GAMES FOR HEALTH JOURNAL: Research, Development, and Clinical Applications

Volume 10, Number 5, 2021 Original Article

ª Mary Ann Liebert, Inc.
DOI: 10.1089/g4h.2021.0057

Effects of Exergame-Based Dual-Task Training on Executive

Function and Dual-Task Performance
in Community-Dwelling Older People:
A Randomized-Controlled Trial

Ray-Yau Wang, PhD,1,2 Yuan-Chen Huang, MSc,1–3 Jun-Hong Zhou, BSc,1,2

Shih-Jung Cheng, MD,1,2,4 and Yea-Ru Yang, PhD1,2,5,i
Downloaded by 5.239.148.135 from www.liebertpub.com at 09/19/21. For personal use only.

Abstract

Objective: Aging is associated with decline in executive function that may lead to reduced dual-task perfor-
mance. Regular exercise has been recommended for promoting or maintaining mental and physical health in
older adults, yet only a fraction of older adults exercise regularly. Exergame training may have the potential to
enhance exercise adherence. Therefore, the aim of this study was to examine the effects of exergame-based
dual-task training on executive function and dual-task performance in community-dwelling older adults.
Materials and Methods: This was a single-blinded, randomized-controlled trial. Twenty community-dwelling
older adults were recruited and randomly assigned to one of two groups. All participants completed 36
trainings, including three 60-minute sessions/week over 12 weeks. Participants in the experimental group
received exergame-based dual-task training, while those in the control group received home-based multi-
component exercise training. Measures of executive function, dual-task performance, and community walking
ability were assessed before and after the intervention.
Results: Significant group · time interactions (P = 0.000–0.027) with large effects were found in all selected
outcome measures. Compared with the control group, the experimental group improved significantly in mea-
sures of general executive function (P = 0.014), inhibitory control (P = 0.037), cognitive dual-task performance
(P < 0.001), and community walking ability (P = 0.002). Enhanced general executive function was highly
correlated with either improved motor dual-task performance (r = 0.674) or improved cognitive dual-task
performance (r = -0.701).
Conclusion: These results suggested that exergame-based dual-task training improved both executive function
and dual-task performance in older people. These positive effects could be transferred to enhance community
walking ability. Clinical Trial Registration number: ACTRN 12617000095369.

Keywords: aging, cognitive function, community mobility, dual task, exercise intervention, exergame

Introduction Executive function is particularly affected by aging.3

Executive function is a higher level cognitive ability that

P opulation aging is widespread across the world. It is

one of the most significant social transformations of the
21st century. Aging leads to a gradual decrease in mental and
physical capacity and a growing risk of disease.1,2 In an aging
population, the consequences of mental and physical decline
may ultimately have a severe social and economic impact.
controls and regulates lower level cognitive processes and
goal-directed actions.4 Executive function plays a key role in
dual-task coordination and is sensitive to dual-task interfer-
ence in older adults.5 Aging-related decline in executive
function may contribute to increased dual-task deficits in
older adults. During many activities of daily living, people

1
Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
2
Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
3
Department of Physical Medicine and Rehabilitation, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan.
4
Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan.
5
Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
i
ORCID ID (https://orcid.org/0000-0003-1548-3511).

