BACKGROUND: It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities. METHODS: Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants' capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montreal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade's non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (eta2p) effect sizes were calculated. RESULTS: Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score 17.2 +/- 4.5; aged 70 to 91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, eta2p = 0.41), total SPPB (p < 0.001, eta2p = 0.64), SRTT (p < 0.001, eta2p = 0.51), MoCA (p < 0.001, eta2p = 0.38), and reductions in CSDD (p < 0.001, eta2p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, eta2p = 0.05), DQoL (p = 0.012, eta2p = 0.16), and ADL (p = 0.008, eta2p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team. Conclusions: The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04436302.

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