Effects of exergaming on cognition, lower limb functional coordination, and stepping time in people with multiple sclerosis: a randomized controlled trial

Abstract

Purpose

To compare the effects of exergaming versus conventional exercises on cognition, lower-limb functional coordination, and stepping time in people with multiple sclerosis (PwMS).

Methods

Thirty-six PwMS were randomly assigned to either intervention (n = 18) or control (n = 18) group and received 18 training sessions during six weeks. The intervention group performed exergames that required multidirectional timed-stepping, weight-shifting, and walking while the control group performed conventional matched exercises. Trail making test (TMT part A, B; TMT-A, TMT-B, TMT B-A), six-spot step test (SSST), and choice stepping reaction time (CSRT-including reaction time (RT), movement time (MVT), and total response time (TRT)) were assessed pre- and post-intervention (short-term), and after three-month follow-up (mid-term).

Results

The intervention group showed faster TMT-B (p = 0.003) and TMT B-A (p = 0.002) at post-intervention and faster SSST at both post-intervention (p = 0.002) and follow-up (p = 0.04). The CSRT components showed no between-group differences at post-intervention; however, at follow-up, the intervention group had lower TRT (p = 0.046) and MVT (p = 0.015). TMT-A and RT had no significant between-group differences.

Conclusions

In short-term, exergames led to more improvements in complex attention, executive function, and lower-limb functional coordination comparing to the matched conventional exercises. In mid-term, exergaming was more effective for improving stepping time and lower-limb functional coordination. However, the two approaches did not show any superiority over each other for improving simple attention and RT.

Implications for rehabilitation

• When designed properly, exergames have great potential to improve attention and executive function of people with multiple sclerosis (PwMS), at least in the short-term.

• Exergames seem like an appropriate option for improving lower limb coordination and decreasing choice stepping response time among PwMS in the mid-term.

• Exergames do not have superiority in improving the choice stepping reaction time compared to their matched conventional treatment.

Keywords:

• Exergame
• virtual reality
• rehabilitation
• cognition
• multiple sclerosis

Acknowledgements

Special thanks to Khuzestan MS Society and PwMS participated in this study. The authors would also like to thank Dr. Saeed Hesam for his help on reviewing the statistical analysis and Dr. Alireza Sedighi for reviewing the final manuscript.

Registry number: IRCT20171106037286N2; registration date: 2018-05-11; URL of the record: https://www.irct.ir/trial/30604

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This study was supported by Ahvaz Jundishapur University of Medical Sciences under the Grant Number: PHT-9642.