Xbox-Based Exergames Versus Structured Home-Based Cognitive Training for Attention and Executive Functions in Healthy Adults

Background: Exergames are increasingly used to support cognition in older adults; however, evidence comparing exergames with non-computerized cognitive training in healthy adults remains limited. Objective: This randomized controlled trial aimed to compare the effects of Xbox-based exergames and structured home-based cognitive training on attention and executive functions in healthy adults. Methods: Twenty healthy adults aged ≥50 years were randomly allocated to either an Xbox-based exergames group (n=10) or a structured home-based cognitive training group (n=10). Both groups received 12 sessions twice weekly. Before and after the intervention, participants were assessed using the Standardized Mini-Mental State Examination, d2 Test of Attention, Stroop Test, WMS-R Digit Span Test, Trail Making Test, and Benton Judgment of Line Orientation Test.

Study Overview

• Status: Completed
• Conditions: Healthy Adults; Cognitive Training; Attention; Executive Functions (EF); Xbox-based Exergames
• Intervention / Treatment: Behavioral: Xbox-based exergames intervention; Behavioral: Structured home-based cognitive training

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Beykoz, Istanbul, Turkey (Türkiye)
      • Istanbul Medipol University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Being 50 years of age or older
• Obtaining a score of 24-30 on the Standardized Mini-Mental State Examination (SMMSE)

Exclusion Criteria:

• A Geriatric Depression Scale (GDS) score ≥9
• A Berg Balance Scale (BBS) score ≤40
• A history of head trauma
• A diagnosis of a psychiatric or neurodegenerative disorder
• A history of alcohol dependence
• The presence of any physical illness

