The gaming group played active video games via Xbox kinect 3 days per week, addition to conventional physiotherapy for 8 weeks.

The aerobic group engaged in cycling-based aerobic exercise (20 minutes per session) 3 days per week addition to conventional physiotherapy for 8 weeks.

The control group received only conventional physiotherapy and continued their daily activities.

The participants played the video game using an Xbox 360 Kinect console connected to a 55-inch Full HD television. The video games were planned with the assistance of a physiotherapist, 3 days per week, with 8 repetitions during the first 4 weeks and 12 repetitions during the final 4 weeks. The warm-up and cool-down periods were designed and applicated.

The WOMAC index was used to assess functional disability in patients with knee osteoarthritis. It consists of 24 items divided into three subcategories: pain severity, stiffness, and physical function. Each item is scored on a 5-point Likert scale ranging from 0 to 4. The total score is calculated as a percentage, with higher scores indicating increased pain and stiffness and reduced physical function.

The 6MWT was used to measure patients' functional capacity. Two cones were placed 30 meters apart, and participants were instructed to walk as quickly as possible without running. The total distance walked in six minutes was recorded in (m) meters.

The TUG test was administered to assess dynamic balance, walking speed, and functional performance. Participants were seated in a fixed chair without armrests, with their hips and knees positioned at a 90-degree angle. Upon the "START" command, they were instructed to stand up, walk three meters, turn around a designated cone, and return to the starting position. The total time (seconds) required to complete the task was recorded.

The modified Y-Balance test was used to assess dynamic balance. In this test, the maximum distances reached in the Anterior (A), Posteromedial (PM), and Posterolateral (PL) directions were recorded. The assessment was conducted using a specialized platform with Y-shape. Participants were instructed to position the foot being tested at the center of the platform while reaching as far as possible with the opposite foot in the A, PM, and PL directions. Measurements were taken bilaterally, ensuring that the participant's balance was maintained throughout the procedure. The test was repeated three times, and the average distances were recorded in (cm) centimeters.

The strength of selected lower extremity muscles was measured using a hand-held dynamometer (HHD) (Model-01165, Lafayette Instrument®, Lafayette IN, USA), with results recorded in newtons. Quadriceps, hamstring, gluteus medius muscles strength were measured. Before strength measurements, each participant performed a familiarization trial. Three measurements were taken for each muscle group, and the average value was used for analysis. A 120-second rest period was provided between measurements,