Acute Effect of Exergaming Based Sitting Tai Chi

Acute Effect of Exergaming-Based Sitting Tai Chi on Prefrontal Cortex Efficiency in Young and Older Adults: An fNIRS Study

This study examines whether a single session of exergaming-based seated Tai Chi can acutely improve working memory, executive function, and prefrontal cortical efficiency in younger and older adults, compared with seated stretching. Using a within-subject crossover design, 40 participants aged 18-30 years and 60-75 years will complete both conditions in counterbalanced order on separate days. Cognitive performance will be assessed with Flanker and n-back tasks, while prefrontal activity will be recorded with fNIRS over the dorsolateral, ventrolateral, and frontopolar prefrontal cortex. Neural efficiency will be estimated by integrating task performance with task-evoked oxygenated hemoglobin responses.

The Tai Chi intervention is a 40-minute seated, exergame-guided 12-form routine preceded and followed by brief warm-up and cool-down periods. The control condition is a time-matched seated stretching programme without Tai Chi-specific movements or game feedback. Both conditions will be delivered at light-to-moderate intensity and supervised for safety and adherence.

The study tests whether acute exergaming-based seated Tai Chi produces greater post-intervention improvements in cognitive performance and more efficient prefrontal activation than stretching, and whether these effects differ by age group. Findings may clarify how a feasible seated mind-body exergame influences acute cognitive and neural responses across the adult lifespan.

Study Overview

• Status: Not yet recruiting
• Conditions: Healthy
• Intervention / Treatment: Behavioral: Seated Stretching; Behavioral: Exergaming based sitting Tai Chi

Detailed Description

This proposal examines the immediate cognitive and neural effects of a seated, exergame-supported Tai Chi session in younger and older adults. The study is designed to test whether a single bout of this low-impact mind-body exercise can influence working memory, inhibitory control, and prefrontal cortex activity more effectively than a seated stretching session of equal duration. By comparing two age groups, the project also seeks to determine whether age modifies the size or pattern of these acute responses.

The study uses a randomized within-subject crossover design, in which each participant completes both the exergaming-based seated Tai Chi condition and the control stretching condition on separate days. Forty older adults will be recruited, including 20 younger adults aged 18-30 years and 20 older adults aged 60-75 years. Before and after each session, participants will complete computerized cognitive tasks measuring executive function and working memory. At the same time, brain activity will be monitored with functional near-infrared spectroscopy, focusing on prefrontal regions linked to attention, control, and task monitoring.

The Tai Chi session is delivered through an interactive exergame platform that standardizes movement pace, provides visual and auditory cues, and includes a structured sequence of seated Tai Chi forms. This format is intended to preserve the cognitive-motor features of Tai Chi while making the activity accessible to adults who may have limited mobility. The comparison condition consists of seated stretching exercises matched for overall duration and physical effort but without Tai Chi-specific sequencing or game-based feedback.

Outcome analysis will compare changes in task performance, prefrontal oxygenation, and a combined neural efficiency index across conditions, time points, and age groups. The study aims to clarify whether this form of seated exergaming can produce measurable short-term benefits for cognition and brain efficiency, and whether such effects differ between younger and older adults.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Chun Yan Ho; Phone Number: 852 + 39708714; Email: twliu@hkmu.edu.hk