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Xbox-based exergames intervention group	Behavioral: Xbox-based exergames intervention; The intervention was delivered using the Microsoft Xbox 360 Kinect™ as a non-VR exergaming platform. The Kinect system detects and tracks participants' body movements in real time without requiring a handheld controller. Exergames were selected by the researchers (DT, HA, and MK) based on their cognitive demands and relevance to the targeted cognitive functions. The selected games were incorporated into a predetermined intervention session plan. Before the intervention, each game was demonstrated once to familiarize participants with the gameplay and required movements. All games started at a basic level, and progression to advanced levels was determined by the therapists according to each participant's performance. Game levels and repetition numbers were individually adjusted to ensure appropriate progression throughout the intervention. The Xbox-based exergames group received 12 sessions twice weekly.
Active Comparator: Structured home-based cognitive training group	Behavioral: Structured home-based cognitive training; The structured home-based cognitive training program consisted of tasks specifically designed to improve different cognitive skills. The program included cognitive activities such as mathematical sequences, identifying differences between two pictures, finding missing objects, pattern completion, Sudoku, and maze completion. Taken together, these tasks provided a comprehensive and individualized program aimed at strengthening fundamental cognitive skills such as attention, EFs, spatial orientation, and visuomotor coordination. The cognitive tasks included in the structured home-based cognitive training program and their targeted parameters were specified, and the activities were explained to the participants once before implementation. The cognitive tasks and homework assignments were planned and adjusted based on the participants' initial assessment findings and in accordance with their individual performance capacities. This groups also received 12 sessions twice weekly.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Standardized Mini-Mental State Examination (SMMSE)	The SMMSE is a brief 30-item cognitive screening tool that assesses attention, memory, orientation, language, and visuospatial abilities. The Turkish validity and reliability of the Standardized Mini-Mental State Examination (SMMSE) were established by Güngen et al. (2002). In the Turkish version, a cutoff score of 23/24 has been established for dementia.	Baseline and 1 week after completion of the 12-session intervention
d2 Test of Attention	The d2 Test assesses sustained and selective attention, visual scanning, and mental concentration. The d2 Test of Attention consists of 14 rows, each containing 47 characters/items. Each row includes lowercase "p" and "d" letters accompanied by one to four marks positioned above or below the letters. Participants are required to identify and mark the letter "d" accompanied by two marks within a time limit of 20 seconds for each row. Scoring is based on the total number of items processed (TN), errors of omission (E1), errors of commission (E2), and concentration performance (CP). Higher TN and CP scores indicate better attentional performance, whereas higher E1 and E2 scores indicate a greater number of errors.	Baseline and 1 week after completion of the 12-session intervention
Stroop Test	The Stroop Test is a neuropsychological measure of selective attention, inhibitory control, processing speed, and cognitive flexibility. The Stroop Test Çapa Version consists of three parts: Stroop A, in which participants name the colors of colored rectangles; Stroop B, in which they read color words printed in incongruent ink colors; and Stroop C, in which they name the ink color while inhibiting the tendency to read the word. Completion time is recorded for each part. In the present study, the Stroop Test Interference Time Difference was calculated by subtracting the completion time of Stroop B from that of Stroop C. The Turkish validity and reliability of the Stroop Test Çapa Version were established by Emek-Savaş et al.	Baseline and 1 week after completion of the 12-session intervention
WMS-R Digit Span Test (DST)	The Digit Span Subtest of the Wechsler Memory Scale-Revised (WMS-R) assesses attention, short-term memory, and working memory. It consists of Forward and Backward Digit Span conditions, in which participants repeat progressively longer digit sequences in the presented or reverse order, respectively. Each sequence length includes two trials, and the respective condition is discontinued when both trials are answered incorrectly. The Turkish standardization of the WMS-R has been established, and normative data are available for the Digit Span Test in Turkish adults aged 50-83 years.	Baseline and 1 week after completion of the 12-session intervention
The Trail Making Test (TMT)	The Trail Making Test (TMT) consists of two parts, TMT-A and TMT-B. TMT-A primarily assesses visual scanning, attention, and processing speed, whereas TMT-B additionally requires cognitive flexibility, set-shifting, working memory, and inhibitory control. The basic scores for TMT-A and TMT-B are completion times in seconds, with longer completion times indicating poorer performance. The Turkish validity and reliability of the Trail Making Test were established.	Baseline and 1 week after completion of the 12-session intervention
Benton Judgment of Line Orientation Test	The Benton Judgment of Line Orientation Test was developed by Benton et al. (1978), and its Turkish standardization was conducted within the BİLNOT battery. The Benton Judgment of Line Orientation Test (BJLOT) is a neuropsychological measure of visuospatial perception and spatial orientation. The test assesses the ability to perceive and identify angular relationships between lines and comprises five practice items followed by 30 test items. Each correct response is scored as one point, yielding a maximum score of 30, with higher scores indicating better visuospatial performance.	Baseline and 1 week after completion of the 12-session intervention

Collaborators and Investigators

• Sponsor: Medipol University
• Investigators: Study Director: Halime Avunç, PhD Candidate, Medipol University; Principal Investigator: Ayşe Seren Taner, Occupational Therapist, Medipol University; Principal Investigator: Eylül Eşin, Occupational Therapist, Medipol University; Principal Investigator: Zeynep Demir, Occupational Therapist, Medipol University; Study Chair: Merve Keskin, PhD Candidate, Medipol University; Study Chair: Devrim Tarakcı, Prof. Dr., Medipol University

Study record dates

Study Major Dates

• Study Start (Actual): April 8, 2025
• Primary Completion (Actual): May 16, 2025
• Study Completion (Actual): May 23, 2025

Study Registration Dates

• First Submitted: August 28, 2026
• First Submitted That Met QC Criteria: September 2, 2026
• First Posted (Actual): September 9, 2026

Study Record Updates

• Last Update Posted (Actual): September 9, 2026
• Last Update Submitted That Met QC Criteria: September 2, 2026
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Attention; Healthy adults; Cognitive training; Executive functions; Xbox-based exergames
• Other Study ID Numbers: E-10840098-202.3.02-1964

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No