Objective: This study examines lower-leg muscle activity during four exergames with varying movement demands in older adults. A secondary objective is to compare individual muscle activity across the exergames.
Background: Exergaming, which combines physical exercise with interactive video games, is increasingly used in older adults' rehabilitation, improving balance, strength, and cognitive function. Prior research suggests that different exergames engage specific motor functions. However, the activity of key lower-leg muscles-critical for balance-has not been systematically analyzed across exergames with varying movement demands (e.g., weight shifts, multidirectional steps, stepping in place, and walking).
Methods: This cross-sectional study investigates muscle activity of the M. tibialis anterior, M. gastrocnemius, and M. soleus during four exergames using surface EMG. Muscle activity is quantified as Root Mean Square (RMS 100) values and normalized to the maximum voluntary contraction (MVC). Exergames are performed on the Dividat Senso platform, each emphasizing different movement patterns: multidirectional stepping, balance shifting, stepping in place, and whole-platform stepping. Thirty older adults (≥65 years) with no major functional or cognitive impairments (SPPB ≥7, MoCA ≥26) will be recruited. Exclusion criteria include severe motor impairments, mobility restrictions, extreme visual impairments, unstable cardiovascular conditions, or language barriers. Muscle activity will be compared across exergames using Multivariate Analysis of Variance (MANOVA), followed by univariate ANOVAs to identify specific differences.
Potential significance: This study will identify muscle-specific activity patterns during exergames, informing targeted rehabilitation and exergame design. Findings may improve training strategies for balance enhancement and fall prevention in older adults, with potential benefits for healthcare cost reduction and quality of life.

