The primary aim of our study is to compare the effects of neuromuscular exercise training versus structured exergaming program on locomotor and cognitive functions in elderly individuals with Motor Cognitive Risk (MCR), which defines the transition state between typical aging and dementia and mild cognitive impairment. This study aims to present for the first time the effects of neuromuscular exercise training and exergaming program on locomotor and cognitive functions in elderly individuals with MCR with comparative results.
Being over 65 years of age
Having a Barthel Daily Living Activities Index score of ≥ 90
Having a Mini Mental Status Score (MMSE) of ≥24
Having the ability to walk with or without a walking aid
Presence of Dementia
Major Depression
Generalized Anxiety Disorder and Delirium
Parkinson's Disease
Parallel
The Neuromuscular Exercise Training program
Other interventionThe Neuromuscular Exercise Training program will be carried out in groups of 2 people for 60 minutes/2 days/8 weeks. The exercise program will consist of warm-up, loading and cooling phases. The warm-up phase will consist of flexibility exercises, mini squat and roll down etc. exercises to prepare the individual for exercise. The loading phase will consist of a cognitive-based neuromuscular exercise program aiming to provide stabilization, increase in balance, neuroplasticity and motor control and is planned to include strengthening exercises, stabilization exercises, balance-proprioceptive exercises and neuromuscular control exercise training with visual feedback. The exercises will progress gradually from easy to difficult with increasing repetition and set numbers.
Exergaming Exercise Training
Other interventionIn our study, Xbox One Kinect game console and Kinect sensor will be used within the scope of Exergaming. Exergaming program will be carried out in groups of 2 people for 60 minutes/ 2 days/ 8 weeks. It will consist of warm-up, loading and cooling phases. The games to be used for the Exergaming program were selected from games that include locomotor and cognitive repetitive tasks. The selected exergames involve repetitive locomotor and cognitive tasks. Piano step will be utilized during the warm-up for its rhythm-based movement patterns. For the conditioning phase, lower extremity exercises will include Reflex Ridge, River Rush, and Rallyball (Kinect Adventures), while upper extremity exercises will consist of Bowling, Table Tennis, Swimming (Kinect Sports), and Fruit Ninja. A progressive training approach will be followed, with game difficulty levels increasing incrementally as the sessions advance.
Timed Up and Go Test (TUG)
TUG test is a frequently used field test to evaluate mobility, balance, fall risk and walking in elderly individuals (Magda,2024; (Racha, 2023). The test involves the individual getting up from a chair, walking 3 meters, turning, and sitting. The time taken to complete this series of movements is measured and recorded using a stopwatch (Racha, 2023).
Stair Climbing Test (SCT)
The stair climbing test is frequently used in the evaluation of locomotor functions in elderly individuals. The validity and reliability of the STAIR, which has been investigated in elderly people with knee osteoarthritis, has been reported to have a test-retest reliability coefficient of 0.93 and high reliability (Jose, 2021). In our study, they will be asked to ascend and descend 4 steps, each of which is 50 cm wide, 15 cm high and 25 cm deep, as quickly but safely as possible. They will be able to use the handrails when they need to while ascending or descending the stairs, and the total time taken to complete the task will be measured in seconds with a stopwatch.
Cognitive Officer TUG-SCT
In our research * Counting backwards from 50 by threes * Cognitive officer TUG and SCT tests will be conducted to answer the questions prepared by the researchers as yes if red and no if blue, and the results will be recorded in terms of time (Li, 2023).
Short Physical Performance Battery (SPPB)
Short Physical Performance Battery (SPPB) is a field test designed to evaluate the physical performance of elderly people, helps interpret their functional abilities, and gives an idea about the individual's biological age (Pavasini, 2016). SPPB, which is frequently used in elderly individuals in the literature, consists of the categories of static balance, 4-meter walking test, and 5-times sit-to-stand test (Corsonello, 2012 ). The balance test in SPPB includes three different postures: side-by-side, semi-tandem, and tandem. Each posture is held for up to 10 seconds. The ability to maintain these positions gives an idea about the individual's balance abilities (Cisternas, 2024). It is emphasized in the literature that the balance test, together with other components of SPPB, can predict all-cause mortality (Pahor, 2014). In our research, SPPB will be used to evaluate the static balance ability, walking speed, functional capacity,
Dynamic Gait Index (DGI)
The Dynamic Gait Index (DGI) is a widely accepted functional gait tool for assessing the risk of falls and functional stability while walking in the elderly (Shumway-Cook et al., 2013). In the literature, DGI is used as a valid, reliable, cheap and fast tool to assess the gait and balance of elderly individuals (Alghwiri, 2014). It consists of eight items including normal walking on level ground, walking with speed changes, walking with horizontal head movements, walking with vertical head movements, walking with pivot turns, walking by jumping over obstacles, taking steps around obstacles and climbing up and down stairs. Each item is rated on a 4-point scale ranging from 0 (severe impairment) to 3 (independent walking). The maximum total score can be 24. The scale, whose validity and reliability in Turkish in elderly individuals was conducted by Zirek, will be used to comprehensively assess walking in our study (Zirek, 2023).
Reaction speed assessment
Reaction speed is defined as the duration between the stimulus reaching the central nervous system and the execution of the appropriate motor response. It is closely associated with cognitive functions such as attention, processing speed, motor planning, and executive functions. Considering the age-related decline in processing speed and motor response, the Light Trainer Flash Light Exercise System (Reaction X) will be utilized to evaluate these parameters. Upper Limb Reaction Speed Assessment The assessment consists of two protocols, each lasting 30 seconds: Choice Reaction (Colored Light): To evaluate decision-making and reasoning, participants must respond to color-coded stimuli (e.g., blue light for the right hand and red light for the left). Lower Limb Reaction Speed Assessment This protocol evaluates decision-making and balance concurrently. Using their dominant leg, participants will deactivate specific colored sensors for 30 seconds.
Performance-Oriented Mobility Assessment
The Performance-Oriented Mobility Assessment (POMA), introduced to the literature by Tinetti in 1986, is frequently used to assess balance and gait in elderly individuals and to assess the risk of falls in individuals with conditions affecting balance and gait (Tinetti, 1986). POMA, whose Turkish validity and reliability were conducted by Ağırcan, will be used in our research for the comprehensive assessment of gait and balance (Ağırcan, 2009). Permissions from the authors are provided as an attachment.
Satisfaction Level
Participant satisfaction levels regarding the program will be evaluated using a researcher-developed questionnaire. Participants will be asked to rate their overall satisfaction with the intervention, their willingness to participate in the program again if it were repeated, and other satisfaction-related metrics on a 10-point scale (ranging from 1 to 10, where 10 represents the highest level of satisfaction).
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