JMIR Publications

ABSTRACT

Background:

Exergame balance training, which integrates cognitive and motor challenges, may enhance neuroplasticity, postural control, and gait stability in adults with mild cognitive impairment (MCI). Varying task difficulty can modulate cognitive load, potentially influencing motor adaptation and functional mobility.

Objective:

This study aimed to compare improvement in balance and gait parameters across variable-difficulty exergame training and a Wii Fit group in adults with MCI.

Methods:

This four-armed, parallel design, randomized clinical trial included 97 participants with MCI (MoCA 18-25), randomly assigned to one of four groups: mild-difficulty, moderate-difficulty, high-difficulty exergame training, or a Wii Fit group. Each participant completed 24 sessions (40 minutes per session, three times per week). Gait and Balance were assessed using Time Up and Go (TUG), Cognitive Time Up and Go (C-TUG), and the Gait&Balance mobile app at the baseline. 4 weeks, and 8 weeks. Mixed models analysis of covariance (ANCOVA), with baseline values as a covariate, was used to assess interaction effects between interventions and time. Post hoc ANCOVA was conducted to analyze the between-group differences.

Results:

High-difficulty training resulted in the greatest improvements in TUG (-0.71±0.32, p<0.028), anteroposterior (AP) steadiness with eyes open (EO) on a firm surface (0.04±0.02, p=0.039), step time variability with head forward (HF) (0.06±0.09, p=0.020) walking speed HF (0.08±0.04, p=0.050), step time head turn (HT) (-0.04±0.02,p= 0.042), step time variability HT (-0.35±0.09, p<0.001), step length variability (-0.27±0.13,p=0.039)and walking speed HT (0.09±0.04,p=0.008) compared to the Wii Fit group. Moderate-difficulty training showed significant improvements in AP steadiness with EO on a firm surface (0.05±0.02, p=0.029) and reduced step time variability HT (-0.26±0.09, p=0.007). Mild-difficulty training improved C-TUG (-1.61±0.63, p<0.013), AP steadiness with a firm EO surface (0.05±0.02, p=0.029), step time variability HF (-0.20±0.09, p=0.027), step time variability HT (-0.25±0.09, p<0.008), step length variability (-0.31±0.12, p=0.014) and walking speed HT (0.11±0.04, p=0.028). No significant differences were observed between the exergame difficulty groups (p> 0.05).

Conclusions:

Cognitive-motor challenging exergame balance training significantly improved balance and gait parameters in adults with MCI. While no significant differences were found between the different difficulty levels. However, high-difficulty and mild-difficulty training showed greater improvements compared to the Wii Fit group. High-difficulty training led to superior enhancements in TUG performance, postural steadiness, gait variability, and walking speed. These findings suggest that difficulty-based exergames can be an effective intervention for improving postural control and walking stability in individuals with MCI, with potential implications for fall prevention and mobility maintenance in aging populations. Clinical Trial: ClinicalTrials.gov NCT04959383