{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T08:29:23Z","timestamp":1789028963275,"version":"build-2803163510"},"reference-count":63,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Aging"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2013based exergame designed to deliver targeted cognitive-motor training within the existing Public Community Care infrastructure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u00d7 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT06664229; https:\/\/clinicaltrials.gov\/study\/NCT06664229<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/93467","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T19:35:09Z","timestamp":1784921709000},"page":"e93467","source":"Crossref","is-referenced-by-count":1,"title":["Feasibility and Preliminary Effects of a Pressure Sensor\u2013Based Exergame on Cognitive and Sensorimotor Frailty in Low-Income Older Adults Receiving Public Community Care Services: Pilot Randomized Controlled 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