Monitoring cognitive load while playing exergames in a four-week intervention for older adults: an explorative EEG study

Müller, Helen; Büchel, Daniel; Skjaeret-Maroni, Nina; Vereijken, Beatrix; Baumeister, Jochen · 2025 · Crossref

DOI: 10.1038/s41598-025-19183-4

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Summary

This study addresses the lack of methods to monitor cognitive demand during exergaming, a combined physical and cognitive training modality shown to improve function in older adults. While exergames are promising for counteracting age-related decline, prescribing individualized training requires understanding how cognitive load changes over time. The researchers aimed to explore the impact of a four-week exergaming intervention on frontal theta power, a neurophysiological marker of cognitive involvement, in independently living older adults. Specifically, they investigated whether cognitive engagement persists across multiple sessions and how it relates to game performance, difficulty, and type. The study employed a one-group multiple posttest design involving 21 older adults (mean age 74.80 years) who completed a four-week intervention. Participants played two distinct exergames, "Puzzle" (balance-focused) and "Fox" (step-focused), at two difficulty levels (easy and hard) three times per week. Electroencephalography (EEG) was used to record brain activity, specifically measuring mean power spectral density in the frontal theta band (4–7 Hz). Data were collected at six time points (sessions 1, 2, 3, 6, 9, and 12) and compared against a reference movement condition. Performance metrics, such as game scores and completion times, were also recorded to assess motor learning and adaptation. The results demonstrated that frontal theta power was significantly higher during exergaming compared to the reference movement across all sessions, games, and difficulty levels (p < 0.01), indicating sustained cognitive engagement. Crucially, the difference in theta power between the reference and gaming conditions increased significantly over the course of the intervention (p < 0.001), paralleling significant improvements in game performance. Performance improved steadily until session 6 for the Puzzle game and session 9 for the Fox game, after which it plateaued. No significant effects were found for game type or difficulty level on theta power changes, although performance was significantly better in the easy conditions. The authors interpret the increasing theta power alongside improved performance as evidence of increased recruitment of attentional resources and automatization of motor control, rather than habituation. The significance of this work lies in its status as the first study to repeatedly measure EEG during an exergaming intervention, confirming frontal theta activity as a robust marker of cognitive involvement over time. The findings suggest that exergames maintain cognitive demand throughout a training period, supporting their efficacy for long-term cognitive training in older adults. By providing a method to monitor cognitive load in real-time, this approach lays the groundwork for developing adaptive, individualized exergaming protocols that can adjust difficulty based on neural feedback, potentially optimizing training outcomes for aging populations.

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• neuro workload indices