PREFRONTAL CORTEX ACTIVITY DURING EXERGAMING ON LAND AND IN SHALLOW WATER : AN EEG STUDY

Cognitive–motor exergaming is increasingly used in rehabilitation to enhance executive and motor functions essential for balance and functional mobility. Aquatic therapy is widely applied due to its safety and sensorimotor benefits; however, shallow water immersion influences prefrontal cortex (PFC) activity during cognitive–motor tasks. This study investigated PFC activation during exergaming performed on land and mid-shin-level water immersion and examined whether environmental differences modulate cortical engagement. A RCT was conducted involving 26 healthy adults (land-based: n = 13; mid-shin water-based: n = 13). Participants completed a 30-minute Nintendo Ring Fit Adventure exergaming session while wearing a 32-channel wireless EEG system. PFC activity was assessed using event-related desynchronization (ERD) in the alpha (8–12 Hz) and beta (13–30 Hz) frequency bands across three task phases: early load (baseline), mid load (peak effort) and late load (recovery).Both groups demonstrated significant alpha and beta ERD during the mid-load phase, indicating increased cortical activation during peak cognitive–motor demand. The mid-shin water group exhibited greater overall alpha and beta ERD than the land-based group. Mann–Whitney U analysis revealed significant between-group differences in beta power at Fz (p = 0.027) and alpha power at Fp1 (p = 0.049). During the late-load phase, neural activity partially recovered but remained below baseline, suggesting sustained cognitive–motor fatigue. Shallow water showed stronger PFC engagement during cognitive–motor exergaming likely due to increased sensory integration and balance demands. These findings highlight the role of cognition in postural control and exergaming as a promising rehabilitation approach.