Effects of Rehabilitative Exergame Training on Foot Muscle Activity, Balance, and Mobility in Older Adults

Evaluation of the Effects of Rehabilitative Exergame Exercises on Foot Muscle Activation, Balance, and Mobility in Older Adults Using Surface Electromyography and Postural Sway Measurements

This study is designed as a randomized controlled trial. A total of 40 healthy older adults residing in private and public nursing homes and rehabilitation centers in Mersin will be enrolled. Participants will be randomly assigned to either the intervention group (Group 1) or the control group (Group 2).

The intervention group will receive rehabilitative interactive game-based exercise training, while the control group will receive functional balance exercise training. Both groups will participate in exercise sessions three times per week, with each session lasting 40 minutes, over a period of 8 weeks.

Participants will undergo pre- and post-intervention assessments, including:

i) clinical tests and measurements for cognitive, functional, and balance evaluation; ii) surface electromyography (sEMG) measurements recorded during the Functional Reach Test (FRT); and iii) biomechanical measurements obtained via integrated inertial measurement unit (IMU) sensors (accelerometer and gyroscope) and the Becure game board.

Electrophysiological and biomechanical data will be analyzed using statistical comparisons, correlation analyses, and regression models. Variables derived from time, frequency, and time-frequency domain analyses will be examined to identify potential sEMG and biomechanical biomarkers.

The increasing prevalence of sedentary lifestyles among older adults represents a major public health concern, as it accelerates age-related declines in physical mobility, muscle strength, postural control, and balance. These declines contribute to an increased risk of falls, highlighting the need for effective and innovative intervention strategies.

Rehabilitative interactive games (exergames) have emerged as a promising intervention by combining motor learning components, such as balance and functional mobility, with cognitive engagement. However, the effects of exergames on lower extremity functionality, balance performance, and their association with neuromuscular activity remain insufficiently understood.

This study adopts an innovative approach by employing surface electromyography (sEMG) to investigate electromyography-force relationships in trunk, leg, and foot muscles-an area that has received limited attention in the existing literature. While prior research has predominantly focused on traditional clinical assessments such as the Functional Reach Test (FRT) or ankle joint biomechanics, this study emphasizes the functional contribution of muscles involved in foot arch stabilization and toe control. This perspective aims to provide additional insight into the coordinated roles of foot, leg, and trunk musculature in balance and mobility.

The study will be conducted as a randomized controlled trial including 40 healthy older adults residing in nursing homes and rehabilitation centers in Mersin. Participants will be randomly allocated to either an intervention group receiving exergame-based exercise training or a control group receiving functional balance exercises. Both groups will complete 40-minute exercise sessions three times per week for a duration of eight weeks.

Pre- and post-intervention assessments will include:

i) clinical tests and measurements evaluating cognitive, functional, and balance performance; ii) surface EMG recordings obtained during the Functional Reach Test to assess muscle activity of the trunk, thigh, leg, and foot; and iii) biomechanical data collected using force plates and integrated IMU sensors (accelerometers and gyroscopes) synchronized with the surface EMG system.

Collected data will be analyzed across time, frequency, and time-frequency domains to examine relationships between electrophysiological and biomechanical variables. Statistical analyses will include comparative analyses, correlation analyses, and regression models to identify potential electrophysiological and biomechanical biomarkers associated with balance performance and exercise-related outcomes.

Inclusion Criteria:

• Aged 65 to 80 years
• Having a minimum of 5 years of formal education
• Ability to walk independently for at least 10 meters, with or without a walking aid if necessary
• Having sufficient cognitive function for communication and participation, defined as a Mini-Mental State Examination (MMSE) score ≥26

Exclusion Criteria:

• Body mass index (BMI ≥30 kg/m²)
• Presence of central or peripheral nervous system disorders or use of medications that may affect balance
• History of vestibular pathology
• Lower extremity amputation, prior lower extremity surgery, or malignancy affecting the lower extremities
• Presence of moderate to severe congenital heart disease, coronary artery disease, or cerebrovascular disease
• Presence of visual, psychiatric, or cognitive impairments that could interfere with study participation or assessment procedures