Immersive Tai Chi for Home-Based Exercise in Older Adults: A Usability and Feasibility Study (Preprint)

<sec> <title>BACKGROUND</title> The extension of life expectancy has increasingly highlighted the importance of physical exercise in active aging. However, adherence to traditional exercise among community-dwelling older adults is generally low. Virtual Reality (VR) and Mixed Reality (MR) Tai Chi exergames, as novel health promotion tools, show significant potential, particularly for older adults exercising in a home setting. </sec> <sec> <title>OBJECTIVE</title> This study aimed to systematically evaluate the overall usability and feasibility of a VR/MR Tai Chi exergame designed for community-dwelling older adult users. It specifically focused on its potential to promote home-based physical activity, including subjective experience, physiological comfort, and objective interaction performance. The study also explored the relationships between key usability factors and user characteristics to provide empirical evidence for design optimization. </sec> <sec> <title>METHODS</title> Of the 86 community-dwelling older adults recruited for this study, data from 70 participants were considered valid after an initial screening in which 18.6% were excluded due to issues with VR adaptation. The study employed a between-groups design where participants were assigned to one of four conditions combining two display modes (VR vs. MR) and two feedback intensities (Soothing vs. Intense). Primary outcome measures included the Game Experience Questionnaire (GEQ), Virtual Reality Sickness Questionnaire (VRSQ), and objective game performance logs data. </sec> <sec> <title>RESULTS</title> The VR/MR Tai Chi game demonstrated good overall usability and acceptability among the screened community-dwelling older adult participants, suggesting its potential as a home-based exercise tool. Subjective experience was highly positive (mean Positive Affect M=3.74, mean Competence M=3.53; P&lt;.001), with low perceived challenge (M=1.43) and high competence. Physiological comfort in the post-screening sample was acceptable, with common mild symptoms being dizziness with eyes closed (20.00%) and vertigo (18.57%), both of low severity; however, the initial exclusion of 18.6% of participants due to VR discomfort is noteworthy. Accuracy showed significant positive correlations with flow (ρ=0.342) and competence (ρ=0.322), while the VRSQ total score was significantly negatively correlated with positive affect (ρ= -0.334, P=.005). </sec> <sec> <title>CONCLUSIONS</title> Tai Chi exergames based on immersive technologies offer a feasible and attractive pathway for promoting physical exercise among community-dwelling older adults, particularly within the home environment, thereby supporting their ability to age in place. Analysis of the key usability factors provides guidance for specific design choices, while indicating directions for future research, such as longitudinal evaluations, extension to more diverse populations, and application in real-world home settings. </sec>