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