## 4 Discussion  
The aim of the present study was to assess the influence of a constant resistance video-based engagement paradigm for pedalling on cadence control, as well as self-reported outcome measures including motivation and enjoyment in stroke patients and a contrasting cohort of healthy younger adults. A secondary aim was to compare the findings to cases pedalling with performance feedback data only and baseline pedalling (i.e., no feedback or engagement). The provision of performance feedback or video-based engagement during low-speed pedalling in stroke patients improved pedalling performance to a similar degree, as demonstrated by a lower speed deviation from the target and CV. While the capacity of stroke patients to maintain a fixed pedalling speed was improved with feedback and engagement, this occurred to a lesser extent at high cadence. As the ventilatory threshold is approached, the ability to meet the oxygen demands of the body is reduced, particularly that of the concentric and eccentric activations of the synergistic agonist and antagonist muscles that generate lower limb flexion and extension joint torques. Neuroplastic adaptations to stroke, altered motor commands, changes in motor performance, and cognitive decline are known to occur in stroke [28] and may have contributed to reduced capacity to maintain target pedalling cadence relative to the healthy adult subjects. \begin{table}
\begin{tabular}{l l l l} \hline \hline
**Question** & & \multicolumn{1}{c}{**Healthy Adults**} & \multicolumn{1}{c}{**Stroke Patients**} \\  & & **(n = 18)** & **(n = 13)** \\ \hline Did you observe a difference between exercise & Yes & 17 (94.4\%) & 11 (84.6\%) \\ sessions when you received feedback compared to & No & 1 (5.6\%) & 2 (15.4\%) \\ when you didn’t? & 1 don’t know & 0 (0\%) & 0 (0\%) \\ \hline \multirow{4}{*}{How did you find your experience of pedaling with performance feedback?} & 5. Really enjoyed & 4 (22.2\%) & 2 (15.4\%) \\  & 4. Enjoyed & 10 (55.6\%) & 8 (61.5\%) \\  & 3. Neutral & 3 (16.7\%) & 1 (7.7\%) \\  & 2. Slightly troublesome & 1 (5.6\%) & 2 (15.4\%) \\  & 1. A hindrance & 0 (0\%) & 0 (0\%) \\ \hline \multirow{4}{*}{How did you find your experience of pedaling with video-based engagement?} & 5. Really enjoyed & 8 (44.4\%) & 3 (23.1\%) \\  & 4. Enjoyed & 7 (38.9\%) & 9 (69.2\%) \\  & 3. Neutral & 2 (11.1\%) & 1 (7.7\%) \\  & 2. Slightly troublesome & 1 (5.6\%) & 0 (0\%) \\  & 1. A hindrance & 0 (0\%) & 0 (0\%) \\ \hline \multirow{4}{*}{Would you perform pedaling exercise with performance feedback in the future if given the opportunity?} & Yes & 15 (83.3\%) & 11 (84.6\%) \\  & No & 0 (0\%) & 1 (7.7\%) \\  & 1 don’t know & 3 (16.7\%) & 1 (7.7\%) \\ \hline \multirow{4}{*}{Do you believe video-based engagement in the future if given the opportunity?} & Yes & 14 (77.8\%) & 13 (100.0\%) \\  & No & 1 (5.6\%) & 0 (0\%) \\  & 1 don’t know & 3 (16.7\%) & 0 (0\%) \\ \hline \multirow{4}{*}{Do you believe performance feedback during pedaling is of benefit to your exercise?} & Yes & 16 (88.9\%) & 11 (84.6\%) \\  & No & 2 (11.1\%) & 2 (15.4\%) \\  & No & 2 (11.1\%) & 2 (15.4\%) \\  & 1 don’t know & 0 (0\%) & 0 (0\%) \\ \hline \multirow{4}{*}{Would performance feedback during pedaling encourage you to exercise more?} & Yes & 16 (88.9\%) & 11 (84.6\%) \\  & No & 2 (11.1\%) & 2 (15.4\%) \\  & 1 don’t know & 0 (0\%) & 0 (0\%) \\ \hline \multirow{4}{*}{Would video-based engagement during pedaling encourage you to exercise more?} & Yes & 16 (88.9\%) & 12 (92.3\%) \\  & No & 2 (11.1\%) & 2 (15.4\%) \\ \cline{1-1}  & 1 don’t know & 0 (0\%) & 0 (0\%) \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Self-reported outcome survey, including results for both stroke patients and healthy young adult participants. External audiovisual stimuli during video-mediated pedalling, and the enjoyment of performing exercise with feedback and engagement, may have provided a dissociation from the physiological cues associated with exertion during pedalling including muscle pain and heavy breathing.