Effect of Exergaming Program Versus Neuromuscular Exercise in Elderly People With Motor Cognitive Risk Syndrome

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).

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.

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) 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,

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 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.

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.

Berg Balance Test (BBS), one of the frequently used tests in balance assessment in elderly individuals, has a test-retest reliability with an ICC (Intraclass Correlation Coefficient) of 0.91 and high inter-rater reliability with an ICC of 0.97 (Neuls, 2011). BBS, which consists of 14 different tasks or activities, is scored from 0 to 4 for tasks such as sitting to standing, standing without support, sitting without support, etc. The total score varies between 0 and 56, with a high score being interpreted as better balance. The scale, which was validated in Turkish by Şahin and colleagues, shows a high risk of falling, a score of 0 to 20 indicates a moderate risk of falling, a score of 21 to 40 indicates a moderate risk of falling, and a score of 41 to 56 indicates a low risk of falling (Sahin, 2008).

The Physical Activity Enjoyment Scale is one of the scales used to measure enjoyment in physical activity. The test-retest reliability of the scale was reported to be 0.69, showing strong internal consistency and reliability (Weyland et al., 2024). The Turkish validity and reliability of the scale, which consists of 8 items and a single dimension, was conducted by Özkurt et al. in 2022, and it was reported that the Turkish form can be used as a valid and reliable measurement tool (Özkurt, 2022).

To monitor exercise adherence, session attendance will be recorded by the researchers using an Exercise Program Attendance Tracking Chart. Participants who fail to attend four or more sessions (representing a dropout/non-attendance rate of ≥25%) of the 16-session program will be excluded from the study. Furthermore, adherence rates will be compared across the exercise groups.

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).