Nintendo Wii Fit group work program; 13 exercises in 5 groups including 3 yoga exercises, 3 balance exercises, 2 aerobic, 2 training plus exercises and 3 muscle-workout will be done respectively. Patients in this group will exercise for 8 weeks, 3 days in a week and 40-50 minutes of exercise within resting interval.

Respiratory training group participants' will do deep breathing exercise against resistance of 30% of intraoral pressure. This exercise will be applied for 8 weeks, each day of the week, twice in a day for 15 minutes and 4-5 normal breaths after 4-5 deep breaths. Each week, intraoral pressure will be measured and new training intensity values will be determined.

Patients in the control group will not be included in any exercise program, but all groups will be advised of walking in order to increase physical activity level.

Heart Failure

Older People

Nintendo Wii Fit group will perform including a series of yoga, balance, aerobics and muscle workout exercises by providing visual feedback on the TV screen with the Nintendo wii fit plus game console. Patients will perform these exercises in a room allocated to the thesis supervisor and together with the thesis supervisor physiotherapist. This process takes 40-50 minutes. Before starting test and after test, weight, blood pressure, pulse, respiratory rate, oxygen saturation value will be recorded. Patients will be rested if necessary during exercise.

Nintendo Wii Fit

Patients in the breathing exercise group will perform deep breathing exercises at home by a small breathing apparatus called as Threshold IMT. It has no unexpected side effects.Patients will do this exercise twice in a day ; morning and evening during 15 minutes. After 4-5 deep breath, patients will take normal breath till feeling relaxed.

Threshold IMT

Istanbul University-Cerrahpasa Institute of Cardiology

The Effectiveness of Nintendo Wii Fit and Inspiratory Muscle Training in Older Patients With Heart Failure

6MWT is used to determine functional exercise capacity, assess treatment efficacy, predict prognosis. This test is applied in a certain length corridor with the start and end point during 6 minute-walk. Before the test, patient is seated in a chair and rest for 10 minutes. Resting blood pressure, pulse, oxygen saturation value, dyspnea and fatigue score is recorded before and immediate after test. Before starting to test, patient is warned to tell if any problem is seen such as dizziness, pain, cramp. The patient is then asked to walk at a fast pace with a supervisor for 6 minutes. If the patient has a significant problem such as dizziness, pain, palpitation , the test is terminated immediately. At the end of test, how many meters the patient has walked for 6 minutes has recorded.

The Timed Up and Go test is a simple test used to assess a person's mobility and requires both static and dynamic balance. It uses the time it takes for a person to get out of the chair, walk three meters, turn around, return to the chair and sit down.

The short physical performance battery (SPPB) is a group of measures that combines the results of the gait speed, chair stand and balance tests. It has been used as a predictive tool for possible disability and can aid in the monitoring of function in older people. The scores range from 0 (worst performance) to 12 (best performance). The SPPB has been shown to have predictive validity showing a gradient of risk for mortality, nursing home admission, and disability.

If the target participant is not reached, the working order can be changed.

Cihan KILIC

Principal Investigator

Istanbul University-Cerrahpasa

Relative Reinforcing Value of high dose exercise (300 kcal expenditure per session) versus sedentary activity will be determined.

Relative Reinforcing Value of low dose exercise (150 kcal expenditure per session) versus sedentary activity will be determined.

Relative Reinforcing Value of no exercise (0 kcal expenditure per session) versus sedentary activity will be determined.

Overweight

Obesity

Physical Activity

Subjects will participate in 3 physical activity sessions per week expending 300 kcal per session and rate their liking of exercise.

High Dose Exercise (300 kcal)

Subjects will participate in 3 physical activity sessions per week expending 150 kcal per session and rate their liking of exercise.

Low Dose Exercise (150 kcal)

Subjects will participate in 3 sessions per week expending 0 kcal per session and rate their liking of exercise.

No Exercise (0 kcal)

Subjects will rate their liking of sedentary activities (reading magazines, playing word games, puzzles) as an alternative to exercise.

Sedentary Option

USDA Grand Forks Human Nutrition Research Center

Motivation to Exercise

RRV of physical activity will be assessed by evaluating the number of responses (mouse button presses) a subject is willing to complete to gain access to physical activity or a sedentary alternative.

Changes in preference for intense physical activity and tolerance for exercise discomfort will be assessed by self-report questionnaire responses to the Preference for and Tolerance of the Intensity of Exercise Questionnaire (PRETIE-Q).

Minutes of physical activity will be assessed by having participants wear an Actigraph accelerometer for 7 days (minimum 10 hours per day) on the right hip.

Changes perceived support for physical activity from friends and family members will be assessed by self-report questionnaire responses to the Social Norms and Support for Exercise Questionnaire.

Changes in perceptions of how much exercise satisfies autonomy, relatedness, and competence needs will be assessed by self-report questionnaire responses to the Psychological Need Satisfaction in Exercise Scale.

Changes in intrinsic, external, interrogated, identified, introjected and amotivation for physical activity will be assessed by self-report questionnaire responses to the Behavioral Regulation in Exercise, 3rd Edition (BREQ-3).

Changes in perceived effort expended during exercise will be assessed by self-report questionnaire responses to the Rating of Perceived Exertion Scale.

Changes in perceived pain/discomfort during exercise will be assessed by self-report questionnaire responses to the Muscle Pain Questionnaire.

Changes in perceived ability to continue exercise long-term will be assessed by self-report questionnaire responses to the Exercise Self-Efficacy Scale.

Changes in perceived ability to stick to an exercise routine will be assessed by self-report questionnaire responses to the Exercise Confidence Survey.

Changes in perceived affective responses (energy, tiredness, tension, calmness) to exercise will be assessed by self-report questionnaire responses to the Activation Deactivation Adjective Check List (ADCL).

Changes in average daily calorie intake will be assessed by reporting all foods and beverages consumed over a 3-day period.

kilocalorie/fatigue

The Effectiveness of Nintendo Wii Fit and Inspiratory Muscle Training in Older Patients With Heart Failure

Motivation to Exercise

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