Effects of exergame combined with elastic band resistance training on exercise self-efficacy and physical activity levels in older adults with cognitive frailty: A mixed-methods study

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2026 Jul 28;51(7):1476-1486. doi: 10.11817/j.issn.1672-7347.2026.250650.

ABSTRACT

OBJECTIVES: Cognitive frailty is a geriatric syndrome characterized by the coexistence of physical frailty and mild cognitive impairment. It is a strong predictor of adverse health outcomes including disability, dementia, falls, and mortality. Exergaming can enhance exercise appeal and immersion, while elastic band resistance training can safely and effectively improve muscle function. Nevertheless, few studies have systematically integrated these two approaches, and most evaluations have focused on quantitative outcomes without exploring participants’ subjective experiences. This mixed-methods study aims to evaluate the effects of a combined exergaming and resistance training intervention on exercise self-efficacy and physical activity levels in community-dwelling older adults with cognitive frailty.

METHODS: An explanatory sequential mixed-methods design was adopted. A total of 79 community-dwelling older adults with cognitive frailty were randomly assigned using a random number table method to an intervention group (n=39) or a control group (n=40). The control group received routine health education, while the intervention group received a 12-week exergame combined with elastic band resistance training program in addition to routine health education. The intervention was conducted 3 times per week, with each session lasting 50 min, including 5 min of warm-up, 20 min of elastic band exercises, 20 min of exergame training, and 5 min of cool-down and relaxation. Exercise intensity was maintained at a moderate level. Physical activity levels were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and exercise confidence was evaluated using the Self-Efficacy for Exercise Scale (SEE) before and after the intervention. After the intervention, 13 participants from the intervention group were purposively sampled based on age, sex, and intervention adherence for semi-structured interviews. Qualitative data were analyzed using Colaizzi’s 7-step phenomenological analysis method.

RESULTS: The exercise adherence rate in the intervention group was 86.5%. After 12 weeks of intervention, improvements in IPAQ-SF scores [adjusted mean difference (MD)=586.1 MET-min/week, 95% CI 454.5 to 717.7] and SEE scores (adjusted MD=3.3, 95% CI 2.4 to 4.2) were significantly greater in the intervention group than in the control group (both P<0.001). Sensitivity analyses, including complete-case analysis and per-protocol analysis, showed results consistent with the primary analysis. Qualitative analysis identified 3 themes: enhanced exercise enjoyment and intrinsic motivation for participation, promotion of positive perceptions of physical and psychological health, and improvement in quality of life and social interaction.

CONCLUSIONS: Exergame combined with elastic band resistance training effectively improves exercise self-efficacy and physical activity levels among community-dwelling older adults with cognitive frailty. The beneficial effects of this intervention may be attributed to its positive impacts on enhancing exercise enjoyment, promoting health perceptions, and improving social interaction. This program provides a practical exercise intervention model that integrates enjoyment and scientific rigor for community-dwelling older adults with cognitive frailty.

PMID:42763302 | DOI:10.11817/j.issn.1672-7347.2026.250650