Background <p>Chronic stroke often results in lasting motor and cognitive impairments that compromise balance, gait, and daily living activities. Dual-task exergaming, which combines physical and cognitive challenges in a single intervention, has emerged as a promising rehabilitation strategy. Therefore, this study aims to compare the effects of dual-task exergame rehabilitation with conventional balance training on motor and cognitive function improvements in chronic stroke survivors.</p> Methods <p>In a prospective, assessor-blind randomized controlled trial, adults with chronic stroke (&gt; 6&#xa0;months post-stroke) were randomly allocated to general balance training group (GBG) or exergame training group (EGG). Each group completed 20 sessions over 4&#xa0;weeks. Motor function improvements were evaluated using the Functional Gait Assessment (FGA) and the Short Physical Performance Battery (SPPB). Improvements in cognitive performance were measured using Trail Making Tests A/B (TMT-A/B) and the Stroop Test. Pre- and post-intervention changes were analyzed with paired and between-group statistics. A 2 × 2 mixed analysis of variance (ANOVA) was conducted to examine group-by-time interactions.</p> Results <p>A total of 28 participants were enrolled, but two in the GBG withdrew, resulting in a final sample of 26 participants (EGG n = 14, GBG n = 12). Significant group × time interactions were observed for FGA (<i>p</i> &lt; 0.001) and SPPB (<i>p</i> = 0.001), indicating superior motor recovery in the EGG compared to the GBG. Regarding cognitive outcomes, the EGG demonstrated significantly greater reductions in TMT-A (<i>p</i> = 0.017) and TMT-B (<i>p</i> = 0.013) completion times compared to the GBG. While both groups showed improvements, the EGG achieved markedly greater gains in executive function and processing speed.</p> Conclusion <p>Dual-task exergaming is a feasible and effective approach for enhancing both motor and cognitive functions in chronic stroke survivors, yielding superior outcomes compared to conventional balance training. By providing an immersive environment with real-time feedback, exergaming may reduce cognitive–motor interference and support better coordination under dual-task demands, highlighting its potential as an integrated rehabilitation modality.</p> Trial registration <p>ClinicalTrials.gov (NCT06806384).</p>