Rewiring the aging brain: exergaming modulates brain complexity in older adults.

Introduction: Age-related changes in brain signal complexity are associated with cognitive decline and reduced neural adaptivity in older adults. Exergaming offers a promising prophylactic intervention combining physical and cognitive training. The aim of the present study was to assess how exergaming alters the temporal trajectory of brain signal complexity at rest and during gameplay in older adults. Methods: Twenty-eight healthy older adults participated in a 4-week exergaming intervention. Electroencephalography was recorded using 64 electrodes at rest (pre- and post-intervention) and during exergaming (pre-, mid-, and post-intervention). Brain signal complexity was quantified using multiscale entropy across 64 time scales on preprocessed signals. Results: Post-intervention resting-state analysis revealed significant reductions at fine and increases at coarse scales in frontal, central, and posterior entropy. During gameplay, entropy declined widespread by mid-intervention, particularly at coarse scales over frontal, central and temporal regions. From mid- to post-intervention, the decline narrowed leaving a net pre-to-post reduction concentrated at coarse scales in these regions. Discussion: Resting-state changes indicated a shift toward a younger brain profile, characterized by a transition from age-related increases in local processing to enhanced distributed processing, which may potentially mitigate the rise in neural modularity associated with aging. During gameplay, brain signal complexity decreased in week 2, followed by a modest change by week 4, consistent with the framework in which complexity initially streamlines and then adjusts toward a task-specific optimum. These findings suggest that exergaming can beneficially modulate brain complexity in older adults, offering the potential to reduce age-related neural decline and support healthy brain aging.