JMIR Publications

ABSTRACT

Background:

Older adults (OAs) who reside in long-term care (LTC) homes are often unable to engage in adequate amounts of physical activity (PA) due to multiple co-morbidities including frailty and severe cognitive impairments. This level of physical inactivity is associated with declines in cognitive and functional abilities and can be further compounded by social isolation. Exergaming, defined as a combination of exercise and gaming, has the potential to engage older adults in exercise and encourage social interaction. However, the physical design of publicly available exergames such as Nintendo Wii Yoga and Dance Dance Revolution are not suitable for older adults (ie. falls risks, accessibility issues, games geared towards a younger population) with diverse physical and cognitive impairments.

Objective:

The aim of this study was to design and develop a novel user-centered, evidence-based exergaming system for use among OAs in LTC. In addition, we aimed to identify the facilitators and barriers to implementation of our exergaming intervention, the MouvMat, into LTC homes according to staff.

Methods:

The study employed a user-centered design (UCD) process which consisted of four rounds of usability testing. The exergame was developed and finalized based on existing evidence, end-user and stakeholder input, and user testing. Interviews and standardized and validated scales were used iteratively to evaluate the acceptability, usability, and physical activity enjoyment of the MouvMat.

Results:

A total of 28 participants, 13 LTC residents and 15 staff and family members, participated in UCD over 18 months to design and develop the novel exergaming intervention, the MouvMat. Iterative use of validated scales (SUS, PACES-8, m-TEI) indicated an upward trend in the acceptability, usability, and enjoyment scores of MouvMat over rounds of usability testing suggesting that identified areas for refinement and improvement were appropriately addressed by the team. Qualitative analysis of semi-structured interview data found that residents enjoyed engaging with the prototype, appreciated the opportunity to increase their physical activity. Additionally, staff and stakeholders were drawn to MouvMat’s ability to increase residents’ autonomous physical activity. The intended and perceived benefits of MouvMat use, improved physical and cognitive health, were the most common facilitator to its use identified by study participants.

Conclusions:

This study was successful in applying UCD to collaborate with LTC residents despite their high number of physical and sensory impairments. By following a UCD process, an exergaming intervention that meets the diverse requirements (i.e. hardware design features, motivation), and considers the environmental barriers, and residents’ physical and cognitive needs was developed. The effectiveness of the MouvMat to improve physical and cognitive abilities should be explored in future multisite randomized controlled trials.