Feasibility and Acceptance of Augmented and Virtual Reality Exergames to Train Motor and Cognitive Skills of Elderly

Round 1

Reviewer 1 Report

Comments for author File: Comments.pdf

Author Response

We would like to sincerely thank the reviewer for thoroughly reviewing our work and for the constructive comments. Every effort was made to address all the issues raised.

Please find in the attached file the original comments made by the reviewer, followed by our corresponding responses detailing the measures we took to address each comment.

Author Response File: Author Response.pdf

Reviewer 2 Report

 The submitted manuscript reports on the development of several screen- and VR- based exercise games meant to reduce the fall risk of seniors. This is a meaningful topic that could improve the health and life quality of elderly people. A positive aspect is that the applications developed are tested with the target group and field experts are involved in the development process. However, there are several issues with the scientific quality of the manuscript that need to be addressed.

General comments:

I don’t understand why you describe previous studies from other authors in so much detail (e.g. sample size, hardware, detailed procedure), as you don't evaluate the previous approaches and emphasize their strengths or weaknesses. It seems that your study is barely based on the reported studies. Is this manuscript supposed to be a review or a study report?

The background is missing important information and references on elderly fall risks and which physical exercises have proven to reduce fall risk.

You make a lot of statements in the text that are not supported by references. Common knowledge (e.g. “pervasive use of android” or reasons for VR sickness (line 548 to 555)) is not sufficient for a scientific paper.

You describe the use of Microsoft Kinect and a TV as an augmented reality application. I would disagree, (at least in your case as displayed in figure 1) as there are no virtual elements added to the recorded real world environment. Instead, real world objects are tracked and their movements are mirrored into a completely virtual environment.

You argue that your approach can “make it more likely that older adults will stick with an exercise program long-term”. However, you did not test long term motivation. This should be addressed as a limitation and investigated further in future studies.

There are some strange phrasings and word choices. I would recommend that the authors ask a colleague who is competent in English writing to read and revise the manuscript.

Detailed comments:

L73: „An evaluation study was conducted with seniors to justify that the AR/VR exergames are acceptable and engaging. “ I think justify is the wrong term here. Maybe “test whether”, “investigate whether” or “to evaluate the acceptability and engagement of the AR/VR exergames”?

L80: “The correlation between the UTAUT factors is also investigated.” Please inform the reader why the correlation was investigated.

L84: “…according to recent studies.” References to these studies should be given here.

L85: “Exergames, which combine physical and cognitive tasks, can increase motor-cognitive function, a person's level of independence, and their adherence to therapy.” Same as above, references to studies proving this are required.

L131: “execution zone“ Weird word choice that could be interpreted wrong. Maybe better “workout zone”?

L179: “A simultaneous approach” Do you mean “similar approach”?

L187: “Additionally, the experimental group participated in an activity that exclusively required cognitive function, such as cooking.” Does cooking not require motor skills?

L269: What is a “smart floor”?

L376: “In order to be engaging and inter-376 active, games integrate immersive graphics, sound effects, and physical interaction that 377 can keep users motivated and interested in the game.” DO you have supporting references for that statement?

L388: Figure 4 needs an overhaul. At original A4 size it is impossible to read the labels. Also, what should the reader do with the information in this figure? It is not self-explanatory.

L 457: “For all users, measurements of motor and cognitive functions are recorded before and after using the GAME2AWE platform.” How did you measure motor and cognitive functions?

L496: “five-point scale from 1 (strongly disagree) to 5 (strongly 496 agree).” Shouldn’t it be from 0 to 4? Otherwise the maximum score cannot be 40. Also, please mention whether the values of the negative statements were rescored.

Author Response

We would like to sincerely thank the reviewer for thoroughly reviewing our work and for the constructive comments. Every effort was made to address all the issues raised.

Please find in the attached file the original comments made by the reviewer, followed by our corresponding responses detailing the measures we took to address each comment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Nicely performed research with adequate data.

However a few comments:

1) The aims of the study could be more clearly presented in the introduction, with coherent outcomes in the conclusion.

2) It remained unclear, how the Microsoft Kinect was utilized during the study.  Where the sensor was located and how connected to the mobile device (?).

3) Are the exergames iOS compatible?

4) What year the present study was conducted? Apparently the data collection continues.

Author Response

We would like to sincerely thank the reviewer for thoroughly reviewing our work and for the constructive comments. Every effort was made to address all the issues raised.

Please find in the attached file the original comments made by the reviewer, followed by our corresponding responses detailing the measures we took to address each comment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

The authors have now provided detailed information concerning the motivation of their research (preventing falls of elderly) and provided additional literature to support their statements. Furthermore, limitations concerning the long term motivation of users are now addressed.

The details of the cooking task and why it is a cognitive task should be provided in the text (Response 2.13).

I am still not convinced that the amount of detail provided in the literature review is necessary (e.g. sample sizes of other studies, or experimental and control group assignments). This information can distract the reader from the actual relevant findings of previous studies (which training types improved balance or reduced falls) and the authors could think about reduce the amount of provided detail.

All other comments have been sufficiently addressed and the authors substantially improved the quality of the manuscript.

Author Response

Please see the attached file for our response to review comments.

Author Response File: Author Response.pdf