Co-developing a novel gamified strength and balance training programme designed to slow disease progression in primary hereditary ataxia: a feasibility and acceptability study.

We will facilitate co-production workshops with people with ataxia and their carers/families to identify barriers and facilitators to physical activity. Individuals with ataxia will be exposed to gamified seated eccentric strength training and static balance training exercises to gain their thoughts on these types of exercises to ensure the internal validity of the exercises and co-design a novel physical activity programme that could improve physical function and quality of life.

We will undertake several workshops with people with ataxia (a neuromuscular condition) and their carers/families to identify factors that help or hinder physical activity. These individuals will be shown gamified seated muscle lengthening (eccentric) strength and static balance training exercises to gain their thoughts on these types of exercises to ensure they are appropriate for them to undertake and help to design a new physical activity programme that could improve physical function and quality of life.

Barriers to physical activity included poor motivation, balance, fear of falling, and fatigue, but needing to attend a local facility to access specialist equipment was not a barrier. In fact, a preference to exercise away from home was revealed, with a reduced motivation for, and adherence to, home-based activities. There was a high level of acceptability for our proposed eccentric-dominant modifications to familiar home-based exercises. Laboratory-based gamified seated eccentric strength training machines were well received whilst balance training exercises on an unsteady platform was met with reluctance from many, despite the presence of handles to prevent falls. Co-developed programme design recommended the need for ‘YouTube’ video to demonstrate correct technique, a range of core, lower and upper body exercises performed 2-7/week at 30-60 min per session for a minimum of 12 weeks. These findings are invaluable as they confirm the feasibility and suitability of these exercises for an ataxia population and provide useful information on programme design to help co-produce a novel exercise programme that would be acceptable to individuals with ataxia.