Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study.

Knee injury prevention and rehabilitation exercises often work biomechanically but feel repetitive, and low enjoyment can undermine how consistently people actually do them. This trial tested a training approach called MOTIFS, which pairs physical exercises with mental imagery and sport-specific context, against standard care-as-usual training that used physical exercise alone, in a crossover design where the same athletes tried both. Athletes rated MOTIFS training as more enjoyable than the standard training, and several secondary measures, including mood-related ratings, perceived exertion, heart rate, and training duration, also differed between the two conditions in favor of MOTIFS. The study is small, involving 30 athletes from team ball sports, so it speaks to enjoyment and engagement rather than to whether this approach actually changes injury or rehabilitation outcomes, which the authors say still needs testing.

If you've ever found injury-prevention or rehab exercises boring, you're not alone, and that boredom can matter because people are less likely to stick with exercises they don't enjoy. This study looked at a training method called MOTIFS, which combines physical movements with mental imagery and sport-specific scenarios, and compared it to standard exercise-only training in the same group of 30 athletes who tried both approaches. The athletes reported enjoying the MOTIFS-style training more than the standard training, and other measures like mood and effort also came out differently in favor of MOTIFS.

This is encouraging for making training feel more engaging, but it's a small study focused on one group of young, previously or currently active athletes, and it did not test whether this approach actually reduces injuries or improves rehabilitation recovery. So while it hints that mixing mental and physical training could make exercise sessions more enjoyable, it doesn't yet tell us whether that translates into better physical outcomes.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This trial addresses a practical adherence question: when physical exercises for knee injury prevention or rehabilitation feel repetitive, does adding a structured motor-imagery component (the MOTIFS model) make the session more enjoyable than standard exercise-only training? The primary outcome, enjoyment measured with the Physical Activity Enjoyment Scale, was notably higher after MOTIFS training compared with care-as-usual (point estimate 24.67, 95% CI 19.0 to 30.3), and secondary psychological measures (valence, arousal, dominance), perceived exertion, pulse, and training duration also differed between conditions in the same direction. The design, a block-randomized 2x2 crossover trial in 30 athletes aged 18 to 31 from team ball sports, means each participant experienced both conditions, strengthening within-person comparison of enjoyment and psychological response, but the sample is small and drawn from a specific athletic population without existing pain or movement-limiting injury. This limits generalizability to broader rehabilitation populations, including older adults or those with more significant pathology. Crucially, the abstract frames this as evidence about enjoyment and psychological engagement, not injury prevention or rehabilitation effectiveness.

The authors explicitly note that further studies are needed to explore whether MOTIFS principles affect actual injury prevention or rehabilitation outcomes, so this trial should be read as informing adherence-related training design considerations rather than establishing clinical benefit for injury reduction or recovery.