JMIR Publications

ABSTRACT

Background:

Early rehabilitation is essential for post-transplant inpatients, who typically develop profound deconditioning and intensive care unit (ICU)-acquired weakness. However, systemic resources and clinical constraints often lead to insufficient rehabilitation doses, compounding the challenge for bed-bound patients. Although exergaming can be an adjunct to usual rehabilitation, its feasibility for post-ICU inpatients remains unclear.

Objective:

We evaluated the utility of Nintendo Ring Fit Adventure™ (NFA) as an adjunct for augmenting rehabilitation volumes.

Methods:

This prospective, single-center, feasibility study, conducted at a tertiary hospital between October 2024 and October 2025, included non-ambulatory adult post-transplant inpatients (Functional Ambulation Category (FAC) ≤ 3). Exclusion criteria were clinical instability, cognitive or sensory impairments precluding participation, and musculoskeletal constraints limiting bed-based exercise. Aside from usual physical therapy, participants received 10 sessions of an individually prescribed in-bed NFA program. The primary objective was to assess feasibility and safety. Secondary objectives included changes in muscle strength and physical function measures (Medical Research Council Sum Score (MRC-SS), FAC, ICU Mobility Scale (ICUMS)) and patient-reported satisfaction and health-related quality of life.

Results:

Of 26 patients enrolled, 20 completed the final evaluation. Participants had prolonged ICU stays (mean 25.8 (SD 12.3 days)) and mechanical ventilation courses (mean 21.9 (SD 13.3 days)) and severe baseline functional impairment (FAC: 0.5 [interquartile range: 0–1]). NFA feasibility was high, with 99.5%(199/200) of planned sessions and 96.9%(1875/1936) of prescribed movements completed and no adverse events (hemodynamic instability or device-related complications) reported. Heart rate responses were consistently within the safety range, corresponding to very light to light exercise intensity. Significant improvements in MRC-SS, FAC, and ICUMS (P<.001) paralleled a progressive increase in prescribed exercise duration. Participants reported high levels of satisfaction, motivation, and perceived effectiveness.

Conclusions:

An individualized in-bed NFA exergaming program is feasible, safe, and highly acceptable for severely deconditioned inpatients requiring structured, therapist-guided physical rehabilitation. Clinical Trial: Trial Registration: ClinicalTrials.gov NCT06937463; https://clinicaltrials.gov/study/NCT06937463?term=NCT06937463&rank=1