In an aging population, exergames, a means for simultaneous cognitive-motor training, in a telerehabilitation setting show promise in overcoming treatment accessibility issues. This study aimed to investigate feasibility and effectiveness of a 10-week home-based stepping exergame training program (60 min/week) under remote supervision in older adults as compared to usual care.

An international pragmatic randomized controlled trial (RCT) was conducted in Switzerland, Italy, and Cyprus, including 127 older adults aged ≥60 years, who were randomly allocated to an intervention (n=62) or a control group (n=65).

The adherence rate was 101.4%, the attrition rate 11.8%, and the average exergame enjoyment was rated with 69.1±18.7 out of 100 points. Significant interaction effects were observed in the Go/No-Go test (Q(1, 53.17)=5.44, p=.02) and significant differences between pre- and post-measurements in the intervention group were found when analyzing the 3 study sites separately (ABC (CY, r=.38, p=.05), Go/No-Go (IT, r=3.0, p=.03), Flexi (CH, r=.67, p=.007), TUG (CH, r=.52, p=.04; CY=r.46, p=.02)).

Thus, the step-based exergame intervention appeared to be feasible and safe for older adults, supporting its application in out-patient rehabilitation settings. Additionally, it was effective in improving response inhibition. However, to enhance physical functions, especially in non-acute patients, it may be necessary to increase the training load.

Trial Registration: ClinicalTrials.gov NCT05751551

The authors have declared no competing interest.

NCT05751551

This work was funded by the European Union and the involved national funding authorities (Innosuisse, the Swiss Innovation Agency; the Italian ministry of health; and the Cyprus Research and Innovation Foundation) as part of the AAL Association joint program (aal-2020-7-145-CP). In Italy, the study was also supported by Ricerca Corrente 2023-2024 (Italian Ministry of Health).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study protocol was approved by all local ethical committees, including the Cantonal ethics committee in Zurich, Switzerland (2022-01746); the Don Carlo Gnocchi Foundation ethics committee in Italy (06_16/12/2022); and the Cyprus National Bioethics Committee (ΕΕΒΚ ΕΠ 2021 51).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes