Extended Abstract
Background and Purpose
Aging constitutes a natural biological progression accompanied by incremental physical and cognitive alterations that may adversely affect balance control, functional mobility, and mental performance in older adults. The preservation of postural stability and cognitive capacity is essential for sustaining independence and mitigating fall risk within aging populations. Among the emerging strategies designed to counteract age-related decline, game-based exercises—commonly referred to as exergaming—have garnered considerable scholarly and clinical attention. These interventions integrate physical activity with interactive, motivationally salient game elements, thereby promoting active engagement and multisensory stimulation. Despite their growing adoption, empirical evidence comparing the efficacy of game-based interventions against conventional exercise regimens remains comparatively sparse, particularly among older women. Accordingly, the present study was undertaken to investigate the effects of an eight-week game-based exercise program on balance and cognitive performance in elderly women and to compare its outcomes with those of basic physical exercises.
Methods
This investigation employed an experimental, applied, single-blind controlled design. Forty elderly women aged 65–75 years were recruited through convenience sampling and randomly assigned to one of two groups: (1) an intervention group receiving game-based exercise, and (2) a control group undergoing basic physical exercise. Both groups participated in three training sessions per week over an eight-week period, with each session lasting approximately 60 minutes. The game-based exercise protocol comprised structured exergame tasks that required coordinated bodily movements, visuomotor responses, dynamic balance adjustments, and rapid decision-making. Interactive challenges and real-time feedback were incorporated to augment engagement and cognitive involvement. The control group performed basic physical exercises, including low-impact aerobic activities, stretching, strengthening movements, and balance-oriented drills devoid of game-like components. Intensity and duration were standardized across both groups to ensure comparability. Outcome measures included balance, assessed via the Berg Balance Scale (BBS), and cognitive performance, measured using the Montreal Cognitive Assessment (MoCA). Assessments were conducted at baseline and post-intervention. Data were analyzed using MANCOVA and ANCOVA to compare post-test results while controlling for baseline differences. Statistical assumptions concerning normality, homogeneity of variances, linearity, and equality of covariance matrices were verified prior to analysis.
Results
The findings revealed significant differences between the two exercise modalities. Participants in the basic exercise group exhibited greater improvement in balance, as evidenced by higher BBS post-test scores. Conversely, participants in the game-based exercise group demonstrated greater enhancement in cognitive performance, reflected in elevated MoCA scores. These results suggest that while both interventions were beneficial, each conferred distinct advantages: basic physical exercises appeared to more effectively support balance improvements, whereas game-based exercises provided stronger stimulation for cognitive enhancement, attributable to their interactive and multisensory nature.
Conclusion
The findings of the present study demonstrated that basic exercises were more effective than game-based exercises in improving balance among elderly women. This result is consistent with prior research. For instance, Halvarsson et al. (23) reported that regular strength-balance training significantly improved postural stability and reduced postural sway in older adults. Similarly, a systematic review by Sherrington et al. (24) concluded that exercise programs emphasizing postural control, somatosensory input, and lower limb strengthening constitute the most effective interventions for fall prevention. Soltanian-Dehkordi et al. (25), in a comparative study of virtual reality-based game exercises versus basic exercises, found that although both intervention types improved balance and gait speed, the basic exercise group performed better on static balance indices. The present study corroborates this differential effect, indicating that basic exercises enhance pure physical balance by delivering precise somatosensory challenges and engaging core stabilizing musculature. The repetition of purposeful movements facilitates neural adaptation and the stabilization of motor pathways. In contrast, while game-like exercises are motivationally richer, they place less emphasis on precise muscle control and consequently exert a more limited effect on static balance. A second key finding was that game-based exercises exerted a greater effect than basic exercises on improving cognitive performance in the elderly. Prior studies have also shown that game-based exercises and visuomotor interaction activate neural networks associated with the prefrontal cortex, yielding significant improvements in executive function tests (29, 30). The findings of Pasand et al. (26) further support this, demonstrating that sensory-cognitive integration exercises concurrently improve dynamic balance and cognitive performance indicators. These results align with the hypothesis of the present study that mental engagement and decision-based processing inherent in game-like exercises stimulate the prefrontal cortex and enhance the efficiency of attention and working memory networks. Game-based exercises appear to activate neural circuits in the prefrontal cortex and hippocampus by simultaneously engaging visual, motor, and cognitive systems (29). This process enhances cognitive function through increased cerebral blood flow, release of brain-derived neurotrophic factor, and improved synaptogenesis. From the perspective of self-determination theory (32), the intrinsically enjoyable and motivating nature of play fosters heightened intrinsic motivation and cognitive engagement. Overall, the findings suggest that basic exercises are more effective for improving balance and postural stability, whereas game-based exercises confer greater benefits for cognitive function and motivational engagement. A targeted combination of both exercise modalities could thus represent a comprehensive strategy for promoting psychomotor health and preventing functional decline in older adults. Future research should investigate the durability of these effects and the precise neural mechanisms underlying both approaches, utilizing longitudinal designs, follow-up assessments, and neuroimaging tools.

Article Message
The findings of the present study indicate that game-based interventions exert a significant positive effect on cognitive performance in elderly women. Furthermore, the design and implementation of targeted intervention programs tailored to specific exercise types may constitute an effective approach for enhancing cognitive indicators in aging populations.
Ethical Considerations
Ethical standards were fully observed throughout the research process. All participants provided informed consent and retained the right to withdraw from further participation at any time. Confidentiality of data was strictly maintained, and ethical approval was obtained from the Islamic Azad University of Isfahan (Khorasgan) Branch (Code: IR.IAU.KHUISF.REC.1403.401).
Authors' Contributions
Ideation: Hanieh Khazaeli, Rokhsareh Badami; Data collection: Hanieh Khazaeli; Data analysis: Hanieh Khazaeli, Rokhsareh Badami; Article writing: Hanieh Khazaeli; Reviewing and editing: Hanieh Khazaeli, Rokhsareh Badami, Zahra Serjooei, Hamid Zahedi, Khosro Jalali Dehkordi; Literature review: Hanieh Khazaeli, Rokhsareh Badami, Zahra Serjooei, Hamid Zahedi, Khosro Jalali Dehkordi; Project manager: Rokhsareh Badami.
Conflict of Interest
The authors declare that there is no conflict of interest associated with this article.
Acknowledgments
We wish to express our sincere gratitude to all participants, the management of Majd Sports Hall for their cooperation and provision of facilities, and the elderly individuals and their families, who demonstrated exceptional patience and cooperation throughout all phases of this research. Without their support and collaboration, this study would not have been possible.