Effects of a Combined Zumba and Video Game–Based Cognitive Intervention on Cognitive Function Among Older Adults in Klang Valley, Malaysia: Semirandomized Trial

Abstract

Abstract Background Age-related cognitive decline can threaten independence in older adults, creating an urgent need for effective and practical preventive strategies. Nonpharmacological approaches such as physical activity, cognitive stimulation, and combined programs show promise, but their comparative effectiveness and the specific cognitive domains they influence are not yet clearly established. Objective This study evaluated the effects of 3 nonpharmacological interventions. These consisted of a physical activity program using Zumba, a video game–based cognitive stimulation program, and a combined physical and cognitive program. The aim was to determine their effects on global cognition and specific cognitive domains in community-dwelling older adults in the Klang Valley of Malaysia. A secondary objective was to examine the influence of adherence on cognitive outcomes. Methods A total of 96 participants (median age 69 y, IQR 65-72 y; n=63, 65.6% female) were assigned to 4 groups: physical (n=12), cognitive (n=23), combined (n=43), and control (n=18). Global cognitive performance was measured using the Montreal Cognitive Assessment at baseline and postintervention. Mixed ANOVA examined time and time × group effects. Additional nonparametric analyses (Kruskal-Wallis, Mann-Whitney, Wilcoxon signed rank tests) were conducted under intention-to-treat and per-protocol (PP) frameworks. Adherence was defined as attending 50% or more of scheduled sessions, with PP analyses reclassifying participants accordingly. Results Global cognition improved significantly over time across all groups (time main effect:=7.03,=.008; time × group interaction:=0.57,=.64). PP analyses showed moderate gains for participants attending 50% or more of cognitive sessions (=0.46) and larger gains for those adhering to the combined intervention (=0.66), with median Montreal Cognitive Assessment scores increasing by approximately 2 points in both adherent groups. Subdomain analyses indicated improvements in language (all groups), visuospatial function (combined group), and orientation (cognitive group). Conclusions All intervention types were associated with improvements in cognitive performance over time, with comparable gains across groups. Participants who achieved at least moderate adherence (≥50%) to the cognitive or combined interventions demonstrated larger and more consistent within-group effect sizes, highlighting the importance of sustained engagement. These findings support the feasibility and potential cognitive benefits of structured, multimodal nonpharmacological interventions for community-dwelling older adults.