JMIR Publications

ABSTRACT

Background:

Cognitive impairment remains a pervasive concern among older adults, often escaping timely detection or being misdiagnosed, thereby garnering increasing recognition as a critical public health challenge in rapidly aging populations. Notably, long-term care facilities (LTCFs) report a higher prevalence of cognitive impairment compared to community-dwelling older adults, a pattern compounded by constraints such as staffing shortages, limited resources, and the resultant difficulties in maintaining structured exercise regimens. Furthermore, older adults may exhibit declining engagement when repetitive interventions lack novelty. Against this backdrop, the novel exergame “WarioWare: Move It!” (Nintendo) has emerged as a promising intervention, weaving together aerobic exercise, motor coordination, balance training, and cognitive engagement into an immersive gaming experience.

Objective:

This study aims to assess the clinical effectiveness of an exergame-based training program delivered via “WarioWare: Move It!” in improving physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function in elderly residents of LTCFs.

Methods:

The training program was conducted across multiple rural LTCFs in Shanxi Province, involving participants aged 65 and older. Participants were randomly assigned to either the intervention group (receiving the “WarioWare: Move It!” intervention) or the control group (receiving standard care). The intervention protocol encompassed two 60-minute sessions per week over a 12-week period, employing motion-sensing exercises such as waving, jumping, arm swinging, rotational movements, and object-mimicking postures using the Joy-Con controllers. Primary outcome measures were derived from a battery of clinical tests, including the Sit and Reach test (the distance between the hands and toes upon forward bending), Shoulder Flexibility test (the distance between hands clasped behind the back), Trunk Rotation Flexibility test (the angle of the waist rotation bilaterally), Shoulder Range of Motion test (the angles of shoulder flexion, extension, abduction, and adduction), Elbow Range of Motion test (the angle of elbow flexion), Figure of Eight Walk test (completion time), Standing Balance test (balance duration), Hand Dexterity test (the number of blocks moved by the dominant hand in one minute), and Cognitive Function tests (e.g., Cognitive Abilities Screening Instrument, the Chinese version of the Mini-Mental State Examination, and the Montreal Cognitive Assessment). Statistical analysis was performed using mixed ANOVA, with time as the within-subject factor and intervention group as the between-subject factor, to assess the training effects on the various outcome measures.

Results:

A total of 232 participants were recruited and randomly allocated to the intervention group, comprising 18 (56%) individuals with mild dementia, 9 (50%) with moderate dementia, and 89 (49%) with mild cognitive impairment. The mixed ANOVA results revealed significant group × time interactions across several physical flexibility assessments. Specifically, there was a significant interaction for the remaining distance between the hands and toes during the forward bend (F = 8.484, P < 0.001, η² = 0.098), as well as for the distance between the hands clasped behind the back (F = 3.666, P = 0.035, η² = 0.045) and the angle formed by trunk rotation to the left and right (F = 17.353, P < 0.001, η² = 0.182). Significant group × time interactions also emerged for forward flexion (F = 17.655, P < 0.001, η² = 0.185) and abduction (F = 6.281, P = 0.004, η² = 0.075) of the shoulder joint, as well as for elbow flexion (F = 17.353, P < 0.001, η² = 0.041). Additionally, the time to complete the Figure of Eight Walk test showed a significant interaction (F = 11.846, P < 0.001, η² = 0.132), and the number of blocks moved within one minute was similarly affected (F = 4.016, P = 0.022, η² = 0.049). Lastly, all scale-based measures exhibited statistically significant group × time interactions (all P < 0.001), with effect sizes of 0.145 for the Cognitive Abilities Screening Instrument, 0.406 for the Mini-Mental State Examination, and 0.169 for the Montreal Cognitive Assessment.

Conclusions:

The “WarioWare: Move It!” intervention significantly improved physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function among older adults with mild cognitive impairment or dementia residing in rural LTCFs. The intervention offers an innovative and feasible approach for promoting elderly health in resource-limited settings, demonstrating the potential for widespread application in diverse low-resource environments. Clinical Trial: ClinicalTrials.gov NCT06717971; https://clinicaltrials.gov/study/NCT06717971.