Custom game paced video games played by persons post-stroke have comparable exercise intensity but higher accuracy, greater enjoyment and less effort than off-the-shelf game

Use of active video games in stroke rehabilitation is supported with efficacy studies of balance and mobility for persons in acute, sub-acute and chronic phases post-stroke. They have been characterized as well for their potential promotion of physical activity (PA). Games may be designed specifically for rehabilitation, or adapted from their intended recreational use for serious application such as rehabilitation or promotion of PA. A major limitation of the commercially available games is their lack of customization of movement parameters and inability to record performance metrics that are useful for practice. They are however, considered engaging and may promote high intensity of therapy (repetitions and physiologic correlates). This study compared the performance of persons in the chronic phase post-stroke playing a custom rehabilitation game to a comparable recreational active video game. The goal of the study was to determine, which game promoted greater exercise intensity and which was more enjoyable and less effortful. Fifteen participants in the chronic phase post-stroke were studied. The recreational game was played at a significantly higher intensity, both for repetitions, and energy expenditure while the experience of playing the custom game was reported as more enjoyable and less effortful. Further, movement accuracy was greater during custom game play. While intensity for metabolic equivalents (METs) and % of maximum heart rate were significantly greater when the recreational game was played, both games were played in the same intensity band to promote moderate activity. The custom game was comparable in intensity but superior in performance, enjoyment and perception of effort. The findings support efforts to develop custom games to promote physical activity for persons poststroke.