Study Locations

• Hong Kong
  • Kowloon
    • Ho Man Tin, Kowloon, Hong Kong
      • Exergaming Research Centre, Hong Kong Metropolitan University
      • Contact: Tai Wa Liu; Phone Number: 852 + 39708714; Email: twliu@hkmu.edu.hk
      • Principal Investigator: Tai Wa Liu, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Are aged 18-30 years (young adult group) or 60-75 years (older adults)
• Have no current regular participation (e.g., ≥1 session/week) in Tai Chi, martial arts, or other mind-body exercise (e.g., yoga or qigong) in the last 3-6 months
• Have no self-reported or clinically documented history of mild cognitive impairment, dementia, or other neurological (e.g., stroke) or psychiatric disorders (e.g., schizophrenia) known to affect cognition
• Score within the normal range on the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) based on established age- and education-adjusted cutoffs
• Are medically stable, with or without controlled chronic conditions (e.g., controlled hypertension or diabetes)
• Are able to tolerate light-to-moderate seated exercise (Chinese version of Physical Activity Readiness Questionnaire score = 0)
• Have no significant sensory impairment (e.g., vision) not corrected by assistive devices (e.g., glasses)
• Are not engaged in regular structured exercise involving moderate-to-vigorous intensity physical activity (e.g., brisk walking, running, or racquet sports) more than two times per week over the preceding three months
• Are able to communicate in Chinese (Moved from Exclusion for clarity)

Exclusion Criteria:

• Have medical conditions that may interfere with safe participation, including pacemaker implantation or prosthetic devices
• Have serious orthopedic or cardiovascular disorders that could affect participation in exergaming training
• Have significant motor or balance impairment that would prevent performing basic seated arm and trunk movements
• Are currently undergoing other clinical trials or structured exercise or cognitive training programmes >2 times/week during the preceding three months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Crossover Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Seated stretching; In the seated stretching condition, participants will complete a series of structured, low-intensity exercise program that would contain comparable social interaction and enjoyment without providing any strength and balance training benefits of Tai Chi. This will match in overall duration and approximate movement amplitude to the Tai Chi sequence but without game-based feedback or Tai Chi-specific components.	Behavioral: Seated Stretching; In the seated stretching condition, participants will complete a series of structured, low-intensity exercise program that would contain comparable social interaction and enjoyment without providing any strength and balance training benefits of Tai Chi. This will match in overall duration and approximate movement amplitude to the Tai Chi sequence but without game-based feedback or Tai Chi-specific components.; Other Names: Intervention
Experimental: Exergaming based sitting Tai Chi; An acute exergaming-based seated Tai Chi protocol will be adapted from a newly developed 12-week training programme by our team, and will be further aligned with acute Tai Chi session parameters reported by a previous Tai Chi study, including comparable total duration, work-rest structure, and target light-to-moderate intensity. Participants will perform upper-limb and trunk movements derived from traditional Tai Chi forms, adapted for a seated posture and integrated into an interactive exergame environment that provides visual feedback and performance scoring to enhance engagement and standardize practice. Movements will be paced using on-screen cues and visual and auditory signals to control tempo across participants.	Behavioral: Exergaming based sitting Tai Chi; An acute exergaming-based seated Tai Chi protocol will be adapted from a newly developed 12-week training programme by our team, and will be further aligned with acute Tai Chi session parameters reported by a previous Tai Chi study, including comparable total duration, work-rest structure, and target light-to-moderate intensity. Participants will perform upper-limb and trunk movements derived from traditional Tai Chi forms, adapted for a seated posture and integrated into an interactive exergame environment that provides visual feedback and performance scoring to enhance engagement and standardize practice. Movements will be paced using on-screen cues and visual and auditory signals to control tempo across participants.; Other Names: Active control