1
 2 WANG ET AL.
need to perform more than one task at a time. The inability to
perform several tasks simultaneously would negatively af-
fect the performance of activities of daily living. In fact,
decreased dual-task performance was associated with in-
creased fall risk in community-dwelling older adults.6
Moreover, alterations in dual-task performance can be de-
tected early in neurodegenerative conditions, including
Alzheimer’s disease and Parkinson’s disease, as well as in
mild cognitive impairment.7–9 Thus, finding ways to improve
executive function and dual-task performance may contrib-
ute to reduce aging-related mental and physical decline.
Several previous meta-analyses have demonstrated the
positive effects of exercise on executive function in older
people.10–13 The earlier meta-analysis by Colcombe and
Kramer reported that the overall effect obtained was mod-
erate.10 However, three other meta-analyses indicated that
older adults engaged in exercise training exhibited small
effect on executive function.11–13 The modalities of exercise
in these previous meta-analyses included aerobic exercise,
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resistance exercise, coordination exercise, combined exercise,
Tai Chi, and yoga. These exercises mainly focus on physical
training, not cognitive training, and therefore are not directly
relevant to executive function. Executive function as indicated
above is responsible for dual-task coordination. It is possible
that dual-task training raises executive function in older
people. Some interventional studies demonstrated that
motor/cognitive dual-task training or motor/motor dual-
task training improved executive function.14–18
Based on a crucial principle in motor learning, task-specific
concept, frequent repetitions of specific task exercises may
contribute to improve the specific task performance. Accord-
ingly, dual-task training has been designed to enhance dual-
task performance. A previous systematic review reported that
effects of dual-task training on motor performance under dual-
task conditions in older adults were heterogeneous.19 The
authors suggested that to improve motor performance under
dual-task conditions optimally, the training protocols should
prefer a dual-task training with a certain level of exercise load
and duration and level of task specificity to gain task-related
adaptations.19 Furthermore, review articles reported that the
degree of transference that occurs after dual-task training may
be limited.19,20 It is important to consider that the training
effects can be transferred to everyday situations.
Training adherence is one of challenges for older
adults. Motivation can be harder to maintain when increas-
ing the level of training load and duration that is important
for obtaining positive effects. Recently, exergames have
been used as an intervention for older adults. Training by
using exergames may increase interest, boost motivation,
and then enhance adherence. A meta-analytical review has
suggested that exergame training was an acceptable method
for improving functional mobility among healthy community
dwellers.21 Another recent systematic review reported that
exergame training yielded inconsistent benefits on execu-
tive function.22 Moreover, investigations into the effect of
exergame training on both executive function and dual-
task performance within the same study are scarce. The
aim of this study was to investigate the effects of an
exergame-based dual-task training on executive function and
dual-task performance and the effect of transference to
community walking ability among community-dwelling
older adults.
Materials and Methods
Participants
Participants were recruited from local communities in
Taipei, Taiwan. Inclusion criteria were as follows: (1)
community-dwelling older adults, (2) age q65 years old, (3)
able to walk independently for 10 m without any assistive
device, (4) a score of mini-mental state examination q24,
and (5) educational level q6 years or ability to read the
Chinese characters. Exclusion criteria were as follows: (1)
diagnosed with any neurologic and cardiopulmonary disor-
ders, (2) any musculoskeletal problems that would preclude
exercise training, and (3) a diagnosis of hand movement
disorders, dysgraphia, agraphia, color blindness, or color
vision deficiency.
Study design and procedure
This study was a single-blinded (assessor-blinded),
randomized-controlled trial. The study protocol was ap-
proved by the Institutional Review Board of National Yang-
Ming University and was registered in the Australian New
Zealand Clinical Trials Registry (ACTRN 12617000095369).
The purpose, nature, procedure, and potential risks of the ex-
periments were fully explained to the participants, and all
participants provided written informed consent before par-
ticipating in the study. Block randomization was used to assign
participants to either the experimental or control group. Par-
ticipants in the experimental group and control group received
a 12-week exergame-based dual-task training and home-based
multicomponent exercise training, respectively. Outcome
measurements, including executive function, dual-task per-
formance, and community walking ability, were evaluated
before and after 12 weeks of training.
Intervention
The intervention was carried out during 12 weeks with
three sessions of 60 minutes per week. Participants in both
groups performed similar routines, which were structured in
three sections: 10 minutes of warm-up, 40 minutes of main
training, and 10 minutes of cool down. Both the warm-up and
cool-down periods focused on stretching exercises of the
trunk and extremities.
Participants in the experimental group received exergame-
based dual-task training using Kinect sensor with the TANO
and PAPAMAMA Software System (Long Good, Taipei,
Taiwan) and the treadmill (Gait Trainer, Biodex, NY)
(Fig. 1). Participants walked with self-selected speed on the
treadmill as the primary task and performed videogames as
the secondary task at the same time. Motor and cognitive
videogames were used for training. Both types of videogame
contained three different games (Table 1). Each game took
up approximately the same proportion of time and was ran-
domly assigned during the 40-minute main training. During
the training duration, the challenge level was increased
progressively by increasing the treadmill speed and the dif-
ficulty of the motor or cognitive tasks to ensure that the
training remained challenging. The training was supervised
and controlled by a physical therapist.
Participants in the control group received home-based
multicomponent exercise training. The exercise program was
demonstrated with a video and included aerobic,
 EFFECTS OF EXERGAME IN OLDER ADULTS
FIG. 1. Instrument of the exergame-based dual-task
training consists of a treadmill, the Kinect, a computer, a
projector, and a screen.
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strengthening, and balance exercise. Participants were re-
