The Effect of Video Game-Based Exercise Training in Patients With Interstitial Lung Disease

FVC will be measured using a spirometry test. During the assessment, participants will be instructed to take a full breath, and with a nose clip in place, exhale into the spirometer with maximum effort. The procedure will be repeated at least three times, and the best value will be recorded. Results will be expressed in liters (L) and compared to predicted values based on age, height, sex, and ethnicity. A value of ≥80% of the predicted capacity will be considered normal.

FEV₁ is defined as the volume of air that will be exhaled during the first second of a forced expiration after a full inspiration. It will be measured by spirometry and expressed in liters (L). Results will be compared to predicted values calculated according to age, height, sex, and ethnicity. A value of ≥80% of the predicted capacity will be considered normal.

The FEV₁/FVC ratio is defined as the proportion of the forced expiratory volume in the first second (FEV₁) to the forced vital capacity (FVC). It will be measured by spirometry. Results will be expressed as a percentage and compared to predicted values according to age, height, sex, and ethnicity. A value of ≥70% will be considered normal, while lower values will indicate airflow limitation.

Peak Expiratory Flow (PEF) is defined as the maximum flow rate that will be achieved during a forced expiration after a full inspiration. It will be measured by spirometry and expressed in liters per second (L/s). The procedure will be repeated at least three times, and the best value will be recorded. Results will be compared to predicted values calculated according to age, height, sex, and ethnicity. A value of ≥80% of the predicted capacity will be considered normal.

Diffusing capacity (DLCO) measurement will be performed with the nose closed after the patient has not exercised before the test and has been sitting for at least 5 minutes. Care should be taken to ensure rapid inspiration. Inspiration time should be kept between 2 and 4 seconds. The final expiration should not exceed 4 seconds. Breath-hold times will be measured for all patients as recommended by the European Respiratory Society (ERS) guidelines. Tests with breath-hold times outside the 9-11 second range, inspirations with inspiratory vital capacity (IVC) below 90% during the DLCO maneuver, and measurements with alveolar ventilation below 10% of total lung capacity will be excluded from the study. DLCO measurements will be performed using gas chromatographs, and the results will be recorded as ml/min/mmHg. Hemoglobin-corrected tests will be used as the basis.

Peripheral muscle strength will be measured using a portable manual muscle strength measurement device (Hoggan MicroFet2 Handheld Dynamometer) for shoulder abductor and adductor, shoulder flexor, extensor, elbow flexor and extensor, hip flexor, extensor, hip abductor, adductor, knee flexor, and extensor muscles. Grip strength will be measured using a handheld dynamometer (Jamar, Nottinghamshire, UK) in a sitting position, with the elbow flexed at 90 degrees and the wrist in neutral. Measurements will be repeated three times for the right and left sides, and the average of the values will be recorded in Newtons (N).

Functional exercise capacity will be assessed with the 6-minute walk test (6MWT). Participants are instructed to walk a 30-meter corridor with the goal of covering the longest possible distance in six minutes. Participants are allowed to stop and rest if necessary but are encouraged to continue walking as soon as possible. Participants' heart rate, blood pressure, peripheral oxygen saturation, self-perceived shortness of breath, and lower extremity muscle fatigue are questioned before and after the test. The distance traveled during the six-minute period is recorded. The 6MWT is a valid and reliable test for interstitial lung disease.

The quality of life score will be assessed using the St. George Respiratory Questionnaire (SGRQ). The SGRQ is a self-assessment questionnaire specific to airway diseases. It consists of 76 questions in three categories. It examines symptoms, activities, and the impact of the disease on daily life. Each section is scored separately from 0 to 100. A score of 0 indicates no impairment in quality of life, while a score of 100 indicates maximum disability and a poor quality of life. So a higher score means a worse outcome.

This scale will be used to evaluate the dyspnea level of the participants. The Modified Borg Scale is scored between 0 and 10. A score of 0 means no shortness of breath at all, while a score of 10 means it's unbearably severe. In other words, a higher score indicates a worse outcome.

This scale will be used to evaluate the dyspnea level of the participants. Modified Medical Research Council Scale (MMRC) is graded from 0 to 4. As the score increases, shortness of breath becomes more severe and functional limitations increase. In other words, a higher score is associated with a worse outcome.

Fatigue status of patients will be evaluated with the Fatigue Severity Scale (FSS). This scale assesses fatigue severity with nine questions. Each question is scored from 1 (completely disagree) to 7 (completely agree). The FSS score is the average of the nine sections. A higher score indicates increased fatigue severity.

Dysfunctional respiratory status of patients will be evaluated with the Nijmegen Questionnaire. The Nijmegen Questionnaire is a questionnaire used to identify dysfunctional breathing patterns and unexplained respiratory symptoms. It consists of 16 items scored from 0 to 4. The total score ranges from 0 to 64. A higher total score indicates dysfunctional breathing.

Patients' cognitive functions will be assessed using the Montreal Cognitive Assessment Scale (MOCA). This scale includes sections assessing executive functions, attention and concentration, memory, language, abstract thinking, visual-spatial skills, orientation, and calculation. The total score is calculated out of 30. The threshold score is 21. Scores of 20 or lower are considered cognitive dysfunction. Higher scores indicate greater cognitive preservation, while lower scores indicate poorer cognitive function.