Research Award Recipients

Virtual Reality Use for Exercise in Hemodialysis (VIRTUE-HD)

Co-Applicant(s): Charles Cook, Helen Noble, Jean-Francois Malouin, Kyle Greenway, Mona Ben m'rad, Soham Re

Lay Abstract

To survive, people affected by End-Stage Kidney Disease have to remove waste from their blood, using renal replacement therapy, typically through three weekly hemodialysis (HD) sessions of four hours. People undergoing HD experience unpleasant psychological and physical symptoms, including fatigue, cramps, pain, muscle wasting, poor aerobic capacity, lack of energy, and psychological distress. The lack of regular physical activity (PA) increases the risk of physical decline and disability.

While regular PA can improve these risks, implementing exercise programs in HD units has proven challenging. Identified barriers include

1/too much focus on moderate to vigorous intensity rather than light PA, which might be more doable and effective to reach health benefits;

2/difficulties in changing a sedentary lifestyle, low motivation, boredom, and fatigue; and

3/lack of access to expert supervision.

We want to seize the opportunity of the 12-hour weekly HD sessions to engage in PA. Virtual reality (VR)-based behavioral interventions are a new exciting technology successfully used to increase the motivation and effectiveness of rehabilitation programs in different medical conditions.

We would like to launch the first feasibility clinical trial of an immersive VR-based exercise program tailored for people living with HD: VIrtual Reality Use for Exercise in HemoDialysis, (VIRTUE-HD), in Canada. VR is a digitally crafted three-dimensional space where users can feel as though they're interacting in a real, tangible manner. This interaction is made possible through specialized gear such as helmets with built-in screens or sensor-fitted gloves. In rehabilitation post-stroke, VR-based programs are more effective than traditional exercise in improving physical function, adherence, pain, and quality of life. In HD, outside of North America, non-immersive VR for exercise (video games on a computer without a headset, with wearable sensors providing motion feedback to adapt the intensity of the exercise) has been used and has shown promising results. Immersive VR (with a headset and motion sensors) provides higher-quality content and experience, to enhance motivation, and stimulate the brain’s perception.

Our research team has experience in testing new behavioral programs in people undergoing HD and older adults, including studies of exercise. We completed a pilot trial of a VR-assisted mindfulness program in 22 older adults who did not use HD, and who found the intervention acceptable and enjoyable. In this Kidney Foundation of Canada study, we will conduct a two-part study.

First, we will co-create an immersive VR-adapted program to increase physical activity in HD in collaboration with patient partners, physicians, a kinesiologist, and a Montreal-based VR tech company, Super Splendide Inc., which specializes in launching VR programs for the Quebecois healthcare network.

Second, we will test its feasibility, acceptability, and safety in a feasibility randomized controlled trial of 40 HD patients in 2 Quebec centers in order to plan a larger effectiveness study in the future. Together, we propose to adapt and bring this exciting cutting-edge technology to people living with HD, who are often the last ones to benefit from novel interventions to improve health outcomes.

In this proposal, we will continue to work with patient partners, our kinesiologist, and the company to refine the immersive intervention so that it is specifically tailored to the needs of HD patients. We hypothesize that HD patients will enjoy and have sustained adherence to VIRTUE-HD, increasing the amount of physical activity both during and outside HD, and that this will translate into improved physical function and other patient-centered outcomes. This study will also lay the groundwork for the potential future widespread implementation of VR-assisted exercise in Canada.