Currently submitted to: JMIR Serious Games
Date Submitted: Jul 23, 2026
Open Peer Review Period: Jul 24, 2026 - Sep 18, 2026
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Usability, Acceptability and Co-design Priorities for Immersive Virtual Reality Exergames in Independent Older People: A Mixed-Methods Study
ABSTRACT
Background:
Immersive virtual reality has considerable potential in gerontology, but intervention designs are often standardised around assumptions of interactive simplicity, overlooking independent and digitally literate older people.
Objective:
This study evaluated the usability, acceptability and perceived clinical relevance of a playful immersive intervention using a mixed-methods approach.
Methods:
A mixed-methods design was used. Twelve older people, with a physically active profile, and seven healthcare professionals were recruited. After a 15-minute exposure to a custom immersive virtual reality therapeutic application, quantitative data from satisfaction questionnaires and the System Usability Scale were triangulated with semi-structured interviews analysed using reflexive thematic analysis.
Results:
Quantitatively, perceived usability was excellent (mean System Usability Scale score: 85/100, standard deviation 10.8). However, although independent users reported a strong initial hedonic response, they criticised the interactive simplicity and aesthetic immaturity of the experience. Future adherence was perceived to depend on gamified progression capable of preventing boredom. In contrast, healthcare professionals interpreted the experience through a frailty-oriented lens, prioritising physical safety, control of dual-task demands and the prevention of falls or cybersickness in the context of non-parameterised visual overstimulation.
Conclusions:
Immersive virtual reality appears to be a feasible tool for use with older people, but its long-term clinical value may depend less on immediate tolerance than on addressing the tension between active users’ need for challenge and therapists’ emphasis on preventive control. Software should move beyond interactive simplification and incorporate flexible, parameterizable architectures that allow interventions to be co-designed according to each person’s physical capacity and cognitive reserve.
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