# An Integrated Program to Improve Cognitive and Physical Abilities in Older People
## 5 Discussion  
This study developed an integrated program aimed at motivating older adults to voluntarily engage in physical activities through gamification strategies while assessing changes in cognition and physical performance. The results revealed significant improvements in the cognitive and physical performance test results, confirming that the integrated program was effective in improving the cognitive and physical performance of older adults. The Cognitive Impairment Screening Test (CIST) results demonstrated significant enhancements in memory and language abilities, aligning with previous research suggesting that integrated programs positively impact cognitive function in older adults. Additionally, this study incorporated a Stroop game combining shapes and colors, referencing the work of [PERSON] [10]. The Stroop effect is widely utilized to assess cognitive function, and gamified Stroop tasks have been shown to enhance cognition [41]. While Stroop tasks have traditionally been used in cognitive assessments, relatively few studies have explored their gamification and application to older adults. This study, therefore, provides valuable evidence that gamified Stroop tasks can positively influence cognitive performance in this population. Assessments of physical performance indicated significant improvements in Timed Up and Go (TUG), Five Times Sit To Stand (FTSTS), and 10-Meter Walk Test (10 MWT) performance times, as well as increases in step length and walking speed. [PERSON] et al. [21] previously reported that exercise and cognitive intervention programs positively influence body composition, cognitive function, and health-related quality of life. Consistently, this study also demonstrated improvements in cognitive function and physical performance, reinforcing prior findings. However, body composition assessments over the twelve-week program revealed no significant changes. As suggested by [PERSON] [40], long-term \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline \multirow{2}{*}{**Sections**} & \multicolumn{3}{c}{**M \(\pm\) SD**} & \multicolumn{1}{c}{**t**} & \multirow{2}{*}{**p**} & \multirow{2}{*}{**d**} & \multirow{2}{*}{**n\({}^{2}\)**} \\ \cline{2-2} \cline{5-7}  & **Pre** & **Post** & **(Post-Pre)** & & & \\ \hline Challenge & 4.23 \(\pm\) 0.75 & 4.17 \(\pm\) 0.52 & \(-\)0.436 & 0.668 & \(-\)0.093 & 0.012 \\ \hline Competition & 4.23 \(\pm\) 0.66 & 4.23 \(\pm\) 0.56 & 0.000 & 1.000 & 0.000 & 0.000 \\ \hline Reward & 4.17 \(\pm\) 0.72 & 4.29 \(\pm\) 0.58 & 0.808 & 0.431 & 0.184 & 0.039 \\ \hline Total & 4.21 \(\pm\) 0.33 & 4.23 \(\pm\) 0.55 & 0.370 & 0.747 & 0.044 & 0.008 \\ \hline \hline \end{tabular}
\end{table} 
Table 13: Results of scores for gamification strategies (\(n=17\)). \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline \multirow{2}{*}{**Sections**} & \multicolumn{3}{c}{**M \(\pm\) SD**} & \multicolumn{1}{c}{**t**} & \multirow{2}{*}{**p**} & \multirow{2}{*}{**d**} & \multirow{2}{*}{**n\({}^{2}\)**} \\ \cline{2-2} \cline{5-7}  & **Pre** & **Post** & **(Post-Pre)** & & & \\ \hline Utility & 3.89 \(\pm\) 0.22 & 4.07 \(\pm\) 0.22 & 60.662 & 0.001 & 0.818 & 0.956 \\ \hline Satisfaction & 4.19 \(\pm\) 0.18 & 4.15 \(\pm\) 0.17 & \(-\)0.557 & 0.589 & \(-\)0.231 & 0.019 \\ \hline Persistence motivation & 4.13 \(\pm\) 0.11 & 4.12 \(\pm\) 0.15 & \(-\)0.328 & 0.968 & \(-\)0.077 & 0.007 \\ \hline Total score & 4.12 \(\pm\) 0.2 & 4.13 \(\pm\) 0.17 & 0.332 & 0.743 & 0.054 & 0.007 \\ \hline \hline \end{tabular}
\end{table} 
Table 12: Results of satisfaction survey (\(n=17\)). implementation of such programs, combined with lifestyle modification education, may have a positive impact on body composition. The satisfaction survey results indicated high levels of participant satisfaction with the program and gamification strategies, with ratings of 4 or higher and a significant increase in perceived usefulness. Overall, participants responded positively to the program and gamification elements, particularly favoring the reward system.