Impact of Nintendo Ring Fit exergaming on lower-limb asymmetry and joint angles in women with chronic nonspecific low back pain during obstacle crossing

Nintendo Ring Fit Adventure (RFA) is a non-immersive exergame involving dynamic, whole-body movements. It provides a gamified alternative to conventional therapy, potentially promoting functional motor adaptations. This study aimed to investigate the effects of RFA on lower-limb bilateral asymmetry and maximum joint angles in female patients with chronic nonspecific low back pain (CNLBP) during obstacle crossing. This study employed a randomized crossover trial. Twenty female patients with CNLBP were randomly assigned to receive both Switch Training (SWI) and Traditional Training (TRA) in a counterbalanced sequence. During the tests, participants crossed obstacles at three different heights (30%, 20%, and 10% of leg length (LL)). Kinematic data were collected using a 10-camera motion capture system, and ground reaction forces were recorded using three force platforms. Bilateral gait asymmetry indices and maximum joint angles of the lower limbs were calculated for each trial. A two-way repeated-measures ANOVA (2 × 3 design) was conducted to assess the effects of training condition (SWI and TRA) and obstacle height (30%, 20%, 10% of LL) on these parameters. When crossing obstacles at heights of 30% and 20% of LL, the SWI group showed lower swing time (SW) (left: P30% = 0.001, P20% < 0.001; right: P30% < 0.001, P20% = 0.004), stance time (ST) (left: P30% < 0.001, P20% < 0.001; right: P30% = 0.001, P20% = 0.004), and swing time/stance time (SW/ST) (left: P30% < 0.001, P20% < 0.001; right: P30% < 0.001, P20% < 0.001), and lower maximum angles of the hip and knee joints (all P < 0.05) than the TRA group. However, there were no significant differences in bilateral asymmetry or maximum joint angles between the SWI and TRA groups when crossing obstacles at 10% of LL (all P > 0.05). Nintendo RFA training improved lower-limb asymmetry and movement patterns in female patients with CNLBP when crossing higher obstacles (30% and 20% of LL), reflected by reduced temporal parameters and joint angles. These improvements may contribute to safer obstacle-crossing performance. This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2300068231) on 10/02/2023.