Impact of Competitive Exergaming on Cognitive-Motor Interference and Fall Risk in Multiple Sclerosis: A Pilot Randomized Controlled Trial

Falls and cognitive-motor interference (CMI) severely impair quality of life in multiple sclerosis (MS), yet conventional training shows limited adherence and dual-task efficacy. This single-center, prospective pilot randomized controlled trial (1:1 allocation) in Gurugram, India (CTRI/2026/06/053588) compared competitive exergaming with non-competitive balance training in MS. Forty adults with MS (EDSS 2.0–6.5, fall history) completed 12-week home-based interventions (3 × 45 min/week). Intervention: competitive multiplayer step exergaming with Xsens feedback and dual-tasks. Control: progressive balance exercises. Outcomes: primary—DTC (gait walkway + serial-7s), SPPB, PPA; secondary—SDMT, MFIS, MSQOL-54, SSQ. Assessor-blinded. Intention-to-treat linear mixed models (group × time); Cohen’s d, 95% CIs; p < 0.05 (SPSS v.29). 90% retention (intervention adherence 87%). Intervention reduced DTC by 12.3% (95% CI: −15.9 to −8.7) vs. control, 5.1% (d=0.42; p < 0.001); SPPB increased by 2.4 (p < 0.001). Secondary gains: SDMT +8.6 (d=0.78; p = 0.001), MFIS: -14.2 (p = 0.003). Falls IRR=0.36 (p = 0.004); SSQ 8.4 (safe). Kinematics: step variability -18%, sway -22% (p < 0.005). Competitive exergaming superiorly mitigates CMI and falls in MS, with strong feasibility. Larger trials are needed to confirm scalability in neurorehabilitation.