This study aims to develop and validate a remote exercise intervention for individuals at risk of or experiencing dementia using a wearable sensor-enabled platform.

Facility-based exercise is often inaccessible for older adults with cognitive impairment, with up to 50% of sessions missed and low adherence to home programs. To address this gap, we developed Tele-Exergame, a self-administered wearable-sensor system delivering virtually guided, interactive motor–cognitive exercises. It provides voice guidance, real-time motion tracking and feedback, emphasizes body perception, and enables remote monitoring to support adherence and safety.

In a 12-week randomized controlled trial, 64 participants (age 70±8 years; baseline MoCA 23±3) were randomized to Tele-Exergame or to home exercise without technology. Both groups were encouraged to exercise daily and to accumulate at least 30 minutes of exercise per week using a standardized set of seated and behind-chair movements. Tele-Exergame delivered reminders, tracked activity automatically, and used a wearable sensor for real-time leg feedback to enhance lower-extremity awareness and targets such as ankle dorsiflexion>20º; the control group documented activity in paper diaries. The platform included gamified features to support engagement. Outcomes, including gait, balance, and Montreal Cognitive Assessment (MoCA), were collected at baseline, week 6, and week 12.

In the Tele-Exergame group, improvements were observed in cognitive and balance outcomes. MoCA increased by about one point at weeks 6 and 12. Balance showed a stronger response: postural sway area was nearly halved at week 6 and this improvement was maintained at week 12, whereas similar trends in the control group were not significant. Despite cognitive impairment and limited technology experience, participants reported high acceptance, with perceived usefulness at 78% and intention to use at 82%.

A self-administered, sensor-guided home exercise program enabled individuals with cognitive impairment to exercise independently, producing meaningful balance improvements and clinically important cognitive gains with high acceptability.