Service Design Strategies to Enhance Exercise Adherence in Extended Reality Interventions for Older Adults:...

Area of Science:

• Gerontology
• Human-Computer Interaction
• Rehabilitation Science

Background:

• Older adults face challenges maintaining exercise due to physical, psychological, and environmental factors, leading to low adherence.
• Extended reality (XR) offers innovative solutions for older adult exercise, but long-term engagement and effective incentives remain under-explored.
• Service design methods can enhance user experience and stakeholder collaboration in XR exercise interventions for sustained participation.

Purpose of the Study:

• To evaluate XR-based exercise interventions for individuals over 50, focusing on service design integration for enhanced adherence.
• To identify gaps in the long-term application of XR exercise interventions within this demographic.

Main Methods:

• Systematic review of studies published between January 2020 and July 2025 across six major databases.
• Inclusion criteria: XR for exercise/rehabilitation, mean participant age >50, reported service design activity, and adherence outcomes.
• Dual independent screening and structured data extraction were employed.

Main Results:

• Nine studies (242 participants) met criteria, primarily using co-design and user-centered approaches with limited full service design implementation.
• Positive user experiences were reported, but evaluations relied heavily on self-reports, lacking objective adherence tracking.
• High short-term adherence (80-100%) was observed, mainly via attendance, with inconsistent definitions and overlooked intensity/accuracy metrics. Most studies were lab-based, limiting real-world applicability.

Conclusions:

• Current XR exercise interventions for older adults demonstrate short-term adherence but lack service design continuity and comprehensive monitoring.
• Integrating structured service design with standardized, multidimensional adherence indicators can improve sustained engagement in XR exercise.
• Community-based implementation of XR interventions can enhance scalability and foster an age-friendly exercise ecosystem.