Exergaming Improves Executive Functions in Patients With Metabolic Syndrome
Phase: NA
Conditions: Executive Functions, Metabolic Syndrome, Aerobic Exercise
Sponsor: Kyoung Im Cho

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Exergaming Improves Executive Functions in 
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Patients with Metabolic Syndrome 
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Date of the document: May/27/2019 
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Shanshan Wu1, Eunah Jo2, Hongqing Ji1, Kyung-Hee Kim3, Jung-Jun Park1, Bo Hyun Kim4*, 
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and Kyoung Im Cho2,* 
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1Division of Sport Science, Pusan National University, Busan 46241, Korea 
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2Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, Korea 
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3Department of Cardiology, Sejong General Hospital, Bucheon 22972, Korea 
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4Department of Internal Medicine, Pusan National University Hospital and Biomedical 
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Research Institute, Busan 49241, Korea 
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Running Title: Exergame in Patients with Metabolic Syndrome 
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∗ Corresponding author  
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Kyoung-Im Cho, MD, Division of Cardiology, Department of Internal Medicine, Kosin 
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University School of Medicine,34 Amnam-Dong, Seo-Ku, Busan 49267, Korea, Tel: (82) 51-
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990-6105, Fax: (82) 51-990-3005, E-mail: kyoungim74@gmail.com 
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∗ Co-corresponding author  
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Bo Hyun Kim, M.D., Ph.D. Department of Internal Medicine, Biomedical Research Institute, 
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Pusan National University Hospital, Busan, 49241, Korea. Tel: (82)-51-240-7678, Fax: (82) 
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51-254-3237, E-mail: pons71@hanmail.net  
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Abstract 
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Background: Recent studies indicate that exercise-related games can improve executive 
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function, attention processing, and visuospatial skills.  
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Objective: This study investigates whether exercise with exergaming can improve the 
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executive function in patients with metabolic syndrome (MetS). 
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Methods: Twenty-two MetS patients were recruited and randomly assigned to the exergaming 
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group (EXG) and treadmill exercise group (TEG). The reaction time (RT) and 
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electrophysiological signal from the frontal (Fz), central (Cz), and parietal (Pz) cortex were 
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collected during a Stroop task after 12 weeks’ exercise. 
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Results: During the Stroop congruence (facilitation) judgment task, both EXG and TEG 
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showed significantly faster RT after 12 weeks of exercise training. For N200 amplitude, EXG 
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significantly increased on Fz and Cz. These changes were significantly larger in EXG than 
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TEG. For P300 amplitude, EXG significantly increased on Fz, Cz, and Pz, while TEG 
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significantly increased on Cz and Pz only. During the Stroop incongruence (interference) 
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judgment task, both EXG and TEG showed significantly faster RT. For P300 amplitude, EXG 
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significantly increased on Fz and Cz only, while TEG significantly increased on Fz, Cz, and 
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Pz.  
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Conclusions: Exergaming improves executive function in patients with MetS as much as 
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normal aerobic exercise. Particularly, the unique benefit of the exergaming beyond increased 
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aerobic capacity is the improvement of selective attention among cognitive functions. Thus, 
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exergaming could be recommended to someone who needs to improve brain responses of 
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concentration and judgment as well as physical fitness. 
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Keywords: exergaming; executive functions; event-related potential; metabolic syndrome 
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Introduction 
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In recent years, the relationship between cognitive function and metabolic syndrome has been 
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widely studied [1,2]. Metabolic syndrome (MetS) has been shown to be associated with a 
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decline in executive function [3,4] due to multiple risk factors, including hypertension, 
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dyslipidemia, impaired glucose homeostasis, and abdominal obesity. Executive functions 
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include basic cognitive processes such as attentional control, cognitive inhibition, inhibitory 
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control, working memory, and cognitive flexibility [5].  
