## 3 Materials and Methods  
The project VITAAL aimed at creating a technological solution--an exergame--to support personalized and multicomponent clinical interventions for older adults with mobility limitations, cognitive impairment, and/or urinary incontinence, while catering for individual capabilities and progress. Motivating the person through fun and entertainment was also an important goal of the project. VITAAL was structured in three phases: investigation, development, and trials [51]. The investigation phase aimed at understanding user needs and expectations, for which partners in the project conducted a survey with end-users and a focus group with clinicians, whose results are reported elsewhere [51]. The development phase comprised the actual development of the solution using the methods thoroughly documented and discussed in this work. Following the development phase, the project foresees two evaluation loops that will assess (i) the acceptability and game experience of the users, and (ii) the feasibility of the intervention. In this study, we focus on the design and development of the VITAAL exergame solution. The design and development of the VITAAL exergame considered inputs from older adults (resulting from the investigation phase of the project [51], and from the feedback obtained in a previous study [45]) and from a multidisciplinary team, including game designers, developers, user experience/user interface (UX/UI) designers, movement scientists, end-users, and clinicians. Through a set of meetings, and following an iterative design process, they helped us to specify the structure and contents of the exergame, ensuring its adequacy concerning training requirements, game design principles, and end-user characteristics. \begin{table}
\begin{tabular}{p{142.3 pt} p{142.3 pt} p{142.3 pt}} \hline \hline
**Lead Author (Year)** & **Description** & **Technology** & **Limitations** \\ \hline [PERSON] (2020) [44] & Three augmented reality exergames for simultaneous motor (strength and balance) and cognitive (attention, memory, and executive functions) training. & Kinect & Individual training times cannot be personalized. Training times are not ensured by the game. \\ [PERSON] (2021) [47] & The exergame combines cognitive and physical tasks to improve older adults’ cognitive inhibition. The theme of the game (table tennis) is chosen considering the local popularity of this sport. & Kinect & Lack of progression mechanisms. Only cognitive inhibition and one type of physical exercise are targeted by the exergame. \\ [PERSON] (2018) [45] & An exergame solution comprising dance (for balance), Tai Chi-inspired exercises (for strength) and motor-cosutive training. Dance and Tai Chi exercises are provided by a virtual instructor (3D Avatar). & Inertial training times cannot be personalized. Training times are not ensured by the game. \\ [PERSON] (2015) [46] & Three exergames for dynamic balance and stability based on weight shifting, knee bending and stepping. In addition, each exergame contains a cognitive component: memory, inhibition, and selective attention. & Individual training times cannot be personalized. Training times are not ensured by the game. \\ [PERSON] (2019) [31] & Two virtual reality-based physical training games and three virtual reality-based cognitive training games for people with mild cognitive impairment. & Kinect & Individual training times cannot be personalized. Training times are not ensured by the game. \\ [PERSON] (2014) [48] & A dancing (stepping) exergame combined with stimuli for pelvic floor muscle contractions. & Dance pad & Lack of progression mechanisms. \\ [PERSON] (2015) [37] & An exergame for the training of pelvic floor muscles. Women would sit on a pressure platform, and command the game through their pelvic movements. & Wii Balance Board & Not designed specifically for older adults. \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Exergames for motor-cognitive and pelvic floor muscle training in older adults.