Feasibility and Preliminary Effects of a Pressure Sensor–Based Exergame on Cognitive and Sensorimotor Frailty in Low-Income Older Adults Receiving Public Community Care Services: Pilot Randomized Controlled Trial

BACKGROUND: Age-related cognitive and sensorimotor declines co-occur and reinforce one another, increasing vulnerability to functional dependence and falls. Exergaming offers integrated cognitive-motor training, but most systems lack features that support personalized care for socially vulnerable, community-dwelling older adults. Low-income older adults receiving Public Community Care services bear a disproportionate burden of cognitive and sensorimotor decline, yet remain underrepresented in digital health research. As part of a broader program to develop a digital health monitoring-to-intervention framework, we evaluated a pressure sensor-based exergame designed to deliver targeted cognitive-motor training within the existing Public Community Care infrastructure. OBJECTIVE: This study evaluates the feasibility and preliminary effects of the Brain Step exergaming intervention on cognitive and sensorimotor frailty in low-income older adults living alone who were receiving Public Community Care services through a pilot study (study 1) and a randomized controlled trial (RCT; study 2). METHODS: Study 1 (n=15) was a 12-week single-arm pilot study. Study 2 was a parallel-group pilot RCT conducted in Seoul, South Korea. Thirty-one low-income older adults living alone who were receiving Public Community Care services (mean age 81.5 years; 26/31, 84%, female) were randomized to the intervention (n=16) or control (n=15) group. The 16-week intervention used custom hardware with integrated safety bars and arcade-style games that progressed from single- to dual-task challenges. Primary outcomes were cognitive function (Korean Mini-Mental State Examination [K-MMSE]), physical function (Berg Balance Scale [BBS] and Timed Up and Go [TUG]), and sarcopenia indicators (appendicular skeletal muscle mass [ASM], Appendicular Skeletal Muscle Mass Index, and grip strength). Secondary outcomes were the Korean Montreal Cognitive Assessment, physical fitness (Figure-8 Walk, 30-second Sit-to-Stand, and 2-Minute Step Test), and fall incidence. Generalized estimating equations with Benjamini-Hochberg false discovery rate (FDR) correction for multiple testing were applied. RESULTS: In the single-arm pilot study (study 1), a pre-post increase in BBS scores and a reduction in TUG time survived FDR correction among the primary outcomes (both FDR-adjusted P=.002), as did all 3 secondary physical fitness outcomes (Figure-8 Walk, FDR-adjusted P=.006; 30-second Sit-to-Stand, FDR-adjusted P=.01; and 2-Minute Step Test, FDR-adjusted P=.02). The K-MMSE Visuospatial subscale showed an uncorrected pre-post improvement (P=.02), with differential risk-stratified patterns for Recall (P=.04) and Attention (P=.006). In the pilot RCT (study 2), a nominally significant group × time interaction was observed for ASM (P=.04, FDR-adjusted P=.11), with the intervention group maintaining muscle mass while the control group declined. The risk-stratified analyses showed an uncorrected significant 3-way interaction for K-MMSE Recall (P=.01). No findings from study 2 survived FDR correction. CONCLUSIONS: These sequential studies demonstrate the feasibility of delivering a culturally adapted exergaming intervention through the existing Public Community Care infrastructure. The pilot study (study 1) showed FDR-corrected pre-post improvements in balance and mobility within an uncontrolled single-arm design. In the pilot RCT (study 2), no primary outcomes survived FDR correction. The observed preliminary signals for muscle mass preservation and, in exploratory risk-stratified analyses, cognitive improvement in the high-risk subgroups should be regarded as hypothesis-generating only. Adequately powered trials with risk-enriched samples and active comparators are needed to evaluate efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT06664229; https://clinicaltrials.gov/study/NCT06664229.