Effectiveness of Game-based Circuit Exercises on Physical Functions and Quality of Life in Stroke Survivors: A Randomised Controlled Trial in Malaysia

Stroke survivors often experience functional decline that limits independence and reduces quality of life.Circuit exercise enhances functional outcomes; however, evidence on incorporating gaming into rehabilitation remains scarce.Checkercise ® , a novel game-based circuit exercise, was developed to integrate therapeutic training with engaging gameplay.This study examined its effectiveness compared with conventional circuit exercise.A parallel randomised controlled trial was conducted with 88 subacute stroke survivors (mean age = 58.6 + 9.9 years), randomised to experimental (Checkercise ® ) or control groups.Both groups received supervised sessions twice weekly for 12 weeks.Outcomes included the 30-second chair rise test (lower limb strength), Dynamic Gait Index (DGI) (dynamic balance), 6-minute Walk Test (6mWT) (aerobic endurance) and Short Form-36 (SF-36) (quality of life).Assessments were performed at baseline (pre-assessment) and at 12, 24 and 36 weeks.Mixed-model ANOVA was used for analysis.Results showed significant interaction effects (p < 0.05) with a small effect size (0.03-0.04) for lower limb strength and SF-36 physical and mental scores, with greater improvements in the experimental group (30 second chair rise test: +34%; SF-36 physical: +41%; mental: +29%) versus controls.Significant group effects (p<0.05) with a small effect size (0.04-0.05) were also observed for DGI (+18% versus +16%) and 6mWT (+30% versus +25%).Post hoc analyses demonstrated sustained improvements at six months (p < 0.05) for 30-second chair rise test (10%), DGI (4%), 6mWT (12.8%) and the SF-36 physical scores (8.9%) in the experimental group, while the control group retained gains only in DGI (4%) (p<0.05).In conclusion, Checkercise ® was effective in improving and sustaining physical functions and quality of life, supporting its potential as an engaging rehabilitation strategy.