Assessing the Clinical Effectiveness of an Exergame-Based Exercise Training Program Using Ring Fit Adventure to Prevent and Postpone Frailty and Sarcopenia Among Older Adults in Rural Long-Term Care Facilities: Randomized Controlled Trial

Abstract

Background: Frailty and sarcopenia are more prevalent among LTCF residents than community dwellers, with exercise, especially multicomponent and PRT, being essential for management. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to healthcare professional shortages. The Nintendo Switch RingFit Adventure (RFA) exergame (exergame-RFA), which combines resistance, aerobic, and balance exercises, offers a potential solution by boosting motivation and reducing staff intervention needs. Objective:We aimed to evaluate the clinical effectiveness of the exergame-RFA in improving muscle mass and functional performance among elderly LTCF residents.Methods: This was a randomized controlled trial, conducted from August 2022 to September 2023, involved elders ?60 years in rural southern Taiwan LTCFs. Participants were randomized into an intervention group (exergame-RFA plus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skills and trunk control exercises via RFA, lasted 30 minutes, twice weekly for 12 weeks. Primary outcomes measured were the study of osteoporotic fracture index, appendicular skeletal muscle mass index, handgrip strength, and gait speed. Secondary outcomes included box and block test, (BBT), maximal voluntary isometric contraction of dominant upper extremity (MVIC), muscle thickness under sonography (sono-thickness), ADLs by the Kihon Checklist, quality of life by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the cognition by brain health test (BHT). We employed an intention-to-treat analysis, incorporating a simple imputation technique in statistical analysis. A mixed analysis of variance, with time as a within-subject factor and intervention as a between-subject factor, was used to compare the training effects on outcomes. Results:The study recruited 96 individuals, with 60 undergoing randomization and 55 completing the study. Significant group X time interactions were observed in the exergame-RFA group in all primary outcomes (all p< .01, except p= .011 for HGS) and most secondary outcomes, including MVIC of biceps and triceps muscle, sono-thickness of biceps muscle, BBT, Kihon checklist, and BHT.Conclusions: Exergame-RFA significantly improve muscle mass, strength, and functional performance among elderly residents of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia. Clinical Trial: This trial was registered at