Effects of Competitive Exergaming-Based Esports on Older Adults in Hong Kong: Nonrandomized Controlled Pilot Study

Hong Kong faces a rapidly aging population, with many older adults not meeting recommended physical-activity levels and struggling to maintain long-term exercise adherence. Exergaming offers an accessible, technology-supported way to promote health conditions while providing immediate feedback and task variability among older adults.

This study aimed to evaluate the effects of an 8-week competitive exergaming intervention on functional fitness, cognition, loneliness, physical activity (PA) enjoyment, and quality of life among community-dwelling older adults in Hong Kong.

We conducted a pragmatic, nonrandomized, 2-group pilot with community participants allocated to either a competitive exergaming group (EG) or a passive control group (CG). EG attended 16 instructor-led 90-minute sessions playing Fitness Boxing (Nintendo Switch), including head-to-head bouts and a bracketed tournament. Outcomes were assessed at baseline and postintervention. Primary analyses used repeated-measure analysis of covariance (time: pre and post; group: EG and CG) adjusted for age, sex, education, marital status, employment, financial status, and housing. Partial η² was used to quantify effect sizes. Given the pilot nature, P values are unadjusted for multiplicity and interpreted cautiously.

A total of 48 older adults completed assessments (EG: n=24; mean age 69.50, SD 4.77 years; CG: n=24; mean age 71.50, SD 6.74 years). Significant group × time interactions favored EG for lower-body strength (30-second chair stand: F_{1, 48}=12.39; P<.001; partial η²=0.22), aerobic endurance (2-minute step: F_{1, 48}=4.89; P=.03; η²=0.10), and PA enjoyment (Physical Activity Enjoyment Scale: F_{1, 48}=9.36; P<.001; η²=0.18). For the Number Comparison Test (processing speed), the group × time interaction was not significant (P=.08); however, an exploratory main effect of group indicated higher performance in EG across time (P=.04). Executive function (Trail Making Test parts A and B), loneliness, and Short Form-36 Health Survey subscales showed no significant effects.

Competitive exergaming was feasible and produced small to moderate improvements in lower-body strength, aerobic endurance, and enjoyment of PA. Cognitive effects were inconclusive and should not be overinterpreted given the nonrandomized design, passive control, small sample, and multiple outcomes. Future randomized trials with active comparators and longer duration are warranted.