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Cognitive neuroscience is using Stroop tasks to measure selective attention capacity and skills, 
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as well as processing speed ability, indicating executive functions [6]. Electroencephalographic 
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(EEG) activity using event-related positioning technology P300 and N200 has been widely 
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used to measure selective attention capacity and skills, and a behavioral performance such as 
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reaction time (RT) is commonly used to measure processing speed ability [7,8]. N200 
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negativity (200~350 ms post-stimulus) is an event-related potential (ERP), which indicates 
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attentional capacity that is usually induced before motion response control and is related to the 
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cognitive processes of stimulus recognition and differentiation [9]. P300 positivity 
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(300~600 ms post-stimulus) is another ERP, reflecting memory-related neural processing that 
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is involved in categorizing incoming information and updating the context of the working 
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memory (e.g., encoding, rehearsal, recognition, and retrieval) [10].  
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It is well known that aerobic exercise training provides various beneficial clinical outcomes in 
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metabolic disease patients [11,12]. Its effects on cognitive function, especially executive 
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function, also have been reported [13]. Furthermore, recent studies reported that both aerobic 
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and resistance exercise training facilitate overall electrophysiological effects (e.g., increased 
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ERP P300 amplitudes) and behavior index (e.g., faster RT) in healthy elderly people [14,15]. 
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In addition, aerobic exercise has also been reported to improve cognitive processes in cortical 
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cognitive control (P300 amplitude) in studies of chronic stroke patients [16]. 
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Recently, exergaming (a combination of “exercise” and “gaming”) has attracted much attention 
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as a novel exercise method to improve cognitive function because it utilizes video games that 
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require body movements while simultaneously presenting the user with a cognitively 
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challenging environment [17]. Along with its popular usage for leisure and entertainment, there 
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is a growing interest in the application of exergaming to improve clinical outcomes. Recent 
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studies using exergaming showed beneficial effects on cognitive and dual-task functions, which 
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reduced falls in older adults [18] as well as cardiovascular disease risks such as body fat, serum 
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adipokine levels, and lipid profiles [19]. Exergaming also promoted executive functions and 
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cognitive processing speed in elderly and children [20,21]. This growing evidence suggests 
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that exergaming’s have the benefit of improving cognitive and physical functions. 
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Although many previous studies have reported improvements in cognitive function following 
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exergaming, it is not clear whether this benefit is due to an exercise effect or video game effect. 
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In addition, all of these studies measured RT, instead of ERP using EEG, which limits to 
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illuminate brain activities. Considering that EEG can measure electrical activities in various 
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cortex areas in the brain, it is necessary to investigate ERP using EEG to evaluate executive 
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function. Therefore, we examined the benefits of exergaming compared to normal exercise and 
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investigated executive function by measuring RT as well as N200 and P300 in three cortex 
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areas during Stroop tasks in patients with MetS.     
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Methods 
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Participants 
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A total of 22 MetS male and female patients aged between 50-80 years participated in this study. 
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MetS was defined according to the modified NCEP Adult Treatment Panel III (NCEP-ATP III) 
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definition for South Asians. Briefly, individuals with three or more of the following criteria 
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were defined as MetS: central obesity (waist circumference ≥90 cm for men; ≥ 85 cm for 
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women), fasting plasma glucose ≥100 mg/dL or current treatment for diabetes mellitus, systolic 
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blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg or current treatment for 
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hypertension, serum triglyceride ≥150 mg/dL, low HDL cholesterol (men<40 mg/dL; 
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women<50 mg/dL) [22]. Subjects were asked to not exercise for 24 hours before the 
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experiment. They were also instructed to eat usual meals and to finish meals 4 hours before the 
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experiment, while avoiding alcohol 1 day before the experiment and caffeine during the 4 hours 
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prior to the experiment. All subjects were required to complete a written informed consent 
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approved by the Institutional Review Board of Kosin University College of Medicine.  
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The sample size was calculated using sample size calculation software (G*Power version 
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3.1.9.2 for Windows; http://www.gpower.hhu.de), with effect size 0.484, statistical power 0.8, 
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and statistical level of significance 0.05. This effect size was calculated from the previous 
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studies [13,14]. As a result, the sample size for each group became 8, and we decided to recruit 
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11 patients for each group, with a potential 30% dropout rate. 
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Exercise Training Interventions 
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Exercise training was conducted at the Kosin University Gospel Hospital U-healthcare Center. 
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Each participant was instructed to immediately inform the supervisor if he or she experienced 
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any unusual symptoms during exercise training and to consult a physician if needed. Subjects 
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were excluded if they did not perform more than 80% of the exercise sessions. 