quested to reach 12 to 14 of rate of perceived exertion during
the training period. Participants had to record their exercise
session in a record form and submit after the exercise pro-
gram was done. Participants received phone calls from the
physical therapist once in 2–3 weeks to check on the prog-
ress.
Outcome measures
Executive function. The Chinese version of the 25-item
Executive Interview (EXIT25), the Trail Making Test
(TMT), and the Chinese version of the Stroop Color and
Word Test (SCWT) were used to measure the executive
function. The EXIT25 consisted of a 25-item rating for ex-
ecutive function on tasks. Scores ranged from 0 to 2 for each
item, and higher scores indicated worse performance.23 The
Chinese version of EXIT25 had high internal consistency
and good reliability.24 The TMT consists of Part A (TMT-A)
and Part B (TMT-B).25 For the TMT-A, participants must
draw a line sequentially connecting 25 encircled numbers.
For the Chinese version of TMT-B, participants must draw a
line sequentially connecting 12 encircled numbers and Chi-
Table 1. Motor and Cognitive Videogames
Games Tasks
Motor
Fire game To detonate fireworks using the head,
shoulder, elbow, hand, or knee
Brick game To hit the brick by shooting the ball
Fishing game To catch fish using hand
Cognitive
Puzzle game To arrange items according to their
characteristics
To choose the correct shape or color
To solve mathematical questions
Digital game To arrange 9 different numbers in order
Wipe game To wipe a dirty picture and state what is
on the picture
3
nese animal zodiac in alternating order. The score on each
part is the number of seconds required to complete the
task. The test/retest reliability of the Chinese version of the
TMT-A and TMT-B was high in community-dwelling older
adults.25 The SCWT consists of two subtasks, congruous and
incongruous conditions. In the congruous condition, the
words black, blue, red, and yellow were printed in the same
color ink with the word. In the incongruous condition, the
words were printed in a different ink color. Participants were
required to name the ink color as quickly and as accurately as
possible within 45 seconds. The scoring was generated using
the correct number of items completed on each subtask. The
test/retest reliability of the Chinese version of the SCWT has
been established.25
Dual-task performance. Motor timed up-and-go dual-
task and cognitive timed up-and-go dual-task were used to
measure dual-task performance.26 During the timed up-and-
go test, participants were required to stand from a seated
position, walk 3 m at their fastest pace, turn around, walk
back to the chair, and sit down. In the motor timed up-and-go
dual-task, participants were asked to perform the up-and-go
task while grasping a drinking glass filled with water without
spilling or else that would be considered failed. The motor
timed up-and-go dual-task test was timed in seconds. In the
cognitive timed up-and-go dual-task, participants were asked
to perform the up-and-go task while counting back in threes,
starting from a random double digit. In addition to the per-
formance time, the correct number of counting steps was
recorded. The cognitive dual-task performance was shown as
correct number/performance time. Each test was repeated
three successful times and the means of the three successful
trials were used for further data analysis.
Community walking ability. Community walk test was
used to evaluate community walking ability.27 Participants
were requested to walk at their usual pace for 400 m in a
nearby community. The 400-m walk comprised cross street,
up and down the ramp/curb, and stepping over an obstacle.
The time to complete community walking was recorded.
Sample size
The effect size was estimated to be 0.70 from the results of
EXIT25 in our previous study.28 The sample size was de-
termined using G*Power 3.1 based on the effect size of 0.70,
an alpha level of 5%, 80% power, and an f test model.
A minimum sample size of 16 participants was indicated.
A total of 20 participants were recruited and allocated into
the experimental and control groups.
Statistical analyses
All of the statistical data were analyzed with the SPSS
statistical package version 24.0 (SPSS Inc., Chicago, IL).
Descriptive statistics (mean – standard deviation) were used
to present the baseline demographics of all participants.
Baseline demographics and the preintervention variables
between groups were compared using the independent t test
for continuous variables and chi-square test for categorical
variables. A two-way analysis of variance (group · time) was
used to determine differences of each dependent variable.
When the interaction effect was significant, the main factor’s
 4 WANG ET AL.
group and time were tested again using the independent t test
and paired t test, respectively. Change scores were calculated
by subtracting preintervention data from postintervention
data. Pearson’s test was used to analyze the correlation be-
tween change in executive function and change in dual-task
performance. The statistical significance was set at P < 0.05.
The current study reported partial g2 as an index of effect
size. The criteria for judging the estimated effect size are as
follows: a large effect size was q0.14, a medium effect size
was 0.06 to 0.13, and a small effect size was 0.01 to 0.05.29
Results
A total number of 85 participants from local communities
were screened and 20 enrolled in the present study. Ten
participants were randomized and assigned to the experiment
group and 10 to the control group. The progress through the
phases of enrollment, intervention allocation, and data
analysis is represented in Figure 2. Table 2 presents an
overview of the demographic characteristics of participants.
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FIG. 2. Flowchart of the experimental design.
No significant between-group differences were found for
demographics and gender- and health-related data. More-
over, there were no significant between-group differences in
any of the preintervention outcome measures (Table 3). All
participants in the current study had 100% of attendance
rates in their 36 exercise sessions. None of the participants
reported any adverse events.
Table 3 shows all results of the two-way analysis of var-
iance. The results showed significant time effects and
time · group interaction effects for all examined variables
(P = 0.000–0.027). Post hoc within-group comparisons re-
vealed significant improvements in the EXIT25 (P = 0.025)
and community walk test (P = 0.048) in the control group and
significant improvements in all the examined variables in the
experimental group (P = 0.000–0.004). Post hoc between-
group comparisons showed significant differences in the
EXIT25 (P = 0.014), both conditions of the SCWT (con-
gruous: P = 0.041; incongruous: P = 0.037), cognitive dual-
task test (P < 0.001), and community walk test (P = 0.002).
 EFFECTS OF EXERGAME IN OLDER ADULTS 5

0.823

0.284
0.411

0.243
0.658
0.603
0.661
0.497
Table 2. Baseline Characteristics by Study Group

ES
Time · group
Control Experimental
group group
Variables (n = 10) (n = 10) P

<0.001

0.016
0.002

0.027
<0.001
<0.001
<0.001
0.001
P
Age (years) 73.50 – 5.66 71.30 – 5.33 0.383
Gender (male/female) 4/6 3/7 0.639
Body height (cm) 157.20 – 6.73 157.30 – 7.47 0.975
Body weight (kg) 62.60 – 8.04 61.50 – 7.76 0.759

0.892

0.406
0.599

0.477
0.684
0.671
0.774
0.681
Body mass index 25.41 – 3.61 24.87 – 2.89 0.718

ES
(kg/m2)

Time effect
Mini-mental state 28.80 – 1.14 28.90 – 0.99 0.836

Table 3. Executive Function and Dual-Task Performance with Two-Way Analysis of Variance
examination
Education (years) 9.80 – 3.77 10.80 – 3.26 0.533

<0.001

0.003
<0.001

0.001
<0.001
<0.001
<0.001
<0.001
No. of chronic 0.90 – 0.74 0.60 – 0.84 0.408

P
diseases
Data are presented as the mean – standard deviation or n.

291.95 – 27.81***,{{
0.84 – 0.16***,{{{
Postintervention
,{

94.40 – 15.05**,{
37.90 – 8.67***,{
52.50 – 15.79***
Table 4 shows correlations between change in executive

3.30 – 1.42***

29.20 – 12.97**

10.15 – 2.79***
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function and change in dual-task performance. The results

Experimental group (n = 10)

showed that improved motor dual-task performance corre-
lated significantly with improved EXIT25 (r = 0.674),
TMT-B (r = 0.629), and both conditions of the SCWT
(congruous: r = -0.471; incongruous: r = -0.681). The simi-
lar correlations between improved cognitive dual-task per-
formance and improved EXIT25 (r = -0.701), TMT-B
(r = -0.641), and both conditions of the SCWT (congruous:
Preintervention

38.80 – 14.74
70.10 – 19.32

83.80 – 13.90

319.50 – 28.16
r = 0.455; incongruous: r = 0.519) were also observed.

8.20 – 2.15

31.10 – 8.69
14.62 – 3.48
0.56 – 0.17
Discussion

*P < 0.05, **P < 0.01, and ***P < 0.001 show a significant difference versus preintervention.
The two main findings of the present study were as

P < 0.05, {{P < 0.01, and {{{P < 0.001 show a significant difference versus control group.
follows: first, that exergame-based dual-task training sig-
nificantly improved executive function and dual-task per-
formance in older adults; and second, that improvement in
Postintervention

331.55 – 20.26*
5.90 – 2.69*

41.50 – 13.75
71.30 – 26.21

79.10 – 16.02
executive function and dual-task performance can translate 30.10 – 6.71
12.74 – 3.10
0.53 – 0.16

Values are mean – standard deviation. Effect size was calculated as partial g2.
into improved community walking ability. These findings are
Control group (n = 10)

important since executive function and dual-task perfor-

mance are particular affected in the aging process.3,30 With
advanced age, decline in mental and physical function may
decrease participation in social and community activities.
The exergame-based dual-task training can be considered
one of the training programs aiming to improve executive
Preintervention

42.80 – 16.95
74.60 – 30.33

76.40 – 20.05

336.80 – 21.17
6.60 – 2.50

29.90 – 6.98
13.07 – 2.87
0.49 – 0.13

function, dual-task performance, and community walking

ES, effect size; EXIT25, 25-item Executive Interview.

ability in the older people. Moreover, 100% attendance was

observed in the exergame-based intervention in the present
study. The high attendance may be due to the interactive,
enjoyable, and challenging training program that is different
from other types of exercise. This finding supports that
exergame training has the potential to promote exercise
Community walk test (seconds)

adherence.
The training program used in the current study was designed
Stroop Color and Word Test

based on the dual-task principle. Both motor/cognitive dual-

Motor dual-task (seconds)
Cognitive dual task (n/s)

task and motor/motor dual-task were incorporated in our

training program, since our everyday actions consist of these
Part A (seconds)
Part B (seconds)

Incongruous (n)
Trail Making Test

two types of dual-task. In addition, walk is one of the most

Congruous (n)

