{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T16:16:32Z","timestamp":1783613792347,"version":"3.55.0"},"reference-count":91,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Serious Games"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exergame balance training integrates cognitive and motor challenges, potentially enhancing neuroplasticity, postural control, and gait stability in mild cognitive impairment (MCI). However, whether modulating the task difficulty of a balance-based exergame training may influence posture- and gait-related outcomes remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We compared balance and gait improvements across exergame training groups performing exercise with different difficulty levels and a Wii Fit group in adults with MCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 4-armed, parallel design, double-blinded, randomized clinical trial included 97 participants with MCI (Montreal Cognitive Assessment score=18-25). Participants were convenience-sampled from the Railway General Hospital, Rawalpindi, Pakistan, and randomized to one of 4 intervention groups: low-difficulty, moderate-difficulty, high-difficulty exergame training or a Wii Fit training group. Each participant completed 24 sessions (40 min, 3\/week) supervised by physical therapists. Gait and balance were assessed using time up and go (TUG), cognitive time up and go (C-TUG), and the Gait &amp; Balance mobile app at baseline and after 4 and 8 weeks. Although the calculated sample size was 80, 97 were recruited to offset attrition. Eighty-seven participants completed the study (94% adherence) (attrition: low-difficulty 1, moderate 3, high 2, Wii Fit 2; 10% total). Data were analyzed using mixed-model analysis of covariance with baseline values as covariates to assess time\u00d7group interactions. Bonferroni-adjusted post hoc comparisons revealed between-group differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>High-difficulty training showed the greatest TUG gains (\u20130.71, SD 0.32; P=.03, anteroposterior (AP) steadiness with eyes open (EO) on firm surface (0.04, SD 0.02; P=.04), step time variability head forward (HF; 0.06, SD 0.09; P=.02), walking speed HF (0.08, SD 0.04; P=.05), step time head turn (HT; \u20130.04, SD 0.02; P=.04), step time variability HT (\u20130.35, SD 0.09; P&lt;.001), step length variability (\u20130.27, SD 0.13; P=.04), and walking speed HT (0.09, SD 0.04; P=.01) versus Wii Fit. Moderate-difficulty training improved AP steadiness EO firm (0.05, SD 0.02; P=.03) and reduced step time variability HT (\u20130.26, SD 0.09; P=.01). Low-difficulty training improved C-TUG (\u20131.61, SD 0.63; P=.01), AP steadiness EO firm (0.05, SD 0.02; P=.03), step time variability HF (\u20130.20, SD 0.09; P=.03), step time variability HT (\u20130.25, SD 0.09; P=.01), step length variability (\u20130.31, SD 0.12; P=.014), and walking speed HT (0.11, SD 0.04; P=.03). No significant differences observed between exergame difficulty groups (P&gt;.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Balance-based exergame training improves balance and gait in adults with MCI, with no significant differences across difficulty levels, while the high- and low-difficulty training outperformed Wii Fit in several outcomes. High-difficulty training yielded the most consistent improvements in TUG, postural steadiness, gait variability, and walking speed. These results support graded cognitive-motor exergaming as an effective strategy for enhancing postural control and walking stability in MCI, potentially aiding fall prevention and mobility preservation in aging populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT04959383; https:\/\/clinicaltrials.gov\/study\/NCT04959383<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/74092","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T19:00:07Z","timestamp":1757962807000},"page":"e74092","source":"Crossref","is-referenced-by-count":3,"title":["Effects of Balance-Based Exergame Training With Variable Difficulty on Balance and Spatiotemporal Gait Outcomes in Adults With Mild Cognitive Impairment: Randomized Controlled Trial"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9528-0740","authenticated-orcid":false,"given":"Aruba","family":"Saeed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2824-0079","authenticated-orcid":false,"given":"Imran","family":"Amjad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8752-7224","authenticated-orcid":false,"given":"Imran Khan","family":"Niazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4718-7568","authenticated-orcid":false,"given":"Abdullah","family":"Alzahrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9757-2118","authenticated-orcid":false,"given":"Muhammad","family":"Shafiq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7182-2085","authenticated-orcid":false,"given":"Heidi","family":"Haavik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxs004"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2013.02.009"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.exger.2024.112481"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1590\/1980-5764-DN-2022-S101PT"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.56.3.303"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00277-2"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1159\/000445831"},{"key":"ref8","author":"Michel, 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