Assessing the Clinical Effectiveness of an Exergame-BasedExercise Training Program Using Ring Fit Adventure to Preventand Postpone Frailty and Sarcopenia Among Older Adults in RuralLong-Term Care Facilities:Randomized Controlled Trial

Background: Frailty and sarcopenia are geriatric syndromes of increasing concern and are associated with adverse healthoutcomes. They are more prevalent among long-term care facility (LTCF) users than among community dwellers. Exercise, especially multicomponent and progressive resistance training, is essential for managing these conditions. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to health care professional shortages. Moreover, older adults often become bored with repetitive exercise training and may lose interest over time. The Nintendo SwitchRing Fit Adventure (RFA) exergame is a novel exergame that combines resistance, aerobic, and balance exercises and offers apotential solution by boosting motivation in an immersive manner and reducing staff intervention needs. Objective: We aimed to evaluate the clinical effectiveness of an exergame-based exercise training program delivered via RFA(exergame-RFA) in improving muscle mass and functional performance among older adult LTCF users. Methods: This was a randomized controlled trial conducted from August 2022 to September 2023 and involved older adultLTCF users (aged >= 60 y) in rural southern Taiwan. Participants were randomized into an intervention group (exergame-RFAplus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skillsand trunkcontrol exercises using the RFA, lasted 30 minutes twice weekly over 12 weeks. The primary outcomes measured were the Studyof Osteoporotic Fractures index (serving as an indicator of frailty status) and the diagnostic criteria for sarcopenia (appendicularskeletal muscle mass index, handgrip strength, and gait speed). The secondary outcomes included functional performance (boxand block test as well as maximum voluntary isometric contraction of the dominant upper extremity), muscle condition (musclethickness measured using ultrasonography), activities of daily living (Kihon checklist), health-related quality of life (Short FormHealth Survey-36), and cognitive function (brain health test). We used an intention-to-treat analysis, incorporating a simpleimputation technique in statistical analysis. A mixed ANOVA, with time as a within-participant factor and intervention as abetween-participant factor, was used to compare the training effects on outcomes Results: We recruited 96 individuals, of whom 60 (62%) underwent randomization. Of these 60 participants, 55 (92%) completedthe study. Significant groupxtime interactions were observed in the intervention group in all primary outcomes (all P<.001, exceptP=.01 for handgrip strength) and most secondary outcomes, including maximum voluntary isometric contraction of the biceps(P=.004) and triceps brachii (P<.001) muscles, biceps muscle thickness measured using ultrasonography (P<.001), box and blocktest (P<.001), Kihon checklist (physical function: P=.01, mood status: P=.003, and total: P=.003), and brain health test (P<.001). Conclusions: The exergame-RFA intervention significantly improved muscle mass, strength, and functional performance amongolder adult users of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia.