# Conceptual Design of an Extended Reality Exercise Game for the Elderly
### Problem and Scope  
To know the current status and developing trends of XR games in healthcare, we conducted four previous studies (including a systematic literature review of AR, VR, and MR game applications in healthcare (SLR) [10], a survey of possibilities and challenges with AR/VR/MR and gamification usage in healthcare (Healthcare Survey) [11], a survey on AR/VR games for mental and physical public health (Public Survey) [12], and a review of XR exercise games for elderly (Elderly SLR) [13]). The previous studies found that the applications and evaluations of XR (especially VR) techniques combined with game technology in health have received much attention and expectations. However, the lack of VR exercise games for elderly was evident.  
Based on the papers from six databases, 2014 to the first half of 2020, the previous SLR results show that the number of included papers has increased year by year, whether it was the overall XR technologies or the applications of different XR technologies [10]. Publications in the first half of 2020 alone reached the full year of 2017 [10]. In particular, the related research based on VR technology had the highest proportion [10]. From the PERKINS COIE AND XR Association's industry survey of XR techniques, there is also evidence of a growing trend in XR technologies [14]. The results show that, except for entertainment games, immersive games for healthcare are the most anticipated and high-profile [14]. The interviewees believed that immersive techniques were recognized and appeared to become a more critical part of daily lives for people worldwide [14].  
Moreover, the SLR found that XR games focusing on elderly health have attracted attention in several works [10]. However, most of these studies focused on the disease treatment, prevention, or test for the mental and psychological health of the elderly, such as Alzheimer's disease, dementia, and mild cognitive impairment [10]. Although the two primary health needs of the XR applications were (1) physical fitness or disease prevention by encouraging exercise and (2) adjuvant therapy or rehabilitation training through physical exercise, only a small number were aimed at elderly users [10]. These applications are mainly designed for certain diseases, achieving the prevention aim through exercise. So, they are targeting people at high risk for specific diseases, and not aiming at providing a fitness game for all elderly people.  
It was proven by these two surveys that there is a gap in the design and development of XR games for the elderly, especially physically healthy ones. According to the Healthcare Survey, in the 15 papers mentioning XR software, VR technology was indeed more applied in the medical and health organizations, whether combined with or without game elements [11]. However, only one aimed at physical exercise targeting the public [11]. Although the need for XR games for the elderly has been repeatedly mentioned, there is no existing XR game software for the elderly applied in healthcare-related institutions [11]. In the public survey, one could see (1) although many participants mentioned Pokemon Go as a famous AR game, VR games still had an absolute advantage in number; (2) almost all the respondents who participated in the survey were young people and middle-aged people (<44 years old); and (3) interviewees believed AR/VR games had a positive effect on physical and mental health [12]. Through this research, it was possible to see the positive attitude of users toward VR games and their recognition of achieving physical and mental exercise through VR games. The age distribution characteristics of the respondents explain to a certain extent that existing VR games lack an elderly user group. It is therefore evident that there is a gap in the development of VR exercise games for the elderly.