Original Article Published on 29 Jul, 2026

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

Game-Based Circuit Exercises among Stroke Survivors
Vol. 21 No. 2 : 2026 (963-986)

Mohd Naqiuddin Johar Mohd Naqiuddin Johar
Nor Azlin Mohd Nordin Nor Azlin Mohd Nordin
Aznida Firzah Abdul Aziz Aznida Firzah Abdul Aziz

Abstract
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.
Keywords : Function; quality of life; stroke,
Abstrak
Pemandiri strok kerap mengalami kemerosotan fungsi yang menjejaskan tahap kendiri dan kualiti hidup. Senaman litar terbukti memberi manfaat, namun bukti mengenai integrasi elemen permainan dalam rehabilitasi masih terhad. Checkercise®, iaitu senaman litar berasaskan permainan yang inovatif, dibangunkan untuk menggabungkan latihan terapeutik dengan pengalaman interaktiviti yang menyeronokkan. Kajian ini menilai keberkesanannya berbanding senaman litar konvensional. Satu kajian rawak terkawal telah dijalankan melibatkan 88 pemandiri strok subakut (min umur = 58.6 + 9.9 tahun) yang dibahagikan kepada kumpulan kajian (Checkercise®) atau kawalan. Kedua-dua kumpulan mengikuti sesi latihan berjadual dua kali seminggu selama 12 minggu di bawah pengawasan ahli fisioterapi. Ukuran hasil meliputi ujian duduk berdiri 30 saat (kekuatan kaki), Dynamic Gait Index (DGI) (kestabilan badan), ujian berjalan 6 minit (ketahanan aerobik) dan soal selidik Short Form-36 (SF-36) (kualiti hidup). Penilaian dilakukan pada peringkat awal (pra-ujian), minggu ke-12, ke-24 dan ke-36. Analisis menggunakan mixed model ANOVA telah dijalankan. Hasil kajian menunjukkan kesan interaksi yang signifikan (p < 0.05) dengan saiz kesan yang kecil (0.03–0.04) terhadap ujian duduk berdiri 30 saat dan skor fizikal serta mental SF-36, dengan peningkatan lebih besar dalam kumpulan kajian (ujian duduk berdiri 30 saat: +34%; skor fizikal SF-36: +41%; skor mental SF-36: +29%) berbanding kumpulan kawalan. Kesan kumpulan kajian yang signifikan (p < 0.05) dengan saiz kesan kecil (0.04–0.05) turut dicatat untuk DGI (+18% berbanding +16%) dan ujian berjalan 6 minit (+30% berbanding +25%). Analisis post hoc mengesahkan peningkatan prestasi yang berkekalan sehingga 6 bulan (p < 0.05) dalam kumpulan kajian bagi ujian duduk berdiri 30 saat (10%), DGI (4%), ujian berjalan 6 minit (12.8%), dan komponen fizikal soal selidik SF-36 (8.9%), manakala kumpulan kawalan hanya mengekalkan peningkatan pada DGI sahaja (4.5%). Kesimpulannya, Checkercise® berkesan dalam meningkatkan serta mengekalkan fungsi fizikal dan kualiti hidup, seterusnya berpotensi sebagai strategi rehabilitasi yang menarik dan berkesan.
Kata Kunci : Fungsi; kualiti hidup; strok,

Correspondance Address
*Correspondence: norazlin8@ukm.edu.my


Design of the Checkercise® board

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