{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:36:08Z","timestamp":1790649368301,"version":"4.1.0"},"reference-count":50,"publisher":"BMJ","funder":[{"name":"FISM \u2014 Fondazione Italiana Sclerosi Multipla","award":["2017\/R\/22"],"award-info":[{"award-number":["2017\/R\/22"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2025,9,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Motor and cognitive dysfunctions are common and disabling features in multiple sclerosis (MS) that remain challenging to treat. Here, we aimed to explore the effect of exergames as a stand-alone approach for people with MS and impaired processing speed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a three-arm, randomised, rater-blinded, sham-controlled trial. People with MS and impaired processing speed were randomised in a 1:1:1 ratio to an 8-week home-based training with exergames (intervention of interest), adaptive Cognitive Training Kit (COGNI-TRAcK) (working memory training as comparator intervention) or sham intervention. A postintervention assessment was scheduled at week 16 postrandomisation. Statistical analyses were conducted to test the hypotheses that exergames were superior to sham intervention and non-inferior to adaptive COGNI-TRAcK on the symbol digit modalities test (SDMT).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We screened 165 people with MS, of whom 102 were randomised (34 per arm). At week 8, both exergames and adaptive COGNI-TRAcK yielded improvements in SDMT, with adjusted mean differences versus sham intervention of 4.3 (95% CI 0.1 to 8.5) and 5.7 (95% CI 1.3 to 10.1) points, respectively. The non-inferiority analysis was inconclusive, as the mean between-arm difference (adaptive COGNI-TRAcK versus exergames) was 1.3 points (90% CI \u20131.7 to 4.3), crossing the predefined non-inferiority margin of 4 SDMT points. Exergames additionally demonstrated benefits on executive function, dynamic balance, fatigue and reduced work absenteeism. None of these benefits was retained at week 16.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study provides evidence that home-based exergames are suitable as a standalone approach to improve some specific MS-related cognitive and motor dysfunctions, but there is no evidence about their non-inferiority to working memory training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04169750\">NCT04169750<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jnnp-2025-336609","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:35:50Z","timestamp":1759307750000},"page":"jnnp-2025-336609","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Home-based EXergames To impRovE cognitive function in MUltiple Sclerosis (EXTREMUS)"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct04169750","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04169750","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3237-6267","authenticated-orcid":false,"given":"Luca","family":"Prosperini","sequence":"first","affiliation":[{"name":"Department of Neurosciences, San Camillo Forlanini Hospital, Roma, 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Esmeralda","family":"Quartuccio","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, San Camillo Forlanini Hospital, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Alcamisi","sequence":"additional","affiliation":[{"name":"Azienda Sanitaria Locale RM\/2, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachele","family":"Di Giovanni","sequence":"additional","affiliation":[{"name":"Rehabilitation Unit ML Novarese, Hospital Moncrivello, Moncrivello, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Gamberini","sequence":"additional","affiliation":[{"name":"Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, 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