Exergaming-based Sitting Tai Chi for Sarcopenia and/or Frailty

June 29, 2026 updated by: Dr Liu Tai Wa, Hong Kong Metropolitan University

Exergaming-based Sitting Tai Chi for Older Adults in Residential Care at Risk of Sarcopenia and/or Frailty

This randomized controlled trial will evaluate the effects of an exergaming-based sitting Tai Chi program on muscle strength, physical function, cognition, and psychosocial outcomes in older adults living in residential care facilities who are at risk of sarcopenia and/or prefrailty. Eligible participants aged 60 years or older will be identified using simple screening criteria for sarcopenia and prefrailty and will not meet full diagnostic criteria for sarcopenia or frailty. A total of 152 participants will be randomly assigned to either an individually supervised exergaming-based sitting Tai Chi intervention or a group-based general health education control, each delivered twice weekly for 12 weeks. The primary outcome is dominant-hand grip strength, a core indicator of sarcopenia-related muscle weakness. Key secondary outcomes include sitting balance and functional reach assessed by the Modified Functional Reach Test, with additional secondary measures of muscle mass, lower-extremity function, activities of daily living, reaction time and health-related quality of life. Outcomes will be assessed at baseline, mid-intervention, post-intervention, and 3-month follow-up. The findings will provide preliminary evidence on whether chair-based exergaming Tai Chi can be integrated into routine residential care to support healthy aging and functional independence.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Enrolling by invitation

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

This randomized controlled trial will evaluate the effects of an exergaming-based sitting Tai Chi program on sarcopenia-related muscle weakness, balance, physical function, cognition, and psychosocial outcomes in older adults living in residential care facilities who are at risk of sarcopenia and/or prefrailty. Sarcopenia and frailty are common in residential care and are associated with falls, disability, loss of independence, and mortality. Although conventional exercise and Tai Chi may improve physical function, participation can be difficult for residents with mobility limitations, fluctuating health status, or low motivation. Sitting Tai Chi offers a lower impact alternative, and exergaming may further enhance engagement by providing interactive tasks and real-time feedback. This single-blind, parallel group randomized controlled trial will recruit 152 participants aged 60 years or older from collaborating residential care facilities. Eligible participants must have screening indicators of sarcopenia or prefrailty, score at least 7 on the Chinese (Hong Kong) version of the Abbreviated Mental Test, be able to stand independently for assessment, and be able to follow intervention instructions. Residents with confirmed sarcopenia, confirmed frailty, severe cognitive or sensory impairment, unstable medical conditions, prior regular Tai Chi practice, or current participation in another clinical trial will be excluded. Participants will be randomly allocated in a 1:1 ratio to either an exergaming-based sitting Tai Chi group or a general health education control group, stratified by age, gender, and prefrailty status. Randomization will be performed by an independent off-site researcher using computer software. Outcome assessors and the statistician will be blinded to group allocation, although participants and intervention providers cannot be blinded because of the nature of the intervention. The intervention group will receive a 12-week exergaming-based sitting Tai Chi program delivered twice weekly in 60-minute sessions. The program uses a 12-form sitting Tai Chi exergame with body tracking and real-time feedback. Training progresses from learning mode to skill-specific training and game modes, with a focus on balance control, eye-hand coordination, and limb flexibility. The control group will receive time-matched general health education sessions on generic health topics relevant to older adults, without any content related to sarcopenia, frailty, exercise, or physical activity. All participants will continue to receive usual care and routine activities provided by their residential care facility. Outcome assessments will be conducted at baseline, mid-intervention, post-intervention, and 3-month follow-up. The primary outcome is dominant-hand grip strength. The key secondary outcome is sitting balance and functional reach assessed by the Modified Functional Reach Test. Other secondary outcomes include skeletal muscle mass index, lower-extremity function, activities of daily living, reaction time and health-related quality of life. Data will be analyzed according to the intention-to-treat principle using linear mixed-effects models to examine group-by-time effects. This trial will provide preliminary evidence on whether chair-based exergaming Tai Chi is an effective and practical intervention for older adults at risk of sarcopenia and/or prefrailty in residential care settings.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
152

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Hong Kong
    • Kowloon
      • Ho Man Tin, Kowloon, Hong Kong
        • Exergaming Research Centre, Hong Kong Metropolitan University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • aged ≥60 years;
  • at risk of sarcopenia and/or prefrailty. At risk of sarcopenia is defined as meeting at least one of the following criteria: SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls) score ≥4, calf circumference <34 cm for men or <33 cm for women, while prefrailty is defined as a Fried Frailty Phenotype score of 1-2;
  • score ≥7 on the Chinese (Hong Kong) version of the Abbreviated Mental Test;
  • can stand independently for assessment; and
  • can understand and follow intervention and assessment instructions.

