# Age Differences in Flow Experience During Body Movement–Controlled Video Game Rehabilitation Tasks: Cross-Sectional Study

## TL;DR

Older adults experience less flow during movement-controlled video game rehabilitation tasks compared to younger adults, suggesting the need for age-specific design adjustments.

## Contribution

The study provides empirical evidence of age-related differences in flow experience during BMCVG rehabilitation tasks and identifies key dimensions affected by age.

## Key findings

- Older adults had significantly lower overall flow experience compared to younger adults.
- Dimensions like 'sense of control' and 'challenge-skill balance' showed the most significant age-related differences.
- Tailoring game design with clearer goals and reduced motor demands could improve engagement in older adults.

## Abstract

Body movement–controlled video games (BMCVGs) are increasingly adopted in rehabilitation because they combine physical training with interactive engagement. Flow experience, a critical factor for enhancing user engagement and training efficacy, exhibits age-related differences that are essential for designing age-appropriate rehabilitation tasks. However, current BMCVG rehabilitation tasks often overlook these age-related differences in subjective experience, leading to insufficient engagement among older adults.

This study aimed to explore differences in flow experience between younger and older adults when performing the same BMCVG rehabilitation task and to provide empirical evidence for designing personalized and age-appropriate programs.

A total of 40 participants were recruited, including 21 older adults (mean age 63.00, SD 6.64 y; n=10, 48% male participants) and 19 younger adults (mean age 24.68, SD 1.16 y; n=9, 47% male participants). Participants performed the “Space Pop” task in Kinect Adventures, simulating limb coordination training. Flow experience was assessed using the Chinese version of the Flow State Scale-2, which measures 9 dimensions of flow. Group differences were analyzed using the nonparametric Wilcoxon rank-sum tests, and effect sizes (Cohen d) were calculated via bootstrap estimation.

Older adults exhibited significantly lower overall flow experience than younger adults (W=339.5; P<.001; Cohen d=1.45; η2=0.37). Significant differences were also found in the dimensions of “challenge-skill balance” (W=339; P<.001); “clear goals” (W=271; P=.04); “sense of control” (W=389.5; P<.001); and “loss of self-consciousness” (W=268; P=.048). The largest effect was observed in the “sense of control” dimension (Cohen d=3.22; η2=0.74), indicating it was the most significantly impacted by age. Other dimensions (eg, concentration and time transformation) showed no significant differences.

Age plays a significant role in shaping flow experiences during BMCVG rehabilitation tasks. Older adults’ reduced flow may be attributed to declines in cognitive processing speed, motor control, and self-efficacy, which particularly impair their sense of control and goal clarity. Tailoring designs through strategies such as dynamic difficulty adjustment, clearer goal cues, and reduced motor demands is crucial. These adaptations can enhance older adults’ sense of control and immersion, promoting active participation and ultimately improving rehabilitation outcomes.