The effects of exergaming technology on postural sway, user-acceptance and flow experience in people with multiple sclerosis

Student thesis: Doctoral Thesis


Through this PhD thesis a systematic review of the literature was first performed to establish the quantity and quality of previous research specific to exergaming in people with Multiple Sclerosis (MS). This indicated the limited evidence on the effects of exergaming technology, the critiques of previous research, and the need for continued investigation in this field. The effects on balance performance were overall positive; however, the need for quantitative, reliable and accurate analyses was apparent. Additional gaps in the literature were the lack of research to establish the user-acceptance of exergaming technology, as well as the flow properties (engagement) of such technology. The first study was an exploratory trial comparing the purpose designed IREX™ system and the game-based Nintendo Wii Fit™ in terms of postural sway, user-acceptance and flow experience in 33 healthy sedentary adults. Following a four-week intervention, there were no statistically significant post-intervention between-group differences for any of the recorded measures. However, there were statistically significant within-group improvements in both exergaming systems. These findings support the use of both the IREX™ and Nintendo Wii Fit™ as supplements to therapeutic exercise in terms of not only improving balance, but also user-acceptance and flow experience, which may assist in exercise uptake and concordance. A second study, using the design of a definitive randomised controlled trial, was employed using two experimental conditions (Nintendo Wii Fit™, n = 20; and matched traditional balance training, n = 18) and a third control group (which received no intervention, n = 18) in 56 adults with a clinical diagnosis of MS. Both intervention groups received four-weeks of balance-orientated exercise. Postural sway and gait were measured, in addition to user-acceptance and flow experience. Secondary outcome measures were self-reported walking ability, and perceived activity and participation restrictions. A between-group analysis found significantly higher post-intervention scores in both intervention groups for postural sway than in the control group, as well as significantly higher scores for flow experience in the Nintendo Wii Fit™ group than in traditional balance training group. There were significantly higher post-intervention scores in the traditional balance training group for self-reported walking ability than in the control group and, in both intervention groups for perceived activity and participation restriction than in the control group. Also, a within-group analysis found significant improvements over-time for both intervention groups for all the reported measures; with the exception of flow experience for the traditional balance training group. Overall, while exergaming was not proven to be superior to traditional means of balance training, exergaming did encourage greater user-acceptance and flow experience, which may address a longstanding problem in exercise prescription – exercise concordance. These findings support the use of the Nintendo Wii Fit™ as an effective means of balance and gait training for people with MS, which is both accepted and intrinsically motivating to MS users.
Date of AwardMar 2015
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorDenis Martin (Supervisor), John Dixon (Supervisor), Paul Van Schaik (Supervisor) & Alasdair MacSween (Supervisor)

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