Exergaming-based Sitting Tai Chi for Sarcopenia and/or Frailty

This randomized controlled trial will evaluate the effects of an exergaming-based sitting Tai Chi program on sarcopenia-related muscle weakness, balance, physical function, cognition, and psychosocial outcomes in older adults living in residential care facilities who are at risk of sarcopenia and/or prefrailty. Sarcopenia and frailty are common in residential care and are associated with falls, disability, loss of independence, and mortality. Although conventional exercise and Tai Chi may improve physical function, participation can be difficult for residents with mobility limitations, fluctuating health status, or low motivation. Sitting Tai Chi offers a lower impact alternative, and exergaming may further enhance engagement by providing interactive tasks and real-time feedback. This single-blind, parallel group randomized controlled trial will recruit 152 participants aged 60 years or older from collaborating residential care facilities. Eligible participants must have screening indicators of sarcopenia or prefrailty, score at least 7 on the Chinese (Hong Kong) version of the Abbreviated Mental Test, be able to stand independently for assessment, and be able to follow intervention instructions. Residents with confirmed sarcopenia, confirmed frailty, severe cognitive or sensory impairment, unstable medical conditions, prior regular Tai Chi practice, or current participation in another clinical trial will be excluded. Participants will be randomly allocated in a 1:1 ratio to either an exergaming-based sitting Tai Chi group or a general health education control group, stratified by age, gender, and prefrailty status. Randomization will be performed by an independent off-site researcher using computer software. Outcome assessors and the statistician will be blinded to group allocation, although participants and intervention providers cannot be blinded because of the nature of the intervention. The intervention group will receive a 12-week exergaming-based sitting Tai Chi program delivered twice weekly in 60-minute sessions. The program uses a 12-form sitting Tai Chi exergame with body tracking and real-time feedback. Training progresses from learning mode to skill-specific training and game modes, with a focus on balance control, eye-hand coordination, and limb flexibility. The control group will receive time-matched general health education sessions on generic health topics relevant to older adults, without any content related to sarcopenia, frailty, exercise, or physical activity. All participants will continue to receive usual care and routine activities provided by their residential care facility. Outcome assessments will be conducted at baseline, mid-intervention, post-intervention, and 3-month follow-up. The primary outcome is dominant-hand grip strength. The key secondary outcome is sitting balance and functional reach assessed by the Modified Functional Reach Test. Other secondary outcomes include skeletal muscle mass index, lower-extremity function, activities of daily living, reaction time and health-related quality of life. Data will be analyzed according to the intention-to-treat principle using linear mixed-effects models to examine group-by-time effects. This trial will provide preliminary evidence on whether chair-based exergaming Tai Chi is an effective and practical intervention for older adults at risk of sarcopenia and/or prefrailty in residential care settings.

Inclusion criteria

• aged ≥60 years;
• at risk of sarcopenia and/or prefrailty. At risk of sarcopenia is defined as meeting at least one of the following criteria: SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls) score ≥4, calf circumference <34 cm for men or <33 cm for women, while prefrailty is defined as a Fried Frailty Phenotype score of 1-2;
• score ≥7 on the Chinese (Hong Kong) version of the Abbreviated Mental Test;
• can stand independently for assessment; and
• can understand and follow intervention and assessment instructions.

Exclusion criteria

• absence of full diagnostic criteria is required; therefore residents with confirmed sarcopenia as defined by the Asian Working Group for Sarcopenia 2019 or confirmed frailty as defined by the Fried Frailty Phenotype (score 3-5) will be excluded;
• severe cognitive, sensory, or communication impairments not adequately corrected with aids;
• uncontrolled medical, neurological, orthopaedic, cardiovascular, or psychiatric conditions that preclude safe participation;
• prior experience of regular practice of Tai Chi >1 month; or
• current participation in another clinical trial.
• absence of full diagnostic criteria is required; therefore, residents with confirmed sarcopenia as defined by the Asian Working Group for Sarcopenia 2019 or confirmed frailty as defined by the Fried Frailty Phenotype (score 3-5) will be excluded;
• severe cognitive, sensory, or communication impairments not adequately corrected with aids;
• uncontrolled medical, neurological, orthopedic, cardiovascular, or psychiatric conditions that preclude safe participation;
• prior regular practice of Tai Chi for more than 1 month; or
• current participation in another clinical trial.