Exclusion Criteria:

  • absence of full diagnostic criteria is required; therefore residents with confirmed sarcopenia as defined by the Asian Working Group for Sarcopenia 2019 or confirmed frailty as defined by the Fried Frailty Phenotype (score 3-5) will be excluded;
  • severe cognitive, sensory, or communication impairments not adequately corrected with aids;
  • uncontrolled medical, neurological, orthopaedic, cardiovascular, or psychiatric conditions that preclude safe participation;
  • prior experience of regular practice of Tai Chi >1 month; or
  • current participation in another clinical trial.
  • absence of full diagnostic criteria is required; therefore, residents with confirmed sarcopenia as defined by the Asian Working Group for Sarcopenia 2019 or confirmed frailty as defined by the Fried Frailty Phenotype (score 3-5) will be excluded;
  • severe cognitive, sensory, or communication impairments not adequately corrected with aids;
  • uncontrolled medical, neurological, orthopedic, cardiovascular, or psychiatric conditions that preclude safe participation;
  • prior regular practice of Tai Chi for more than 1 month; or
  • current participation in another clinical trial.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Exergaming-based sitting Tai Chi
Participants allocated to the intervention group will receive a structured exergaming-based seated Tai Chi program. The program uses a 12-form seated Tai Chi exergame delivered in 24 sessions over 12 weeks, with each session lasting approximately 60 minutes.
Behavioral: Exergaming-based sitting Tai Chi
The structure and content of the 12-form seated Tai Chi routine build on earlier sitting Tai Chi programs developed by Tsang and colleagues for frail older adults and neurological populations. The program targets three domains: (i) balance control, (ii) eye-hand coordination, and (iii) limb flexibility. Training is organized into progressive phases (learning, skill-specific training, and game modes). Each session begins with a 5-minute warm-up and ends with cool-down stretching and breathing exercises.
Placebo Comparator: General health education
Participants allocated to the control group will attend small-group health education sessions focusing on general health topics relevant to older adults (e.g., oral health, common colds, and skin care) for 24 sessions over 12 weeks, with each session lasting approximately 60 minutes.
Behavioral: General health education
Health education will be delivered using audio visual materials, brief talks and interactive discussion to provide engaging but non specific information about daily health management.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Maximal handgrip strength
Time Frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Change in maximal handgrip strength (kg) measured with a Jamar Plus+ Digital Hand Dynamometer. Participants are seated with the elbow flexed at approximately 90 degrees. Three trials per hand are performed, and the highest value recorded from either hand is used. Higher values indicate greater muscle strength.
Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Skeletal Muscle Mass Index (SMI)
Time Frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Change in skeletal muscle mass index (kg/m²) assessed by multi-frequency bioelectrical impedance analysis (MC-780MA, TANITA). Appendicular skeletal muscle mass is obtained from device output and divided by height squared to calculate SMI (kg/m²). Higher values indicate greater muscle mass.
Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Lower-Extremity Function (Five Times Sit-to-Stand Test)
Time Frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Change in performance on the Five Times Sit-to-Stand Test. Participants stand up and sit down five times as quickly as possible from a standard-height chair without using their arms. Time to completion (seconds) is recorded with a stopwatch. Shorter times indicate better lower-extremity function.
Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Independence in Activities of Daily Living (Katz ADL-C)
Time Frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Change in independence in basic activities of daily living measured by the Chinese version of the Katz Index of Independence in Activities of Daily Living (Katz ADL-C). Items cover bathing, transferring, dressing, toileting, eating, and continence. Total scores range from 0 to 6, with higher scores indicating greater dependence in basic activities of daily living.
Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Reaction Time on a Computer-Based Finger-Press Reaction Task
Time Frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Change in reaction time measured by a computer-based finger-press reaction task. Participants respond as quickly as possible when an on-screen box changes color at random intervals. Mean reaction time is recorded in milliseconds. Lower values indicate faster reaction time.
Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Health-Related Quality of Life on the EQ-5D-5L Utility Index
Time Frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Change in health-related quality of life measured by the EuroQol 5-Dimension 5-Level (EQ-5D-5L) utility index. Health states are converted to a utility score using the Hong Kong-specific EQ-5D-5L value set. Utility scores range from values below 0 (health states considered worse than death) up to 1.0 (full health), with higher utility scores indicating better health-related quality of life.
Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Sitting Balance and Functional Reach (Modified Functional Reach Test)
Time Frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Change in sitting balance and forward and lateral functional reach distance (cm) measured by the Modified Functional Reach Test (mFRT). Participants sit on a backless, standard-height chair with hips and knees at approximately 90 degrees and feet flat on the floor. With the shoulder flexed to 90 degrees and the elbow extended, participants reach forward and laterally as far as possible without losing balance or taking a step. The maximal distance reached in each direction by the third metacarpal is recorded using a wall-mounted tape measure. After two practice trials, three test trials are performed in each direction and the mean distance in each direction is used. Greater distances indicate better sitting balance and functional reach.
Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Hong Kong Metropolitan University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Tai Wa Liu, PhD, Hong Kong Metropolitan University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
March 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 30, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 31, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 21, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 29, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 1, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
July 1, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 29, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • ETC - LTCF

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

De-identified individual participant data underlying the published results may be made available upon reasonable request.

IPD Sharing Time Frame

After the study published.

IPD Sharing Supporting Information Type

  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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