This case study describes the creation of a headmounted display virtual reality exergame program for promoting physical exercise for people with mild cognitive impairment (MCI), namely people with earlystage dementia. We engaged in an iterative participatory design process with kinesiologists, recreational therapists, and people with MCI prior to pilot-testing a prototype program with three persons with MCI. The test participants engaged in the exergame, were able to do the exercises, and their feedback was very positive. Engaging with professionals and people with dementia throughout the design process was very beneficial to creating a usable and engaging design as well as identifying areas that could be further improved. In conclusion, the approach illustrated through this case study resulted a new way for older adults with MCI to engage in physical activities that is fun and tailored to their abilities. The next phase in our research is to evaluate the exergame against comparable human-guided movements.

BackgroundHealthcare professionals (HCPs) are vital conduits of leisure-time physical activity (LTPA) information; however, few discuss LTPA with their patients with disabilities. ‘Changing Minds, Changing Lives’ (CMCL) is a nationwide, theory- and evidence-based seminar aimed at increasing LTPA-discussion among HCPs by enhancing their attitudes, subjective norms, perceived behavioural control (PBC), and intentions. The purposes of the current study were to: examine the effectiveness and short- and long-term maintenance of a CMCL seminar on HCPs’ social cognitions to discuss LTPA; and explore key implementation variables that predict changes in HCPs’ social cognitions.MethodsPrior-to, as well as immediately, one, and six months following a CMCL seminar, 97 HCPs (Mage ± SD = 36.23 ± 10.42; 69.0% female; 97.9% Caucasian; 38.1% rehabilitation therapists; years in profession = 11.56 ± 9.94) from five Canadian provinces completed questionnaires that assessed the Theory of Planned Behaviour constructs with regard to discussing LTPA with their patients with a physical disability. Key presenter characteristics and intervention delivery components were extracted from presenter demographic questionnaires and seminar checklists, respectively. Separate repeated-measures ANOVAs and post-hoc t-tests evaluated changes in HCPs’ social cognitions. Hierarchical multiple regressions were conducted to predict intentions and to understand which implementation variables may help explain significant changes in social cognitions.ResultsSignificant increases in HCPs’ social cognitions for discussing LTPA were reported from pre- to post-seminar (ps <0.002); however, increases were not maintained at follow-up. PBC emerged as the strongest predictor of participants’ post-CMCL intentions (β = 0.45, p <0.001). Although several implementation characteristics were related to changes in perceptions, the number of seminars the presenter delivered was the only significant negative predictor of post-seminar PBC (β = -0.18, p <0.05).ConclusionsFuture iterations of the CMCL intervention should include additional strategies to sustain improvements in HCPs’ social cognitions over time. Future CMCL evaluations should measure additional implementation variables so that the key ingredients for ‘Changing Minds’ can continue to be investigated.

Exercise is an important factor for people living with dementia as it improves physical fitness and quality of life; however, it can be challenging for them to engage in exercise. This research created two virtual reality environments using Oculus Rift head-mounted display and Oculus touch controllers, with the goal of increasing the accessibility to exercise for people living with dementia. A three-week evaluation was conducted with six persons living with dementia to compare the virtual programs with human/therapist-guided exercise. The results showed that both virtual exercise programs were comparable to the therapist-guided exercise in terms of subjective enjoyment, comfort, and difficulty level of the activities. All the participants completed all the tasks designed for them in each day and five wanted to continue using virtual reality exercises. This research demonstrates promising potential of virtual reality exergames for people living with dementia. Future studies are needed to expand the available tasks, increase the available environments, and to examine clinical impact.

The theory-driven, participatory development process facilitated interventionists' social cognitions towards and adoption of the new curriculum. Positive increases in TPB cognitions from pre- to post-training were not maintained at follow-up. Further research is needed to determine if these changes in cognitions are indicative of a curriculum "reinvention" process that facilitates long-term curriculum use. Understanding curriculum adoption and implementation is a crucial step to determining the potential population impact of the intervention.