A difficulty based comparison of novel exergame balance training for cognitive functions in adults with mild cognitive impairment: A randomized trial

Background and aims

Exergaming combines physical and cognitive exercises, can enhance cognitive functions by increasing attentional demand. Similarly, balance training on unstable surfaces elevates cognitive-motor challenges. By integrating exergaming of varying difficulty levels with unstable surface balance training, cognitive processing, and neurocognitive functions may be further improved. This study compared the effects of novel exergame balance training of mild, moderate, high difficulty, and control groups for global cognition, cognitive flexibility, inhibitory control, recall ability, working memory, and attention in adults with MCI.

Methodology

In this four-armed parallel design randomized clinical trial, ninety-seven adults with MCI were randomly assigned to exergame balance training groups of mild, moderate, high difficulty, and control. The difficulty levels were determined by adjusting the size of the goal spot (large, medium, small) and the speed of moving the ball (fast, moderate, slow) in the exergame. All participants received 40 min/session three times/week for eight weeks. Montreal cognitive assessment (MoCA), Trail making test (TMT), Stroop colour word test, Stroop colour word test errors, ADAS word list, digit span forward and backward test, and count backward test were used to assess cognitive abilities. Assessment was conducted at baseline, after the 4th and 8th week. Mixed model ANCOVA, One-way ANOVA, and repeated measure ANOVA were used to determine group × time interaction, between, and within-group effects. Minimal clinical important difference (MCID) responders proportion analysis was conducted to determine clinical improvement.

Results

There was significant time × group interaction for MoCA, Stroop Colour word, Stroop Colour word Error, Digit span, and counting backward test (p < 0.05). Post-hoc analysis at difficulty level depicted no significant difference between mild, moderate, and high difficulty groups (p > 0.05), while a significant difference between mild, moderate, and high difficulty groups with the control group for MoCA, ADAS word list, digit span, and count backward task (p < 0.05) was observed.

Conclusion

The results concluded no significant difference between exergame balance training of mild, moderate, and high difficulty groups for various cognitive functions. Furthermore, differences were observed between the mild, moderate and high-difficulty groups and the control group for global cognition, inhibitory control, and attention. Additionally, the high-difficulty group showed greater clinical improvement in various cognitive functions.