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All subjects were randomly divided into two groups: exergaming and treadmill exercise group. 
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Subjects had 2 weeks of adaptation and then carried out 12 weeks of exercise training: 60 
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min/day, 60-80% of heart rate reserved (HRR), 3 days/week. Each exercise session consisted 
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of 10 minutes of warm-up, 40 minutes of main exercise, and 10 minutes of warm-down.  
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The exergaming group (EXG) performed exercise using Exerheart® devices (D&J Humancare, 
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Busan, South Korea) composed of a running/jumping mat [730(W) × 730(D) × 130(H)] and a 
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tablet PC on a stand (can be adjusted to any height between 70 and 155 cm) (Supplemental 
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Figure 1A). Exerheart® is an exergaming developed for in-situ running along with the video 
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game called "Alchemist's Treasure" (D&J Humancare, Busan, South Korea) (Supplemental 
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Figure 1B). To play this game, the subject has to run or jump on a spot on the mat to move a 
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virtual avatar on the screen of the tablet PC to the front, back, left, and right along with music 
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(Supplemental Video 1 for online). The subject can control the speed of avatar movement by 
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running or jumping speed on the mat. The treadmill exercise group (TEG) performed exercise 
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using commercial treadmills (MOTUS, Gyeonggi-do, South Korea). Each subject walked or 
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ran on the treadmill at a comfortable speed. 
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For both EXG and TEG, all subjects’ heart rates (HR) during exercise were monitored using 
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HR monitors (polar RS400sd, Madison Height, Michigan, USA) to confirm that the value was 
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within the target HR range. The Karvonen formula (1957) [23] was used to calculate HR 
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reserve (HRR, estimated maximal HR– resting HR) and target HR during exercise [(HRR × 
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given percentage of training intensity) + resting HR)]. 
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Stroop Test 
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For assessment of executive function, a computer-based version of the Stroop task was 
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administered with Telescan software (LAXTHA, Daejeon, South Korea). During the task, 
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subjects were presented with a color word appearing in the same color on congruent trials (e.g. 
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“blue” printed in blue) and in a different color on incongruent trials (e.g. “blue” printed in green) 
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[24]. To provide similar visual content, blue, green, and yellow were chosen as stimuli. 
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Subjects performed Stroop task twice, pre- and post-exercise training. Subjects sat 1 meter 
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from the screen, and when the color words appeared on the screen, they clicked the left 
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keyboard for the congruent test and the right keyboard for the incongruent test. Subjects were 
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instructed to respond as quickly and accurately as possible. The rate of measurement targeted 
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for 50%. Each color word (vertical viewing angle: 2 °) was presented for 200 ms, and the 
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response was allowed within 1500 ms. The inter-stimulus interval varied randomly between 
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1500 and 2500 ms. 
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Electroencephalographic (EEG) Measurements 
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EEG activity was recorded during the modified Stroop task using a computerized polygraph 
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system– Type A: A total of 31-channel Poly G-A (LAXTHA, Daejeon, South Korea). Ag-AgCl 
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electrodes (LAXTHA, Daejeon, South Korea) were placed on frontal (Fz), central (Cz), and 
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parietal (Pz) cortex areas, according to the International 10-20 system. Midline locations 
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referenced to link earlobe electrodes. Horizontal and vertical electrooculograms (EOGs) were 
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monitored by electrodes placed above and below the left eye and at the outer canthus of both 
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eyes, respectively. The impedance of all electrodes was maintained below 10 kΩ. The bandpass 
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filter of the amplifier was 0.1–100 Hz, the sampling rate was 1000 Hz, and a notch filter was 
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at 60 Hz. 
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The N200 component was defined as the largest positive peak occurring between 200-350 ms 
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post-stimulus, and the P300 component was defined as the largest positive peak occurring 
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between 300~600 ms post-stimulus [7]. N200 and P300 amplitudes were measured as the 
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difference between the mean pre-stimulus baseline and maximum peak amplitude. Telescan’s 
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built-in high pass IIR filter was used for filtering. Waveforms were digitally smoothed with a 
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low-pass filter using a half-power cut-off of 10 Hz prior to analysis. 
