This randomized controlled trial will evaluate the effects of an exergaming-based sitting Tai Chi program on muscle strength, physical function, cognition, and psychosocial outcomes in older adults living in residential care facilities who are at risk of sarcopenia and/or prefrailty. Eligible participants aged 60 years or older will be identified using simple screening criteria for sarcopenia and prefrailty and will not meet full diagnostic criteria for sarcopenia or frailty. A total of 152 participants will be randomly assigned to either an individually supervised exergaming-based sitting Tai Chi intervention or a group-based general health education control, each delivered twice weekly for 12 weeks. The primary outcome is dominant-hand grip strength, a core indicator of sarcopenia-related muscle weakness. Key secondary outcomes include sitting balance and functional reach assessed by the Modified Functional Reach Test, with additional secondary measures of muscle mass, lower-extremity function, activities of daily living, upper-limb dexterity, cognitive performance, reaction time, mood, and health-related quality of life. Outcomes will be assessed at baseline, mid-intervention, post-intervention, and 3-month follow-up. The findings will provide preliminary evidence on whether chair-based exergaming Tai Chi can be integrated into routine residential care to support healthy aging and functional independence.
This randomized controlled trial will evaluate the effects of an exergaming-based sitting Tai Chi program on sarcopenia-related muscle weakness, balance, physical function, cognition, and psychosocial outcomes in older adults living in residential care facilities who are at risk of sarcopenia and/or prefrailty. Sarcopenia and frailty are common in residential care and are associated with falls, disability, loss of independence, and mortality. Although conventional exercise and Tai Chi may improve physical function, participation can be difficult for residents with mobility limitations, fluctuating health status, or low motivation. Sitting Tai Chi offers a lower impact alternative, and exergaming may further enhance engagement by providing interactive tasks and real-time feedback. This single-blind, parallel group randomized controlled trial will recruit 152 participants aged 60 years or older from collaborating residential care facilities. Eligible participants must have screening indicators of sarcopenia or prefrailty, score at least 7 on the Chinese (Hong Kong) version of the Abbreviated Mental Test, be able to stand independently for assessment, and be able to follow intervention instructions. Residents with confirmed sarcopenia, confirmed frailty, severe cognitive or sensory impairment, unstable medical conditions, prior regular Tai Chi practice, or current participation in another clinical trial will be excluded. Participants will be randomly allocated in a 1:1 ratio to either an exergaming-based sitting Tai Chi group or a general health education control group, stratified by age, gender, and prefrailty status. Randomization will be performed by an independent off-site researcher using computer software. Outcome assessors and the statistician will be blinded to group allocation, although participants and intervention providers cannot be blinded because of the nature of the intervention. The intervention group will receive a 12-week exergaming-based sitting Tai Chi program delivered twice weekly in 60-minute sessions. The program uses a 12-form sitting Tai Chi exergame with body tracking and real-time feedback. Training progresses from learning mode to skill-specific training and game modes, with a focus on balance control, eye-hand coordination, and limb flexibility. The control group will receive time-matched general health education sessions on generic health topics relevant to older adults, without any content related to sarcopenia, frailty, exercise, or physical activity. All participants will continue to receive usual care and routine activities provided by their residential care facility. Outcome assessments will be conducted at baseline, mid-intervention, post-intervention, and 3-month follow-up. The primary outcome is dominant-hand grip strength. The key secondary outcome is sitting balance and functional reach assessed by the Modified Functional Reach Test. Other secondary outcomes include skeletal muscle mass index, lower-extremity function, activities of daily living, upper-limb dexterity, global cognition, reaction time, anxiety, depression, and health-related quality of life. Data will be analyzed according to the intention-to-treat principle using linear mixed-effects models to examine group-by-time effects. This trial will provide preliminary evidence on whether chair-based exergaming Tai Chi is an effective and practical intervention for older adults at risk of sarcopenia and/or prefrailty in residential care settings.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
152
The structure and content of the 12-form seated Tai Chi routine build on earlier sitting Tai Chi programs developed by Tsang and colleagues for frail older adults and neurological populations. The program targets three domains: (i) balance control, (ii) eye-hand coordination, and (iii) limb flexibility. Training is organized into progressive phases (learning, skill-specific training, and game modes). Each session begins with a 5-minute warm-up and ends with cool-down stretching and breathing exercises.
