Understanding adherence and its impact on function in a six-month step exergame intervention for people with multiple sclerosis

OBJECTIVES: To identify predictors of adherence to a six‐month home‐based step exergame intervention to prevent falls and determine the effects of adherence on physical, cognitive and psychological function outcomes in people with MS. METHODS: This is a secondary analysis of a multi‐site randomised controlled trial of a six‐month home‐based step exergame intervention versus usual care in 469 people with MS. Intervention participants were asked to undertake step exergame training for 120 min/week. Adherence was captured by the step exergame system. Participants' baseline characteristics were examined as predictors of adherence. Higher adherers to the intervention were compared to the control group in physical, cognitive and psychological outcome measures. RESULTS: Older age, lower body mass index, site location and fewer depressive symptoms were independent significant predictors of improved adherence to the step exergame intervention. Compared to control participants (n = 228), high adherers (≥100 min/week) (n = 71) reported fewer symptoms of fatigue following the intervention. In a sub‐sample of participants who undertook physical and cognitive tests, 25 high adherers made significantly fewer errors in the Stroop stepping test compared to 104 controls. CONCLUSION: People with MS who were older, had a lower body mass index, and reported fewer depressive symptoms were more likely to adhere to a step exergame intervention to prevent falls. Higher adherers demonstrated clinically meaningful benefits, including reduced fatigue and improved performance on a cognitively demanding stepping task, changes that are directly relevant to daily functioning and fall risk. These findings may help identify individuals who require additional support to engage with and fully benefit from home‐based exergame programs.