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Statistical Analysis 
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Due to the small sample size, we used nonparametric statistics for data analysis. We used the 
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Wilcoxon signed-rank test to examine the changes of each dependent variable after intervention 
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within each group. The Mann–Whitney U test was used to make comparisons of the delta 
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values between training groups (Δ‐EXG vs Δ‐TEG). The effect size of partial eta-squared (η2) 
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was reported for significant effects, where the alpha level for all of the tests was set at 0.05. 
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Data were expressed as mean ± standard deviation of mean. All statistical tests were processed 
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using the software SPSS 24 version. 
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Results  
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Demographic and physical characteristics for all subjects are provided in Table 1. There were 
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no significant group differences at baseline measurements. 
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Reaction Time 
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The changes in congruent RT after 12 weeks of exercise training were not significantly different 
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between EXG and TEG (Table 2). EXG significantly shortened congruent RT, as did TEG 
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(Figure 1A). The changes in incongruent RT after 12 weeks of exercise training were not 
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significantly different between EXG and TEG. EXG significantly shortened incongruent RT, 
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as did TEG (Figure 1B). 
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Event-related Potential Data 
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N200 amplitude 
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The results in Table 3 after 12 weeks of exercise training, the increases in congruent N200 
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amplitude on Cz, and Pz in EXG were significantly greater than in TEG, but not on Fz. EXG 
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significantly increased congruent N200 amplitude on Cz, but not on Fz and Pz. On the other 
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hand, TEG showed no significant changes in congruent N200 amplitude on Fz, Cz, or Pz 
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(Figure 2A). 
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The changes in incongruent N200 amplitude on Fz, Cz, and Pz after 12 weeks of exercise 
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training were not significantly different between EXG and TEG (Table 3). Interestingly, EXG 
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did not significantly change incongruent N200 amplitude on Fz, Cz, or Pz. TEG also did not 
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significantly change incongruent N200 amplitude on Fz, Cz, or Pz (Figure 2B). The waveforms 
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of congruent and incongruent N200 amplitudes on Fz, Cz, and Pz for EXG and TEG before 
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and after exercise are shown in Figure 3. 
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P300 amplitude 
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Table 3 shows the results of Mann–Whitney U test for changes in congruent P300 amplitude 
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on Fz, Cz, and Pz after 12 weeks of exercise training was not significantly different between 
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EXG and TEG. EXG significantly increased congruent P300 amplitude on Fz, Cz, and Pz. 
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However, TEG significantly increased congruent P300 amplitude on only Fz and Cz, but not 
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on Pz (Figure 2C).  
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There were no significant differences in the changes in incongruent P300 amplitude on Fz, Cz, 
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and Pz between EXG and TEG after 12 weeks of exercise training (Table 3). EXG significantly 
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increased incongruent P300 amplitude on Cz and Pz, but not on Fz. On the other hand, TEG 
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significantly increased incongruent P300 amplitude on Fz, Cz, and Pz (Figure 2D). The 
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waveforms of congruent and incongruent P300 amplitudes on Fz, Cz, and Pz for EXG and TEG 
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before and after exercise are shown in Figure 3. 
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Discussion  
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This study was the first to investigate the benefits of exergaming compared to normal exercise 
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on the behavioral performance and executive function of patients with MetS. We found that 12 
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weeks of both exergaming and treadmill exercise training similarly and effectively improved 
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behavioral performance and congruent and incongruent memory-related neural processing. 
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However, only exergaming training improved congruent selective attention, while neither 
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exergaming nor treadmill exercise training affected incongruent selective attention. These 
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results suggest similar overall effects of exergaming and normal exercise on behavioral 
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performance and executive function of patients with MetS, but exergaming could be more 
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effective than normal exercise for congruent selective attention.   