important activities of daily living. Improving dual-task per-

Variable/group

formance with walking is an important goal for prolonging

functionality. Therefore, our training program combined
EXIT25

walking with concurrent cognitive or motor tasks. Previous

studies have reported that both motor/cognitive dual-task
{

training and motor/motor dual-task training showed positive

 6 WANG ET AL.
Table 4. Correlation (R) Between Change
in Executive Function and Change in Dual-Task
Performance (n = 20)
Motor dual-task Cognitive dual
(seconds) task (n/s)
Variables r P r P
EXIT25 0.674 0.001 -0.701 0.001
Trail Making Test
Part A (seconds) 0.174 0.462 -0.373 0.105
Part B (seconds) 0.629 0.003 -0.641 0.002
Stroop Color and Word Test
Congruous (n) -0.471 0.036 0.455 0.044
Incongruous (n) -0.681 0.001 0.519 0.019
effects on executive function.14–18 Consistently, the current
study demonstrated that the exergame-based dual-task training
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showed a larger improvement in executive function compared
with home-based multicomponent exercise training. This
result showed a large effect size with a significance for
the time · group interaction between exergame-based dual-
task training versus home-based multicomponent exercise
training (Table 3). Executive function is mainly processed
in a frontal/cingulate/parietal/subcortical cognitive control
network.31 Neuroimaging evidence revealed that dual-task
training improved the efficiency of neural circuitry and the
synapse communication in the brain network in older
adults.15,32,33 This, in turn, could positively influence the
movement execution.
Furthermore, the exergame-based dual-task training re-
sulted in a higher improvement in inhibitory control (mea-
sured by the SCWT) compared with the home-based
multicomponent exercise training. A previous study also
indicated that dual-task training improved inhibitory per-
formance in older adults.16 The inhibitory control is the
ability to inhibit automated responses, which is a dimension
of executive function, and contributes to anticipation, plan-
ning, and goal setting.34 The inhibitory control may have
relevance to the ability to cope with more than one task at a
time.35,36 The results of this study showed that there were
moderate correlations between change in inhibitory control
and change in dual-task performance (Table 4). These find-
ings support that dual-task training has the potential to in-
duce cognitive plasticity in older adulthood, thus preserving
the efficiency of supervisory brain areas in which inhibitory
control is involved and then enhancing the execution of dual-
task or multitask.37,38
Apart from inhibitory control, TMT-A and TMT-B were
used to assess the information processing speed and shifting,
respectively, in the current study. Participants in the exper-
imental group had significant improvements in both infor-
mation processing speed and shifting. Previous studies also
reported that dual-task training led to improved information
processing speed and shifting.17,39 By contrast, some studies
did not exhibit improvements in information processing
speed and shifting.40,41 A previous study indicated that dif-
ferent types of videogames may have positive effects on the
specific cognitive aspect.42 The videogames used in the
current study included cues that trained speed of information
processing, switching, and inhibition. Therefore, our training
program might trigger the beneficial effects on the measured
executive functions and processing speed.
Our previous results showed moderate-to-high correla-
tions between improved executive function and improved
dual-task performance.28 In line with our previous finding,
the current study showed similar results. This is not sur-
prising since executive function is closely related to dual-
task performance.43,44 Nevertheless, gains in dual-task
performance were lowly correlated with gains in information
processing speed. Processing speed is a cognitive function
related to process information quickly and accurately.
A previous study suggested that poorer processing speed,
short-term memory, and sustained attention were the major
cognitive contributors to slower dual-task walking.44 An-
other study demonstrated that processing speed measured by
the digit symbol task was associated with dual-task step and
stride regularity, whereas processing speed measured by
TMT-A emerged independently of the dual-task walking.45
The great heterogeneity of the use of dual-tasks and tests to
evaluate processing speed makes the comparison of the re-
sults very difficult. The observations presented herein are
that executive function contributed to dual tasks. However,
the relationship between processing speed and dual task re-
mains uncertain.
The results from the current study expanded our under-
standing of the influence of dual-task training on participa-
tion in community activities in older adults. It is important to
consider whether performance gains can be transferred to
everyday tasks. Our results demonstrated that gains from
executive function and dual-task performance transferred to
community walking ability. Wollesen and Voelcker-Rehage
as well as Varela-Vásquez et al. supposed that variable task
prioritization training might help to promote transfer.19,20 In
addition, the transferability of trained tasks to those that are
not would more likely occur when the tasks involve related
demands requiring similar skills.20,46 Our intervention took a
flexible prioritization or resource allocation that is one of the
advantages to reveal transfer effect. Also, our training
combined walking with motor or cognitive tasks that re-
quired participants to actively modify their step while si-
multaneously responding to a variety of tasks. The trained
skills are similar to those in community walking. Therefore,
this kind of intervention may lead to transfer to community
mobility.
Some limitations of the present study must be mentioned.
First, a passive control group might have helped to exclude
the potential test/retest effects in explaining changes in
outcome measures. Second, no follow-up measurement was
performed to ascertain maintenance of effects after exercise
cessation. Last, it remains to be determined whether the
training effects can be obtained with other older populations
such as prefrail or frail older adults.
Conclusion
The current study demonstrated that in community-
dwelling older adults, exergame-based dual-task training has
a more positive impact on executive function and dual-task
performance than home-based multicomponent exercise
training. The exergame-based dual-task training showed a
significant improvement in inhibitory control and shifting as
well as cognitive and motor dual-task performance. Notably,
 EFFECTS OF EXERGAME IN OLDER ADULTS
this impact could transfer to enhance community walking
ability. These findings are important for health promotion
among community-dwelling older adults.
Authors’ Contributions
R.-Y.W., Y.-C.H., and Y.-R.Y. conceived the concept and
rationale for the study. Y.-C.H. collected the data. R.-Y.W.,
Y.-C.H., and Y.-R.Y. analyzed the data. R.-Y.W., Y.-C.H.,
J.-H.Z., S.-J.C., and Y.-R.Y. interpreted the results. R.-Y.W.
and Y.-R.Y. drafted the article. All authors have read and
approved the final article.
Acknowledgments
The authors express sincere appreciation to the partici-
pants for their cooperation. The authors also acknowledge
Mr. Ray Chen and the Long Good team for partly supporting
the exergaming equipment.
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Author Disclosure Statement
No competing financial interests exist.
Funding Information
This work was supported by the Ministry of Science and
Technology of the Republic of China (Grant No. MOST107-
2314-B-010-041-MY3).
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Address correspondence to:
Yea-Ru Yang, PhD
Department of Physical Therapy
and Assistive Technology
National Yang Ming Chiao Tung University
155, Section 2, Li Nong Street, Beitou
Taipei 112
Taiwan
E-mail: yryang@nycu.edu.tw