Effects of Exergame and Gross Motor-Cognitive Training in Older Adults: An RCT

This randomized controlled trial with an active control group compares the effects of an interactive exergaming intervention against a structured gross motor-cognitive training program in older adults, while evaluating the short- and medium-term maintenance of physical and cognitive benefits through a 20-week follow-up and introducing a novel composite gross-motor index. This study was conducted from March 2025 to February 2026, with recruitment initiating in January 2025, as part of the Physical Activity Promotion & Domestic Accidents Prevention project, a collaboration between the University of Palermo and the Azienda Sanitaria Provinciale of Palermo, Italy. A total of 108 community-dwelling older adults, comprising 84 women and 24 men aged over 60, who were independent in activities of daily living and scored $\ge 24$ on the Mini-Mental State Examination, voluntarily participated and were randomly allocated to either the Experimental Group ($n = 65$, mean age: $72.05 \pm 5.8$ years) receiving exergame-based training, or the Active Control Group ($n = 43$, mean age: $71.58 \pm 4.2$ years) receiving gross motor-cognitive training. All sessions and assessments took place in a controlled environment at the University Sports Center and the Pietro Pisani gymnasium, and a total of 79 participants successfully completed the 6-week intervention, representing a physiological drop-out rate of 26.85%. The study was approved by the Ethical Board of the University of Palermo (N. 111/2022) and conformed to the Declaration of Helsinki. Outcome assessments were performed at baseline, immediately post-intervention at 6 weeks, and at a 20-week follow-up, with a researcher evaluating gross motor skills using the Ruler Drop Test, Plate Tapping Test, Foot Tapping Test, Timed Up and Go Test, Aiming Task Test, and the Clap-and-Catch Task, while a psychologist assessed cognitive functions via the Phonemic Verbal Fluency Test, a modified version of the Grooved Pegboard Test, the Symbol Digit Modalities Test, the Digit Span Forward and Backward, and the short version of the Stroop Color-Word Test. Physical activity levels at baseline were also assessed using the International Physical Activity Questionnaire for Adults (IPAQ-EIT). Both protocols lasted 6 weeks with a frequency of 2 sessions per week, where each 90-minute session consisted of a 15-minute warm-up, a 60-minute core phase, and a 15-minute cool-down focused on stretching and respiratory exercises. For the Gross Motor-Cognitive Training group, the core phase included five group-based exercises targeting gross motor coordination, such as locomotion drills, obstacle clearing, rhythmic movements, static or dynamic balance, and object manipulation, with each task strictly paired with concurrent or sequential cognitive or motor dual-tasks like backward counting or color-number associations under progressive overload. In contrast, the Exergame-Based Training group engaged in interactive, playful-competitive exercises developed via graphic design software and custom virtual motor courses designed within Minecraft creative mode, which were projected onto a wall for simultaneous group interaction to create complex dual-task environments where motor actions like balance, target throwing, and walking drills were directly subordinate to processing visual and auditory cues, with the difficulty progressing bi-weekly following gamification principles including increased stimulus speed, time-based challenges, and score tracking.

Statistical analyses were conducted using Linear Mixed Models (LMM), a mixed statistical model ideal for longitudinal studies involving repeated measurements of the same subjects over multiple time points (pre-test, post-test, and follow-up) and highly effective for handling missing data.