PSYCHOSOCIAL BENEFITS OF GAME-BASED CIRCUIT EXERCISE IN STROKE SURVIVORS: A PRE–POST EXPERIMENTAL STUDY IN A MALAYSIA SETTING

Abstract

Background and Objective: Stroke frequently leads to long-term functional impairments and reduced psychosocial well-being, underscoring the need for engaging and effective rehabilitation strategies. Emerging evidence suggests that game-based exercise may enhance motivation, self-efficacy and adherence, yet its psychosocial effect in stroke survivors remains underexplored. Game-based circuit exercise integrates task-oriented training with interactive elements that may promote active participation and meaningful engagement. This study examines the psychosocial benefits of a game-based circuit exercise intervention among stroke survivors, with specific emphasis on motivation level and self-efficacy, using a pre–post experimental study design. Methods: This trial involved 44 subacute post-stroke participants (mean age ± SD = 58.61 ± 9.91 years; mean Montreal Cognitive Assessment score = 26.43 ± 3.32) and was conducted at Hospital Putrajaya, Malaysia, between June 2021 and March 2023. All participants completed supervised game-based circuit exercise sessions twice weekly for 12 weeks. Motivation and self-efficacy outcomes were assessed using the Intrinsic Motivation Inventory (IMI) and the Stroke Self-Efficacy questionnaire (SSEQ). Measurements were obtained at baseline and at 12 and 36 weeks of intervention. A paired t-test was used for data analysis. Results: Post-training, IMI-interest and IMI-competence scores increased significantly (p<0.001), with gains of 6% and 9%, respectively, while mean SSEQ scores improved by 12% from baseline (p<0.001). Participants also reported reduced pressure/tension, demonstrated by a 12% decrease in this subscale (p<0.05) with small effect sizes of 0.3. In contrast, IMI-perceived choice did not change significantly between baseline and 12-week post-intervention (p>0.05). At six-month follow-up, participants showed sustained significant improvements in interest/enjoyment, perceived competence, reduced tension and clinically meaningful gains in self-efficacy (p<0.05) with medium effect sizes of 0.2 to 0.3, while perceived choice remained stable. Conclusion: Overall, the game-based circuit exercise generated psychosocial benefits that persisted well beyond the active training period.