Comparison of the effect of gender on Hemodynamic factors and Normetanephrine after boxing exergame, with and without Blood flow restriction

Background: Despite the fact that researchers have recently turned their attention to the new style of video games with movement (exergames) and considering that these games have been recently accepted as a kind of sports activity with a wide range of people as audience of these games both male and female in various ages, not enough attentions have been paid to the comparison of different dimensions of gender responses to various parameters, including hemodynamic factors, which largely determines the effectiveness of various exercise activities. Therefore, the present study, seeks to answer the questions of whether gender is an influential factor in the response of hemodynamic parameters to exergame, and either restricting blood flow (BFR) can increase activity intensity act as a stimulus to change gender responses, by comparing the acute responses of a boat exergame with and without blood flow restriction, on hemodynamic factors in both non-athlete men and women? Methods: Fourteen healthy young people (Female: 8, Male: 6; Age: 30±10 years; BMI: 21±3 kg.m2) were divided into two groups of men and women and participated in two training sessions of boxing with Microsoft Kinect Xbox 360. Normetanephrine and some hemodynamic factors such as HR, SBP, DBP, RPP and MAP were measured before and after. At the beginning of each session, the subjects performed 5 minutes of warm-up exercises with stretching. Blood samples were taken from serum before training to test for serum Normetanephrine. A Cardiac Holter monitoring system was used to measure Heart Rate. All measurement instructions were followed in the measurement process; before the start of the game, the Avecinna My Patch Holter device with four cables were installed on the subjects' chests by f-55 SKINTACT chest leads made in Austria and poly-gel ultrasound gel to measure the heart rate. The selected exergame was boxing from Kinect Sports with Microsoft's Kinect X BOX360. Subjects were two groups of men and women and competed against each other for 20 minutes, the separated groups of women and men were fighting against each other. In the first week, seven subjects with BFR, which was imposed by an Iranian-made inflatable cuff with 15 to 20% systolic blood pressure restriction by a sphygmomanometer, played against seven competitors without BFR. After seven days, the training session was repeated, but this time the two groups were changed regarding BFR. At intervals of 5, 10, 15, and 20 games, the cuffs were opened and closed again. The Rate of Perceived Exertion (RPE) was also recorded by the Borg 10-point scale at the minutes of 0, 5, 10, 15, and 20 minutes. Accordingly, the subjects were supposed to indicate the rate of perceived exertion by numbers when implementing the protocol. Blood samples were taken again by specialists present at the laboratory immediately after the game. Shapiro-Wilk test was used to evaluate the normality of data distribution. Independent t-test was used to compare before and after data of the two groups and the Analysis of variance with repeated measures was used to evaluate the data of RPE and the significance level was considered as p≤0.05 for all statistical analyses. Data were analyzed using SPSS software version 22. Results: Statistical analysis of the present study showed that boxing exergame in both protocols with and without BFR led to a significant increase in hemodynamic variables except DBP in both men and women, but comparing the increase between the two groups of women and Men did not show significant outcomes. The results showed that although the comparison of increase in SBP, MAP, HR, RPP indices during both protocols in both groups of men and women was not significant; Men showed a greater increase in SBP, HR, RPP in the protocol with BFR compared to without BFR, while in the group of women it was quite the opposite. The group of women in the protocol without BFR showed a greater increase in these parameters compared to the protocol with BFR. Regarding MAP parameter, men in both protocols showed more increase than women. The results of the DBP data, showed an insignificant increase in both groups in the two protocols and no significant difference was observed between men and women. Regarding normetanephrine, like other parameters, the comparison of increase in normetanephrine in women and men during both protocols was not significant and, like the MAP parameter, in men, the increase in both protocols was greater than in women. The results of independent t-test related to hemodynamic and normathephrine indices are presented in the table below. Leven’s test and Independent t-test results related to Hemodynamic parameters and Normetanephrine Parameters Training protocol Leven’s Test Independent T-Test SE F sig df t sig NM (pg/ml) Without BFR 0.652 0.435 12 1.281 0.224 9.558 With BFR 0.145 0.710 12 0.166 0.871 11.995 (mmHg)SBP Without BFR 0.665 0.431 12 0.007 0.995 6.057 With BFR 0.491 0.497 12 0.354 0.729 5.527 DBP (mmHg) Without BFR 0.417 0.530 12 0.530 0.606 6.127 With BFR 0.034 0.858 12 0.112 0.913 2.614 MAP (mmHg) Without BFR 0.188 0.672 12 0.396 0.699 5.533 With BFR 0.091 0.769 12 0.161 0.875 2.805 HR (bpm) Without BFR 0.639 0.439 12 1.453- 0.172 8.370 With BFR 0.056 0.818 12 0.632 0.539 7.256 RPP (bpm.mmHg) Without BFR 0.243 0.631 12 0.790 0.445 1431.2 With BFR 0.248 0.627 12 0.929 0.371 1186.1     Regarding the comparison of reported RPE, both groups of men and women reported significantly higher values ​​in the session with BFR, but the comparison of the values ​​reported in women and men did not show a significant difference in both protocols (without and with BFR, respectively F4,48=0.039, p=0.997; F4,48=1.426, p=0.240). However, in the protocol without BFR, women reported higher values ​​of RPE in all the above minutes. Conversely, in the protocol with BFR, men reported higher values ​​of PRE at different minutes. Conclusion: In general, it can be concluded that a exergame session in both with and without restriction of blood flow in the arteries of the hand, could not cause significant results in increasing hemodynamic factors, normetanephrine and RPE in both men and women. However, there were differences in the responses of some factors between the two groups. The reason for this insignificancy can be due to various factors such as the type of game chosen, the duration of training protocols or the competitiveness of the game that caused excitement in both groups and the degree of obstruction of blood flow and opening and closing the cuffs during the protocol with BFR.  the comparison of hemodynamic responses of men and women in the proposed protocol in the combination of exergame with different training methods such as BFR that was presented in this study has recently come to many researchers attention, that proves the potential of this new style of games with sports activities that appeals to a wide range of audiences. Therefore a closer look at the effects of this proposed protocol on the cardiovascular system and hemodynamic factors in long-term protocols and the comparison of gender responses in other age groups is required.