INRODUCTION/PURPOSE: Little is known about the comparative effectiveness of exercise programs, especially when delivered at a high intensity, in mobility-limited older adults. We compared the effects of 25 sessions of high-intensity agility exergaming (EXE) and stationary cycling (CYC) at the same cardiovascular load on measured and perceived mobility limitations, balance, and health-related quality of life (QoL) in mobility-limited older adults. METHODS: Randomized to EXE (n = 28) and CYC (n = 27), mobility-impaired older adults (age 70) exercised 5x/week for 5 weeks at 80% of age-predicted maximal heart rate. Wait-listed controls did not exercise (n = 28). RESULTS: Groups did not differ at baseline in any outcomes (p > 0.05). The primary outcomes (SF-36 EXE 6.9%, effect size 2.2; CYC 5.5%, 1.94; WOMAC EXE -27.2% to -3.83; CYC -17.2 to -2.90) improved similarly (p > 0.05). Secondary outcomes, including body mass (-3.7%), depression (-18%), and walking capacity (13.5%) also improved (p < 0.05) similarly after the two interventions. Activities of daily living, Berg Balance Score, BestTest scores, and dynamic gait index improved more (p < 0.05) after EXE than CYC. COP of standing sway path improved in 1 of 6 tests only after EXE (p < 0.05). Post-exercise cardiovascular response improved in EXE (p = 0.019). CON did not change in any outcomes (p > 0.05). CONCLUSIONS: When matched for cardiovascular and perceived effort, two diverse high-intensity exercise programs improved health-related QoL, perceived mobility limitation, and walking capacity similarly and balance outcomes more in mobility-limited older adults, expanding these older adults' evidence-based exercise options to reduce mobility limitations.

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