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The present study showed that both 12 weeks of exergaming and treadmill exercise training 
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effectively improved reaction time in MetS patients, and these changes were not different 
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between exergaming and treadmill exercise training. These results indicate that both 
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exergaming and normal exercise improve behavioral performance, but exergaming does not 
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have more beneficial effects compared to normal exercise. In our previous study, we examined 
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the performance of control tasks using a simple acute aerobic exercise and complex exercise 
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[25]. The results indicated that participants did not have different performance when 
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participating in simple exercise compared to very skilled complex exercises. In another study, 
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contrary to our results, an acute single-bout study comparing the effects of standard normal 
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exercise to exergaming on attention performance in young adults found no significant 
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improvement with exergaming [7]. The result of that study suggests that, after 20 minutes of 
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unskilled Wii Fit ™, the brain needs more information processing, which may be the source of 
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control requirements and pressure increases, offsetting the potential benefits of the exercise 
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component. However, compared to the Wii Fit™, exergaming with exerheart® is running-
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based aerobic exercise on an air cushion board with game-based contents such as adventures, 
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racing, and quizzes, which continue to arouse interest in exercise. So, with exerheart®, an 
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individual is running constantly with changing visual stimuli; these repeated effects will 
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simultaneously increase physical activity and cognitive function via interactive virtual reality 
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engagement [20]. Therefore, through exergaming and treadmill exercise, the reaction time of 
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Stroop task conditions of MetS patients could be shortened, which would promote basic 
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information processing and executive function of suppression control. 
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In this study, the congruent and incongruent P300 amplitudes were increased after both 12 
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weeks of exergaming and treadmill exercise training, with no difference between EXG and 
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TEG. These results indicate that both exergaming and normal exercise improve memory-
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related neural processing, but exergaming has no more beneficial effects than normal exercise. 
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In other words, participation in exercise, regardless of exercise modality, induces an increase 
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in working memory in executive function. However, our previous study showed that P300 
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amplitude increased during a control task following futsal relative to seated rest or treadmill 
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exercise, indicating that complex control of the brain stimulates the executive control network 
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of the cortex [25]. It was found that, as age increases, the P300 amplitude in the central (Cz) 
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region decreases, and the scalp distribution of the P300 amplitude is transferred to the frontal 
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region [26]. Pontifex et al. [27] examined P300 components and found that older adults with 
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high cardiorespiratory fitness only exhibited greater P300 amplitudes, and Tsai and colleagues 
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[28] found that different exercise types have greater amplitudes for older P300. However, as 
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they pointed out, regardless of the type of older people to participate in sports, physical exercise 
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is a lifestyle factor that is crucial to preventing age-related biological degeneration in the 
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frontal-to-parietal areas, thus delaying the cognitive declines associated with later life. 
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Considering that exergaming is a kind of aerobic exercise, it stands to reason that exergaming 
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could improve not only cardiovascular health, but also cognitive plasticity, thereby improving 
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categorization of incoming information and updating the context of working memory in MetS 
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patients. 
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We found that neither exergaming nor treadmill exercise training affected incongruent N200 
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amplitude. However, the consistent N200 amplitude only increased by exergaming training. 
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These results indicate that, while neither exergaming nor normal exercise affects incongruent 
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selective attention, only exergaming improves congruent selective attention, which suggests 
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that exergaming have a more beneficial effect on congruent selective attention compared to 
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normal exercise. The results of many studies on the relationship between exercise and N200 
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amplitude indicate show that exercise has no significant effect on N200 amplitude [28,29]. 
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Pontifex and his colleagues showed that general decreases in N200 amplitudes across scalp 
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sites were observed during exercise relative to rest [29]. The N200 component plays a key role 
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in the anterior cingulate cortex (ACC), which is part of the potential prefrontal cortex and 
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regulates dopaminergic neurons in cognitive functions, such as working memory, attention, and 
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decision making [30-32]. Therefore, the reduction of N200 amplitude caused by normal aerobic 
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exercise severely limits ACC activity [29]. In light of our N200 amplitude findings, these 
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results suggest that exergaming better regulates the activity of ACC in the prefrontal cortex 
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than aerobic exercise, thereby effectively increasing consistent selective attention. 
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Recent studies suggest that combining motor and cognitive demands during exercising can 
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improve cognitive function more than training these domains separately [17,33]. In addition, 
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cognitive video game training can have beneficial effects on memory, attention, and reaction 
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time in older adults [34,35]. In previous studies, when participants consistently performed 
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exercises in a virtual environment, an increase in N200 amplitude positively promoted 
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decision-making (frontal and central) and visual perception (occipital) [36]. Therefore, the 
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exergaming positively promotes visual perceptual stimulation in the virtual environment to 
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enhance the selective attention activity associated with the cerebral cortex, thereby strongly 
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promoting executive function. Exercise and video games can each improve brain structure and 
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function [37-40]; thus, their combination can have a complementary effect on brain stimulation 
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and protection. 
