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

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, upper-limb dexterity, cognitive performance, reaction time, mood, 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: Enrolling by invitation
• Conditions: Sarcopenia in Elderly; Frailty at Older Adults
• Intervention / Treatment: Behavioral: Exergaming-based sitting Tai Chi; Behavioral: General health education

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, upper-limb dexterity, global cognition, reaction time, anxiety, depression, 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: Interventional
• Enrollment (Estimated): 152
• Phase: Not Applicable

Contacts and Locations

Study Locations

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

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
Maximal handgrip strength	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

Outcome Measure	Measure Description	Time Frame
Skeletal Muscle Mass Index (SMI)	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)	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)	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).
Upper-Limb Dexterity on the Box and Block Test	Change in upper-limb dexterity and eye-hand coordination measured by a modified Box and Block Test. Participants are instructed to transfer 9 wooden cubes, one at a time, over a central partition as quickly as possible using the dominant hand. The total time required to transfer all 9 cubes is recorded in seconds. Higher scores (shorter completion times) indicate better upper-limb dexterity and eye-hand coordination.	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).
Global Cognition on the Montreal Cognitive Assessment, Chinese Version	Change in global cognition measured by the Chinese version of the Montreal Cognitive Assessment (MoCA). Total scores range from 0 to 30, with higher scores indicating better cognitive 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).
Reaction Time on a Computer-Based Finger-Press Reaction Task	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).
Anxiety on the Chinese Hospital Anxiety and Depression Scale Anxiety Subscale	Change in anxiety symptoms measured by the anxiety subscale of the Chinese Hospital Anxiety and Depression Scale (HADS-A). Scores range from 0 to 21, with higher scores indicating more severe anxiety symptoms.	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).
Depression on the Chinese Hospital Anxiety and Depression Scale Depression Subscale	Change in depressive symptoms measured by the depression subscale of the Chinese Hospital Anxiety and Depression Scale (HADS-D). Scores range from 0 to 21, with higher scores indicating more severe depressive symptoms.	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	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)	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

• Sponsor: Hong Kong Metropolitan University
• Investigators: Principal Investigator: Tai Wa Liu, PhD, Hong Kong Metropolitan University

Publications and helpful links

General Publications

• Tsang WW, Gao KL, Chan KM, Purves S, Macfarlane DJ, Fong SS. Sitting tai chi improves the balance control and muscle strength of community-dwelling persons with spinal cord injuries: a pilot study. Evid Based Complement Alternat Med. 2015;2015:523852. doi: 10.1155/2015/523852. Epub 2015 Jan 21.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2026
• Primary Completion (Estimated): September 30, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: May 21, 2026
• First Submitted That Met QC Criteria: May 29, 2026
• First Posted (Actual): June 1, 2026

Study Record Updates

• Last Update Posted (Actual): June 8, 2026
• Last Update Submitted That Met QC Criteria: June 4, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: frailty; Tai Chi; sarcopenia; exergaming
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neuromuscular Manifestations; Pathologic Processes; Pathological Conditions, Anatomical; Muscular Atrophy; Atrophy; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Frailty; Sarcopenia
• Other Study ID 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