Gamified Augmented Sensorimotor Feedback During Balance Training Improves Postural Control and Nocturnal RMSSD

Background and Objectives: Augmented sensorimotor feedback may enhance motor learning during balance training, but whether these adaptations extend to cardiac autonomic regulation remains unclear. This study compared wobble-board training with gamified augmented feedback versus conventional wobble-board training on dynamic balance and nocturnal heart rate variability. Methods: Thirty adults were assigned to training with gamified-augmented feedback (GBT), conventional training (CBT), or control (CON). GBT and CBT completed three ~20-min sessions weekly for six weeks. Dynamic balance, measured via the modified Star Excursion Balance Test (mSEBT), and nocturnal Root Mean Square of Successive Differences (RMSSD) were assessed. Results: Group × time interactions occurred for RMSSD and mSEBT (both p < 0.001). RMSSD increased 6.93 ± 1.86 ms in GBT, versus 1.01 ± 1.38 and 0.80 ± 1.61 ms in CBT and CON, respectively. GBT exceeded CBT (mean difference, 5.92 ms; 95% CI, 4.37-7.46; Hedges' g = 3.46) and CON (6.12 ms; 95% CI, 4.49-7.76; g = 3.38; both adjusted p < 0.001); CBT did not differ from CON (p = 0.761). mSEBT increased 7.54 ± 1.62 points in GBT, 3.65 ± 1.50 in CBT, and 0.47 ± 1.46 in CON. GBT exceeded CBT (mean difference, 3.89 points; 95% CI, 2.42-5.36; g = 2.39) and CON (7.07; 95% CI, 5.63-8.52; g = 4.40), while CBT exceeded CON (3.18; 95% CI, 1.79-4.57; g = 2.06; all adjusted p < 0.001). Conclusions: Gamified augmented feedback and its associated features were associated with greater improvements in dynamic balance and RMSSD than conventional training. Mechanisms underlying RMSSD response require further investigation.