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Our study provides evidence that exergaming improves reaction time and incongruent memory-
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related neural processing in MetS patients as much as normal aerobic exercise. In addition, 
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exergaming improves congruent selective attention, which was not changed by normal aerobic 
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exercise. Therefore, exergaming could provide an innovative way to enjoy aerobic exercise 
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compared to repetitive, conventional exercises. 
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Although this study found significant results, there are some limitations in this study as follows: 
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1) the sample size in this study is relatively small, even though all patients were very hard 
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motion for 12 weeks; 2) the range of age was relatively large, 50~80 years old. Considering 
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that with age, response time and brain activity are usually slower, we cannot rule out the 
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possibility that age will affect the performance of executive function. However, the mean age 
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was similar in both groups, so this possibility might be low in this study; 3) the intensity of the 
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Exerheart® using "Alchemist's Treasure" game was not able to be controlled. 
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Conclusions 
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The results of this study suggest that exergaming enhances brain response to concentration and 
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judgment, resulting in increased behavioral response of the MetS patients, comparable to that 
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of normal aerobic exercise. Furthermore, the unique advantage of exergaming is that it 
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improves selective attention among cognitive functions, unlike normal aerobic exercise. 
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Therefore, exergaming could be recommended to some patients who need to improve executive 
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function as well as physical fitness. 
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Acknowledgments. We thank the participants for their time and effort while participating in 
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the present study. The authors declare that the results of the study are presented clearly, honestly, 
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and without fabrication, falsification, or inappropriate data manipulation. The authors declare 
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that there are no conflicts of interest.  
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Funding. This research did not receive any specific grant from funding agencies in the public, 
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commercial, or not-for-profit sectors. 
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Conflicts of Interest 
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None declared. 
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Multimedia Appendix 1. MP4. 
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Participants played the video game with Exerheart®.  
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[Author- Kyoung Im Cho, videographer - Shanshan Wu, 15 seconds length and 1.48 MB size] 
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References 
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Figure Legends 
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Figure 1. Mean reaction time (RT) during stroop task (A. congruent/ B. incongruent) 
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performance after exergaming group (EXG) and treadmill exercise group (TEG) before and 
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after the exercise intervention. 
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Figure 2. N200 and P300 amplitudes (mean ± SE) on three electrodes (Fz, Cz, and Pz) during 
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the Stroop task (A. congruent/ B. incongruent N200 amplitudes; C. congruent/ D. incongruent 
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P300 amplitudes) in the exergaming group (EXG) and treadmill exercise group (TEG) before 
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and after 12 weeks of exercise training. 
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Figure 3. Average event-related potential waveforms of electrodes (Fz, Cz, Pz) for mean N200 
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and P300 amplitudes during the Stroop test (A. congruent/ B. incongruent) in the exergaming 
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group (EXG) and treadmill exercise group (TEG) before and after 12 weeks of the exercise 
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training. 
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Supplement Figure 1. A. The exergaming group performed exercise using Exerheart® devices 
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by permission of D&J Humancare which had the copyright holder of Exerheart®. B. Features 
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of the video game "Alchemist's Treasure". 
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Table 1. Baseline characteristics of demographic information. 
507 
Group 
Factor 
EXG (N=11) 
TEG(N=11) 
P value 
Age(years) 
64±10 
60 ±7 
.298 
Height(cm) 
154.24±5.73 
161.66±7.1 
.014 
Weight(kg) 
69.38±10.54 
71.47±11.62 
.663 
BMI(kg/m2) 
29.07±3.3 
27.31±3.52 
.24 
WC(cm) 
97.36±10.95 
93.6±8.78 
.399 
Glucose(mg/dl) 
123.55±25.68 
112.36±29.37 
.353 
HDL-chol (mmol/L) 
46.32±8.91 
50.59±10.52 
.316 
LDL-chol (mmol/L) 
66.19±22.8 
78.38±19.52 
.193 
TC (mmol/L) 
134.81±25.52 
146.67±12.04 
.179 
TG (mmol/L) 
136.82±78.88 
145.73±142.74 
.858 
SBP (mmHg) 
127.09±16.86 
128.09±17.39 
.892 
DBP (mmHg) 
75.55±9.43 
77.73±11.99 
.64 
Values are mean ± SD. EXG, exergame group; TEG, treadmill exercise group; BMI, body mass index; WC, 
waist circumference; TG, triglycerides; HDL-chol, high-density lipoprotein cholesterol; LDL-chol, low‐
density lipoprotein cholesterol; SBP, systolic blood pressure; DBP, diastolic blood pressure. 
