) conventional rehabilitation; b) rehabilitation with VR. The sessions lasted 60 minutes for both groups and the weekly frequency was twice a week. Conventional rehabilitation consisted of two parts: 25 minutes of aerobic exercise followed by 25 minutes of exercises with weights (upper and lower limbs). The intensity control during aerobic exercise was performed by monitoring the heart rate reserve determined by the Karvonen equation (50% and 80%). For resistance exercises, intensity was controlled by rating of perceived exertion (up to 13 on the Borg scale). Rehabilitation with VR was performed using Microsoft’s Xbox 360 with Kinect. The twenty-five minutes of games consisted of exercises for the upper and lower limbs and 25 minutes of dancing with the Dance Central 3 game. In the first part, velcro weights were used in the ankle and dumbbells in the hands for the resistance exercises. The intensity was only controlled in the first part of the activity. Functional capacity was measured through a 6-minute walk test, which significantly increased in both groups. Similarly, both groups had the capillary blood glucose reduced. However, as opposed to what was expected, none of the two strategies significantly reduced fat percentage and body weight. In fact, the VR group presented a significant increase in these two variables compared to the conventional rehabilitation group. The research question studied seems relevant and original and the results contribute to the knowledge on RC. However, this is an experiment with many limitations, some of which have been reported by the authors themselves. The sample size was small and the intervention period may not have been sufficient to promote positive results in the participants’ body composition. 5,6 The absence of a proper nutritional assessment may have directly influenced the results on body composition. 7 In addition, it would be recommended to control exercise intensity and volume in order to quantify the isocaloric protocols for both groups. Therefore, the researchers did not control such measure and, because of this, each exercise protocol may have promoted unequal energy expenditures. Besides, controlling the heart rate of the VR group would have been important to respect the same training zones as the group exposed