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prefrontal cortical activation during inhibitory control (Flanker task)	Prefrontal cortical activity (oxyhemoglobin concentration, µM) will be recorded using functional near-infrared spectroscopy (fNIRS) during the Eriksen Flanker Task, which assesses inhibitory control. Regions of interest include the dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), and frontopolar prefrontal cortex (FPC). Measurements will be taken before and immediately after a single session of exergaming-based seated Tai Chi and a single session of seated stretching in a crossover design. Data will be reported separately for each condition. Unit of Measure: µM (micromolar) oxyhemoglobin concentration.	Baseline (pre-session) and immediately post-session on 2 consecutive days (Day 1 and 2).
Prefrontal cortical activation during working memory (n-back task)	Prefrontal cortical activity (oxyhemoglobin concentration, µM) will be recorded using functional near-infrared spectroscopy (fNIRS) during the n-back Task, which assesses working memory. Regions of interest include the dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), and frontopolar prefrontal cortex (FPC). Measurements will be taken before and immediately after a single session of exergaming-based seated Tai Chi and a single session of seated stretching in a crossover design. Data will be reported separately for each condition. Unit of Measure: µM (micromolar) oxyhemoglobin concentration.	Baseline (pre-session) and immediately post-session on 2 consecutive days (Day 1 and Day 2)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inhibitory Control Performance on the Eriksen Flanker Task - reaction time	Inhibitory control will be assessed using the computerized Eriksen Flanker Task. Participants will respond to the direction of a central target arrow flanked by congruent or incongruent distractor arrows. Reaction time (milliseconds) will be recorded for incongruent and congruent trials. The outcome metric is the difference in mean reaction time between incongruent and congruent trials (Flanker cost in milliseconds). Lower or less positive values indicate better inhibitory control. Unit of Measure: milliseconds	Baseline (Pre-Session) and Immediately Post-Session on 2 consecutive days (Day 1 and Day 2)
Working Memory Performance on the n-back Task - reaction time	Working memory capacity will be assessed using the computerized n-back Task (e.g., 2-back). Participants will view a sequence of stimuli and indicate whether the current stimulus matches the one presented n positions earlier. Reaction time (milliseconds) will be recorded for each correct response. Lower values indicate better performance (faster responses). The primary metric is the mean reaction time across all trials.	Baseline (Pre-Session) and Immediately Post-Session on 2 consecutive days (Day 1 and Day 2).
Title: Working Memory Performance on the n-back Task - Accuracy	Working memory capacity will be assessed using a computerized n-back task (e.g., 2-back). Participants will view a sequence of stimuli and indicate whether the current stimulus matches the one presented n positions earlier. Accuracy (percentage of correct responses) will be calculated. Higher values indicate better performance (fewer errors). The primary metric is the mean accuracy across all trials.	Baseline (Pre-Session) and immediately post-session on 2 consecutive days (Day 1 and Day 2).
Inhibitory Control Performance on the Eriksen Flanker Task - Accuracy	Inhibitory control will be assessed using the computerized Eriksen Flanker Task. Participants will respond to the direction of a central target arrow flanked by congruent or incongruent distractor arrows. Accuracy (percentage of correct responses) will be calculated for incongruent and congruent trials. The outcome metric is the difference in accuracy between incongruent and congruent trials (Flanker cost in percentage points). Higher or less negative values indicate better inhibitory control. Unit of Measure: percentage points	Baseline (Pre-Session) and immediately post-session on 2 consecutive days (Day 1 and Day 2)

Collaborators and Investigators

• Sponsor: Hong Kong Metropolitan University
• Investigators: Principal Investigator: Tai Wa Liu, School of Nursing and Health Sciences, Hong Kong Metropolitan University

Publications and helpful links

General Publications

• Wang H, Guo Y, Fan H, Chen Z, Liu S, Zhao L, Shi Y. The effects of an acute Tai Chi on emotional memory and prefrontal cortex activation: a fNIRS study. Front Behav Neurosci. 2025 Jan 22;18:1520508. doi: 10.3389/fnbeh.2024.1520508. eCollection 2024.

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): March 31, 2027
• Study Completion (Estimated): March 31, 2027

Study Registration Dates

• First Submitted: April 8, 2026
• First Submitted That Met QC Criteria: April 20, 2026
• First Posted (Actual): April 23, 2026

Study Record Updates

• Last Update Posted (Actual): April 23, 2026
• Last Update Submitted That Met QC Criteria: April 20, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Investigative Techniques; Methods
• Other Study ID Numbers: ATC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Non-identifiable individual participant data is available upon reasonable request to the corresponding author after the report published.
• 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