## 4 Discussion
This is reflected in findings of an increase in peak pedalling speed for a given blood lactate level while watching a prerecorded video during pedalling, improvements in pedalling speed and distance, higher intensity exercise while cycling with video assistance, and no change in self-perceived exertion relative to pedalling without video stimulus [19; 20]. However, altered brain activation, volitional motor commands, and pedalling performance following stroke are associated with abnormal muscle activation patterns, kinetics, and kinematics during pedalling [28]. As a result, the task of maintaining a constant cadence during pedalling while focusing on performance feedback data and video-based engagement is likely to be physically and cognitively more challenging in stroke patients compared to healthy adults. This may ultimately limit the capacity of stroke patients to dissociate themselves from the physical exertion of pedalling with feedback and engagement relative to healthy individuals, particularly for tasks requiring high exertion. Enjoyment and efficacy are important factors in the adoption and long-term sustenance of exercise-based therapies [29; 30], particularly in overcoming motivation barriers that prevent sedentary adults with functional deficits from being physically active. While this study is a proof of concept, and further long-term data are required to quantify the influence of feedback and engagement during pedalling on motor control, balance, and gait in rehabilitation, our preliminary data indicate high levels of enjoyment and self-reported motivation with exercise performance feedback and video-based engagement during pedalling for both stroke patients and healthy young adults. For instance, 92.3% of stroke patients either enjoyed or really enjoyed the video engagement regime, with 92.3% stating that video-based engagement would help motivate them to adhere to a routine of pedalling-based exercise therapy. Participants in a variety of other exercise monitoring studies have reported greater enjoyment in physical exercise when aided with video [29; 30; 31], music [17; 20; 32], gaming [33; 34], or immersive virtual reality [35; 36]. A shift from a focus on internal sensations to an external attentional focus, via external distracting stimuli, has been shown to correlate with a decrease in perceived exercise exertion and an increase in exercise enjoyment and performance for moderate intensity levels in adults [37]. However, further research ought to be performed to evaluate the effectiveness of engagement and feedback during progressive resistance training, which is a widely accepted rehabilitation approach to improve strength and function following injury or neuromuscular impairment [38]. This study has limitations that should be considered when interpreting the results. First, this was a single-centre study with a small heterogeneous sample of stroke patients, and the findings may be different in larger cohorts or patients with different levels of neuromuscular impairment. Second, some of the significant mean differences in cadence observed in this study between test conditions were small, and these data ought to be interpreted with caution. Third, the two cohorts assessed were not aged-matched, and so the influence of age on pedalling performance is a confounding variable. Nonetheless, the results provide broad preliminary evidence for the effectiveness of video-based engagement on pedalling performance in these two contrasting groups. Fifth, the duration of the pedalling exercise was chosen to minimise physical exertion and fatigue in stroke patients, and the results may vary with extended pedalling duration. In addition, the low and high speeds employed, which were selected in consultation with a stroke rehabilitation therapist, represent typical cadences used in stroke therapy, and deviation from these may ultimately influence pedalling control performance and engagement.