Cognitive-Motor exergame training across populations and settings: from theory to clinical implementation

Feasible, safe, and well-accepted

Across inpatient geriatrics, Parkinson’s, stroke, and geriatric depression, exergame sessions (10–15 minutes, weekdays) show high adherence, good usability, and no intervention‑related adverse events. A telerehabilitation pilot shows adherence exceeding prescriptions, indicating strong acceptability despite therapists’ underestimated patient willingness.

Outcomes: mixed but promising signals

Simultaneously incorporated cognitive‑motor training appears most promising for gait speed (stroke review). Small inpatient studies indicate gains in walking speed, psychomotor speed, and mobility, yet overall effects remain weak. A large pragmatic RCT shows 26% fall reduction without motor/cognitive changes, possibly reflecting insensitive assessments.

Implementation and personalization priorities

Exergames intertwine cognitive and motor demands; added proprioceptive challenge (unstable platform) targets under‑challenged patients. In long‑term care (n=100, MCI/dementia), most games are playable with graded support; a decision aid maps SPPB/QMCI profiles to game selection. Ongoing trials optimize load, progression, and personalization.

The continuing education session “Cognitive-Motor exergame training across populations and settings: from theory to clinical implementation,” organized by Klinik Barmelweid and delivered by PhD Eleftheria Giannouli (ETH Zurich), presents evidence and implementation experiences with simultaneously incorporated cognitive–motor exergame training. The talk defines exergames as low-immersion, serious, whole-body interactive games (e.g., stepping and weight-shifting on pressure-sensitive platforms) that integrate cognitive tasks such as memory, inhibition, and rapid choice, and reviews the rationale and evidence suggesting simultaneous, incorporated training outperforms sequential or “additional” dual-task formats for selected outcomes. Across inpatient rehabilitation in geriatric, Parkinson’s disease, stroke, and psychiatric populations, the training shows high adherence, good usability, and no intervention-related adverse events, with signals for improvement in gait speed, psychomotor speed, and functional mobility; for higher-functioning stroke patients, an unstable platform variant increases sensorimotor load. A user-centered telerehabilitation program (home foldable mat, therapist portal, lower-limb cognitive assessments) demonstrates high acceptance; in a pragmatic pilot RCT with older adults, participants exceed prescribed training doses and show a selective gain in response inhibition (go/no-go). Complementary external evidence from a large trial (>700 participants) reports a 26% fall reduction with a similar device despite no changes on standard motor/cognitive tests, possibly reflecting measurement insensitivity to cognitive–motor interplay. In long-term care facilities, most residents with MCI/dementia can play the majority of 20 games with graded physical/cognitive support; a decision-support interface now recommends game selection based on functional and cognitive screening data. Overall, cognitive–motor exergaming is feasible, safe, and enjoyable across settings, while functional effects remain modest and ongoing multicountry RCT work focuses on optimizing personalization, progression, and load to enhance efficacy.