Evaluating the Clinical Effectiveness of an Exergame-Based Training Program Using “WarioWare: Move It!” to Enhance Physical and Cognitive Function in Older Adults with Mild Cognitive Impairment and Dementia in Rural Long-Term Care Facilities: A Randomized Controlled Trial (Preprint)
Authors: Li Aoyu , Li Jingwen , Geng Yan , Qiang Yan , Zhao Juanjuan 
Published: November 2024

BACKGROUND

Cognitive impairment is prevalent among older adults and frequently misdiagnosed or diagnosed late, increasingly drawing attention as a significant health issue in aging populations. Compared to community-dwelling individuals, cognitive impairments are more common among residents of long-term care facilities (LTCFs). These facilities face challenges implementing organized exercise programs due to a shortage of professional caregivers and limited resources. Additionally, older adults may lose interest in repetitive interventions over time. “WarioWare: Move It!” by Nintendo, a novel exergame that combines aerobic exercise, body coordination, balance training, and cognitive tasks, provides an immersive experience to enhance motivation and reduce staff intervention, presenting a potential solution.

OBJECTIVE

This study aims to assess the clinical effectiveness of an exergame-based training program delivered via “WarioWare: Move It!” in improving physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function in elderly residents of LTCFs.

METHODS

The randomized controlled trial was conducted across multiple rural LTCFs in Shanxi Province, involving participants aged 65 and older. Participants were randomly assigned to either the intervention group (receiving the “WarioWare: Move It!” intervention) or the control group (receiving standard care). The intervention involved motion-sensing actions and postures (such as waving, jumping, arm swinging, rotating, and mimicking object movements) using the Joy-Con controllers for 60 minutes twice a week over 12 weeks. Primary outcome measures were derived from a battery of clinical tests, including the Sit and Reach test (the distance between the hands and toes when reaching forward), Shoulder Flexibility test (the distance between hands clasped behind the back), Trunk Rotation Flexibility test (the angle of the waist rotation to each side), Shoulder Range of Motion test (the angles of shoulder flexion, extension, abduction, and adduction), Elbow Range of Motion test (the angle of elbow flexion), Figure-of-Eight Walk test (completion time), Standing Balance test (balance duration), Hand Dexterity test (the number of blocks moved by the dominant hand in one minute), and Cognitive Function tests (e.g., Cognitive Abilities Screening Instrument, the Chinese version of the Mini-Mental State Examination, and the Montreal Cognitive Assessment). Statistical analysis was performed using mixed ANOVA, with time as the within-subject factor and intervention group as the between-subject factor, to assess the training effects on the various outcome measures.

RESULTS

A total of 232 participants were recruited and randomly assigned to the intervention group, including 18 (56%) with mild dementia, 9 (50%) with moderate dementia, and 89 (49%) with mild cognitive impairment. The mixed ANOVA results revealed significant group × time interactions across several physical flexibility assessments. Specifically, the remaining distance between the hands and toes during the forward bend showed a significant interaction (F = 8.484, P < 0.001, η² = 0.098), as did the distance between the hands clasped behind the back (F = 3.666, P = 0.035, η² = 0.045) and the angle formed by the trunk during left and right waist rotation (F = 17.353, P < 0.001, η² = 0.182). Significant group × time interactions were also observed for forward flexion (F = 17.655, P < 0.001, η² = 0.185) and abduction (F = 6.281, P = 0.004, η² = 0.075) of the shoulder joint, as well as for elbow flexion (F = 17.353, P < 0.001, η² = 0.041). Similarly, a significant group × time interaction was found for the time taken to complete the Figure of Eight Walk test (F = 11.846, P < 0.001, η² = 0.132). Additionally, a significant group × time interaction in the number of blocks moved within one minute (F = 4.016, P = 0.022, η² = 0.049). Lastly, all scale scores exhibited significant group × time interactions (all P < 0.001), with effect sizes of 0.145 for the Cognitive Abilities Screening Instrument, 0.406 for the Mini-Mental State Examination, and 0.169 for the Montreal Cognitive Assessment.

CONCLUSIONS

The “WarioWare: Move It!” intervention significantly improved physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function in older adults with mild cognitive impairment or dementia residing in rural LTCFs. The intervention offers an innovative and feasible approach for promoting elderly health in resource-limited settings, demonstrating potential for widespread application in similar environments.

CLINICALTRIAL

The study was registered with the Chinese Clinical Trial Registry under Registration No.ChiCTR2400092790.