Objective: As people age, cognitive function gradually declines, increasing the risk of developing diseases such as dementia. Previous studies have shown that exercise has the potential to induce structural and functional brain plasticity and improve cognitive function in older adults. In recent years, exergaming—combining video games with exercise—has emerged as a novel form of physical activity, offering greater variety and engagement. However, most research on exergaming has primarily focused on cognitive performance and hemodynamic response in single-task conditions, with limited exploration of these two indices during dual-task conditions. Therefore, this study aimed to investigate the effects of chronic exergaming on neuropsychological performance and hemodynamic changes in middle-aged and older adults while performing dual tasks.

Methods: Thirty-three participants (male = 12; female = 21) were enrolled and randomly assigned to either the exergaming (EG) group or the traditional aerobic exercise (TAE) group. The eight-week intervention consisted of three 30-minute sessions per week.

Measurements were conducted pre- and post-intervention using functional near-infrared spectroscopy (fNIRS) to record changes in hemoglobin concentration while participants performed the Stroop task at their preferred and fast walking speeds. Additionally, Stroop task accuracy was recorded to assess neuropsychological performance.

Results: During the cognitive test at the preferred walking speed, both the EG and TAE groups showed significant improvements in neuropsychological performance after eight weeks of exergaming and traditional exercise interventions (Ps < 0.001), with no significant difference observed between the two groups post-intervention (P = 0.492). In addition, both groups exhibited significant declines in PFC activation (Ps < 0.001).

However, the EG group demonstrated significantly less PFC activation compared to the TAE group post-intervention (P = 0.002). During the cognitive test at the fast-walking speed, both the EG and TAE groups exhibited significant improvements in