## 4 Discussion
### Adaptive Interaction Strategies in Exergames for Older Adults  
This section explores the interactive strategies used to enhance the physical health and cognitive function of older adults through VR technology and gamification design. Most of the studies designed gamified exercise training combining virtual reality, using task challenges to motivate older adults and increase their physical activity. These designs not only focus on the fun and engagement of the games but also take into account the physiological and psychological characteristics of older adults, providing interaction methods tailored to their needs.  
[PERSON] et al. (2018) designed virtual balance training, where participants used the HTC Vive Pro system to perform gait adjustment tasks. The task required participants to use hand controllers to adjust their gait in a virtual environment, enhancing balance ability and coordination. However, this study also found that the complexity of the equipment could affect the long-term engagement of older adults, as noted by [PERSON] et al. [23], where the complexity of the technology might frustrate participants and lower engagement.  
The studies also emphasized the importance of usability and adaptability; for example, [PERSON] et al. [21] pointed out that timers in the game might create stress for participants with weaker physical abilities, thus suggesting the need for personalized designs based on individual capabilities. Many studies used simplified interface designs, such as [PERSON] et al. [24], who proposed simplifying the virtual reality headset interface, which helped older adults adapt to the technology and increased their participation.  
For multitask training, [PERSON] et al. [26] designed a VR game that combined cognitive tasks with physical activity. Participants completed tasks like memory recall and color recognition while engaging in physical exercises, improving memory, attention, and coordination. While this multitask design had multiple benefits, it did not always account for differences in cognitive abilities among older adults.  
Some studies adopted social interaction strategies to boost engagement, such as [PERSON] et al. [12], who designed a social cooperative VR game that encouraged participation through collaborative tasks while adjusting the difficulty to accommodate different skill levels. These designs effectively enhanced social interaction and emotional support, leading to better long-term engagement with the game.  
Nevertheless, most of the current designs still lack personalized adjustments. For example, [PERSON] et al. [23] noted that although immersive VR experiences provided rich interactivity, some older adults might experience dizziness or discomfort, leading them to stop using the system. Future research should focus more on personalized technical support and adaptive designs that provide suitable interactive experiences for older adults from diverse backgrounds.  
While existing studies have provided useful design strategies for health interventions among older adults, future work should focus more on personalized and inclusive design, ensuring that designs can meet the diverse needs of older adults, especially considering their differences in cognitive and physical abilities.