Background: Declines in physical and cognitive function are natural biological processes, leading to an increased risk of falls. Promising evidence suggests that combined physical-cognitive exercise has beneficial effects in improving both physical and cognitive health. Although moderate-to-high exercise intensity is commonly recommended, it might be impractical for older adults facing physical limitations or contraindications. Thus, low-intensity exercise is a viable option. The main barriers to engaging in exercise in older adults include transportation, time, motivation, and enjoyment. To overcome these challenges, a home-based, gamification-based training system may provide an effective approach to enhance exercise adherence. Objective: This study aimed to develop and evaluate the usability of a low-intensity, gamification-based, interactive physical-cognitive exercise for older adults in a home-based setting. Methods: The prototype of a game-based physical-cognitive exercise was created following the ADDIE model (analysis, design, development, implementation, and evaluation) and assessed for user experience in older adults. A total of 15 older adults engaged in the game-based physical-cognitive exercise at home for 60 minutes per day, 3 days per week, for 4 weeks. The usability of the game-based training system was evaluated using the system usability scale (SUS) after completion of a 4-week training program. As for satisfaction, the 8-item Physical Activity Enjoyment Scale (PACES) questionnaire was used to assess participants’ enjoyment level after 1 week and 4 weeks of training. Descriptive statistics were used to illustrate the SUS score. A Wilcoxon signed-rank test was used to compare the PACES scores between the first week and the end of the 4-week period, with significance set at P<.05. Results: As for experts’ consensus, the game-based training consisted of 3 games: Ocean Diver, Road Runner, and Moving and Memorizing. The games had 3 levels of difficulty: beginner, intermediate, and advanced. A computer vision–based system was selected as the delivery platform for a home setting. The total SUS score for all participants was mean 87.22 (SD 5.76), indicating the user’s perception of the usability of a system ranging from good to excellent. At the end of the 4-week training, the total PACES score was significantly greater than the first week, suggesting an improvement in enjoyment (first week: mean 44.93, SD 3.99 vs fourth week: mean 50.53, SD 4.70; P=.001). Conclusions: The prototype of low-intensity, gamification-based, interactive physical-cognitive training was designed and developed using the ADDIE model, which included both experts and end users in the process. The findings showed that the exergame prototype was a usable and practical approach for a home-based setting, enhancing older adults’ enjoyment and motivation. Further research is warranted to determine the effectiveness of such gamification-based training in promoting physical and cognitive functions.

Background: Combined physical–cognitive training has shown beneficial effects on cognition in older adults with mild cognitive impairment (MCI). However, most interventions employ moderate-to-high intensity, which may limit accessibility for individuals with health concerns. Whether low-intensity exercise provides similar cognitive benefits remains inconclusive. Delivering such training through home-based exergame may improve adherence. This study evaluated the feasibility of a home-based, low-intensity exergame for older adults with MCI. Methods: Older adults with MCI completed 50-min exergaming sessions, triweekly, for 4 weeks. Feasibility outcomes, including recruitment, adherence, adverse events, enjoyment, and cognitive and physical performance, were evaluated at baseline and post-intervention. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA), 10-word recall test, digit span, and verbal fluency tests. Physical performance was assessed with the four-square step and five-times sit-to-stand tests. Results: Fifteen older adults with MCI (mean age 66.07 ± 4.36 years; 75% recruitment rate) participated. The average adherence rate was 93.33% (11.2 sessions), with no adverse events or attrition reported. Enjoyment significantly increased from week 1 to week 4 ( p = 0.001). Significant cognitive improvements were demonstrated for the 10-word immediate and delayed recall ( p = 0.03, p = 0.002), MoCA total scores ( p = 0.002), and MoCA sub-domains: executive function ( p = 0.007), language ( p = 0.034), and delayed recall ( p = 0.001). No significant changes were observed in physical performance. Conclusion: Home-based, low-intensity exergaming is a safe, feasible, and enjoyable approach for older adults with MCI. Preliminary findings suggest potential cognitive benefits of low-intensity exergaming in improving cognitive function, which warrant confirmation in a large-scale, rigorous randomized controlled trial.

Background: Positive end-expiratory pressure (PEEP) influences respiratory mechanics, ventilation distribution, and lung aeration. However, comparative responses to incremental PEEP among healthy individuals, cigarette smokers, electronic cigarette users, and individuals with asthma remain poorly understood. This study aimed to characterize differential respiratory responses to incremental PEEP across these populations. Methods: A secondary analysis was conducted using an open-access respiratory physiology dataset obtained from PhysioNet. Eighty adults were included and categorized into four groups (n = 20 per group): healthy controls, cigarette smokers, electronic cigarette users, and individuals with asthma. Airway pressure, respiratory flow, tidal volume, chest circumference, abdominal circumference, and global aeration were evaluated across incremental PEEP levels ranging from 4 to 12 cmH₂O. Results: Increasing PEEP significantly affected all respiratory and aeration outcomes (all p < 0.001). Significant Group × PEEP interactions were observed for airway pressure (p < 0.001), respiratory flow (p = 0.009), chest circumference (p = 0.002), and abdominal circumference (p = 0.005), indicating differential physiological responses among groups. In contrast, tidal volume (p = 0.067) and global aeration (p = 0.170) demonstrated similar response patterns across groups despite significant overall PEEP effects. Conclusions: Incremental PEEP significantly influenced respiratory mechanics, thoracoabdominal motion, and lung aeration. Respiratory responses differed among healthy controls, cigarette smokers, electronic cigarette users, and individuals with asthma, suggesting group-specific adaptations to increasing PEEP.