 
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512 
 
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515 
 
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22 
 
Table 2. Comparison of Stroop task congruent and incongruent reaction time of EXG and TEG 
517 
groups 
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Effects 
Group 
pre 
post 
P valuea 
η2 
P valueb 
Congruent 
EXG 
1265.91±383.15 
1012.09±221.64 
0.003 
0.053 
0.279 
TEG 
1124.18±161.21 
957.82±138.05 
0.003 
Incongruent 
EXG 
1299.09±367.48 
984.73±204.81 
0.003 
0.008 
0.670 
TEG 
1171.36±163.26 
974.55±120.97 
0.003 
a Wilcoxon Signed Rank Test: comparison pre vs. post within group. 
b Mann Whitney U Test: comparison the delta values between groups (Δ‐EXG vs Δ‐TEG). 
 
 
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526 
 
527 
 
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Table 3. Comparison of Stroop task congruent and incongruent N200 / P300 amplitudes of 
530 
EXG and TEG groups 
531 
Components Effects 
Group 
pre 
post 
P valuea 
η2 
P valueb 
N200 
Amplitude 
Congruent 
Fz 
EXG 
-1.33±1.95 
-4.1±3.02 
0.091 
0.138 
0.088 
TEG 
-0.98±3.14 
-0.41±3.82 
0.328 
Cz 
EXG 
-1.59±2.54 
-5.13±2.94 
0.016 
0.291 
0.010 
TEG 
-1.61±3.89 
-0.97±4.59 
0.424 
Pz 
EXG 
-1.58±1.89 
-4.06±2.89 
0.062 
0.207 
0.034 
TEG 
-1.32±3.62 
-0.89±3.99 
0.534 
Incongruent 
Fz 
EXG 
-2.85±2.3 
-2.78±3.02 
0.477 
0.041 
0.365 
TEG 
-1.37±3.3 
-0.73±3.18 
0.424 
Cz 
EXG 
-3.23±2.69 
-3.93±2.92 
0.286 
0.099 
0.151 
TEG 
-1.9±3.82 
-1.1±3.65 
0.213 
Pz 
EXG 
-2.86±2.45 
-3.07±2.62 
0.722 
0.008 
0.699 
TEG 
-1.4±3.66 
-1.01±3.52 
0.477 
P300 
amplitude 
Congruent 
Fz 
EXG 
2.3±1.94 
7.12±5.73 
0.003 
0.008 
0.699 
TEG 
3.21±1.95 
4.82±3.78 
0.011 
Cz 
EXG 
1.92±1.63 
6.49±5.28 
0.004 
0.006 
0.748 
TEG 
2.36±0.93 
5.08±3.03 
0.013 
Pz 
EXG 
1.44±1.69 
5.2±5.88 
0.004 
0.099 
0.151 
TEG 
1.74±1.26 
4.87±3.64 
0.328 
Incongruent 
Fz 
EXG 
2.26±3.14 
4.48±3.27 
0.091 
0.018 
0.562 
TEG 
1.93±2.26 
3.85±3.04 
0.004 
Cz 
EXG 
2.03±2.8 
4.38±2.81 
0.016 
0.002 
0.847 
TEG 
1.59±1.63 
3.74±2.99 
0.021 
Pz 
EXG 
1.58±2.44 
3.2±2.73 
0.021 
0.000 
0.949 
TEG 
1.05±0.92 
3.33±2.59 
0.033 
a Wilcoxon Signed Rank Test: comparison pre vs. post within group. 
b Mann Whitney U Test: comparison the delta values between groups (Δ‐EXG vs Δ‐TEG). 
 
 
532