Dynamic Adoption of Immersive Tai Chi Training Among Older Adults: Exploratory Qualitative-Dominant Longitudinal...

Immersive exercise systems may support guided movement practice and physical activity among older adults, but adoption of head-mounted systems cannot be inferred from single-session usability or intention ratings. Older adults must negotiate unfamiliar equipment, movement safety, comfort, perceived control, trust, and perceived benefit. Virtual reality (VR) and mixed reality (MR) are often grouped as extended reality despite different sensory and safety affordances.

This study examined how older adults' barriers and facilitators evolved during repeated immersive Tai Chi training and how VR and MR delivery appeared to shape immersion, control, trust, safety appraisal, and conditional willingness to continue use.

We conducted an exploratory, qualitative-dominant longitudinal mixed methods follow-up study in Hunan, China. Community-dwelling adults aged 60 years or older completed guided Tai Chi training in VR or MR while retaining parent-study allocation; comparisons were descriptive and hypothesis-generating. The completed-protocol quantitative sample and the main qualitative denominator each included 34 participants (VR: n=16; MR: n=18). Data sources comprised semistructured interviews, Game Experience Questionnaire dimensions, Virtual Reality Sickness Questionnaire (VRSQ) scores, safety observations, and task performance logs from days 1, 3, and 6. Qualitative data were coded using a Dynamic Barrier Framework-informed codebook and integrated with descriptive quantitative summaries.

Adoption unfolded as a staged process. During entry, unfamiliarity, competence concerns, and mild physical discomfort shaped responses. Initial uncertainty was endorsed by 7 of 16 (43.8%, 95% CI 23.1-66.8) VR participants and 6 of 18 (33.3%, 95% CI 16.3-56.3) MR participants. During adaptation, participants described practice, feedback, social reinforcement, and environmental experience; accuracy improved from day 1 to day 6 by 0.083 (95% CI 0.024-0.142) in VR and 0.103 (95% CI 0.037-0.169) in MR. Late-stage willingness remained conditional on comfort, safety, content variety, and usefulness. VR accounts more often emphasized environmental immersion and affective value, whereas MR accounts more often emphasized reality grounding, perceived control, and trust. Standardized VRSQ scores were low overall (VR 8.65 and MR 5.65, on a 0-100 scale), with no falls, serious adverse events, or session terminations.

This study combines repeated qualitative accounts with symptom, safety, and performance evidence while holding the Tai Chi content constant across VR and MR delivery. Unlike single-session acceptance studies, broad extended reality comparisons, or endpoint-only evaluations, it shows adoption as a phase-sensitive and conditional process rather than a one-time decision. The Dynamic Barrier Framework explains how entry barriers may soften, persist, or change meaning and how modality-sensitive affordances shape experience without implying device superiority. In practice, immersive exercise should combine gradual orientation, monitored exposure, comfort and safety safeguards, understandable feedback, social support, and modality-sensitive design. Longer community or home follow-up remains necessary before inferring sustained adherence or unsupervised safety.