Health education will be delivered using audio visual materials, brief talks and interactive discussion to provide engaging but non specific information about daily health management.
Exergaming Research Centre, Hong Kong Metropolitan University
Ho Man Tin, Kowloon, Hong Kong
Maximal handgrip strength
Change in maximal handgrip strength (kg) measured with a Jamar Plus+ Digital Hand Dynamometer. Participants are seated with the elbow flexed at approximately 90 degrees. Three trials per hand are performed, and the highest value recorded from either hand is used. Higher values indicate greater muscle strength.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Sitting Balance and Functional Reach (Modified Functional Reach Test)
Change in sitting balance and forward and lateral functional reach distance (cm) measured by the Modified Functional Reach Test (mFRT). Participants sit on a backless, standard-height chair with hips and knees at approximately 90 degrees and feet flat on the floor. With the shoulder flexed to 90 degrees and the elbow extended, participants reach forward and laterally as far as possible without losing balance or taking a step. The maximal distance reached in each direction by the third metacarpal is recorded using a wall-mounted tape measure. After two practice trials, three test trials are performed in each direction and the mean distance in each direction is used. Greater distances indicate better sitting balance and functional reach.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Skeletal Muscle Mass Index (SMI)
Change in skeletal muscle mass index (kg/m²) assessed by multi-frequency bioelectrical impedance analysis (MC-780MA, TANITA). Appendicular skeletal muscle mass is obtained from device output and divided by height squared to calculate SMI (kg/m²). Higher values indicate greater muscle mass.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Lower-Extremity Function (Five Times Sit-to-Stand Test)
Change in performance on the Five Times Sit-to-Stand Test. Participants stand up and sit down five times as quickly as possible from a standard-height chair without using their arms. Time to completion (seconds) is recorded with a stopwatch. Shorter times indicate better lower-extremity function.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Independence in Activities of Daily Living (Katz ADL-C)
Change in independence in basic activities of daily living measured by the Chinese version of the Katz Index of Independence in Activities of Daily Living (Katz ADL-C). Items cover bathing, transferring, dressing, toileting, eating, and continence. Total scores range from 0 to 6, with higher scores indicating greater dependence in basic activities of daily living.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Upper-Limb Dexterity on the Box and Block Test
Change in upper-limb dexterity and eye-hand coordination measured by a modified Box and Block Test. Participants are instructed to transfer 9 wooden cubes, one at a time, over a central partition as quickly as possible using the dominant hand. The total time required to transfer all 9 cubes is recorded in seconds. Higher scores (shorter completion times) indicate better upper-limb dexterity and eye-hand coordination.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Global Cognition on the Montreal Cognitive Assessment, Chinese Version
Change in global cognition measured by the Chinese version of the Montreal Cognitive Assessment (MoCA). Total scores range from 0 to 30, with higher scores indicating better cognitive function.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Reaction Time on a Computer-Based Finger-Press Reaction Task
Change in reaction time measured by a computer-based finger-press reaction task. Participants respond as quickly as possible when an on-screen box changes color at random intervals. Mean reaction time is recorded in milliseconds. Lower values indicate faster reaction time.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Anxiety on the Chinese Hospital Anxiety and Depression Scale Anxiety Subscale
Change in anxiety symptoms measured by the anxiety subscale of the Chinese Hospital Anxiety and Depression Scale (HADS-A). Scores range from 0 to 21, with higher scores indicating more severe anxiety symptoms.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Depression on the Chinese Hospital Anxiety and Depression Scale Depression Subscale
Change in depressive symptoms measured by the depression subscale of the Chinese Hospital Anxiety and Depression Scale (HADS-D). Scores range from 0 to 21, with higher scores indicating more severe depressive symptoms.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
Health-Related Quality of Life on the EQ-5D-5L Utility Index
Change in health-related quality of life measured by the EuroQol 5-Dimension 5-Level (EQ-5D-5L) utility index. Health states are converted to a utility score using the Hong Kong-specific EQ-5D-5L value set. Utility scores range from values below 0 (health states considered worse than death) up to 1.0 (full health), with higher utility scores indicating better health-related quality of life.
Time frame: Baseline (Week 0), mid-intervention (Week 6, after 12 sessions), post-intervention (Week 12, after 24 sessions), and 3-month follow-up (Week 24, approximately 12 weeks after the final intervention session).
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