Active Video Gaming Intervention in Adults With Mobility Impairments: Concurrent Mixed Methods Single-Arm Pilot Study

Adults with mobility impairments have limited opportunities for physical activity due to environmental barriers and lack of accessible exercise options. Active video games (AVGs) have shown promise for increasing physical activity by integrating movement into engaging gameplay. However, most commercial AVG controllers are not usable by those with severe mobility limitations. The GAIMplank is a novel adaptive game controller that translates trunk movements into gameplay, addressing this accessibility gap and enabling seated participation for individuals with limited lower-extremity function.

This study aimed to assess feasibility and acceptability of a 6-week GAIMplank-based intervention in adults with mobility impairments and to evaluate participants' perceived exertion, enjoyment, and engagement during gameplay. In addition, qualitative feedback was used to characterize participants' experiences with the intervention and to provide insight into implementation considerations for adapted exergaming in this population.

In total, 6 adults (2 female; mean age 65.2, SD 12.4 years) with mobility impairments due to stroke or Parkinson participated in a concurrent mixed methods single-arm pilot study. The intervention consisted of twice-weekly AVG sessions over 6 weeks using the GAIMplank controller to play video games. Self-report baseline measures included physical function, exercise expectations, and level of physical activity. During gameplay sessions, ratings of perceived exertion (RPEs), engagement, and enjoyment (0-10 rating scale) were collected. Additionally, physical activity and exergame enjoyment surveys were completed after sessions 1, 5, and 12. After the intervention, acceptability, appropriateness, and feasibility of the intervention (0-5 rating scale) were assessed. Qualitative data were collected through session comments and postintervention semistructured interviews. Descriptive statistics were used to summarize quantitative data, thematic analysis for qualitative data, and integration to examine convergence.

Participants reported moderate RPEs during gameplay (median RPE 5, IQR 3-6) and high levels of enjoyment and engagement (median scores of 9, IQR 6-10 and median 10, IQR 8-10, respectively). The intervention was well-received, with high scores on the acceptability, appropriateness, and feasibility measures. Qualitative findings highlighted engagement and enjoyment of the games, as well as participants' perceptions of mental stimulation, sustained attention, and positive emotional experiences during gameplay. Several participants also described a "masking effect," in which physical effort was not perceived as traditional exercise due to immersion in gameplay. Technical challenges related to controller responsiveness were reported, but they did not appear to substantially reduce overall engagement.

Findings from this mixed methods pilot study suggest that AVGs, delivered using an adapted controller such as the GAIMplank, appear feasible and enjoyable in this small pilot sample, supporting the need for further evaluation in larger, controlled studies. While standardized cognitive or mental health outcomes were not assessed, participant feedback indicates potential psychological benefits that warrant further investigation. Future studies should explore the long-term effects of AVG interventions and identify strategies for maximizing their benefits.

ClinicalTrials.gov NCT05310279; https://clinicaltrials.gov/study/NCT05310279.