Design of a Digital Solution to Motivate Older Adults to Follow

Cognitive and Physical Training for an Active and Healthy Ageing

Valentina Guadagno

, Ana Isabel Martins

, Christina Schneegass

, Tilman Dingler

Joana Pais

, Nelson P. Rocha

and

Jos Kraal

Delft University of Technology (TU Delft), Delft, Netherlands

Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Portugal

Neuroinova, EPIUnit—Epidemiology Research Unit, Institute of Public Health, University of Porto, Portugal

Keywords: Digital Solution, Cognitive Training, Physical Training, Active Ageing, Healthy Ageing.

Abstract: Active and healthy ageing depends on maintaining physical and cognitive activity, but it is still challenging

to motivate older adults to participate in regular training. This paper describes the iterative design and

evaluation of a digital platform for increasing older adults' motivation to perform physical and cognitive

exercises. The digital solution was designed and evaluated in four iterations with a total of 13 older adults.

The first stage focused on identifying effective communication methods, including different formats of

instructional delivery and feedback, as well as tone. The second stage explored the combination of physical

activity with cognitively stimulating activities, such as brain games, sport, and hobbies, to find the most

motivating combinations. The final stage developed the prototype further by integrating motivational

elements into one coherent design, emphasizing clarity, guidance, and user agency. The final evaluation

reviewed the overall design, including the importance of adaptive systems that dynamically adjust the

difficulty level to align with users' physical and cognitive abilities to increase motivation. This study

contributes to the growing field of participatory design within digital health interventions, aligning with best

practices that emphasize the need for dynamic user involvement in all stages of development.

1 INTRODUCTION

Europe's aging population is increasing, leading to

health and social challenges such as reduced

independence, higher disease incidence, and

increased healthcare costs (Bernì et al., 2023).

Promoting active living through combined physical

and cognitive training can mitigate these issues,

enhancing well-being and delaying age-related

decline (Chan et al., 2020; Sanchini et al., 2022).

While such interventions are effective, they often

require specialized resources that are not always

accessible. Information and communication

https://orcid.org/ 0009-0007-0375-9644

https://orcid.org/0000-0002-5220-0528

https://orcid.org/0000-0003-3768-5894

https://orcid.org/0000-0001-6180-7033

https://orcid.org/0000-0003-4663-8184

https://orcid.org/0000-0003-3801-7249

https://orcid.org/0000-0001-9667-6926

technology (ICT) offers a scalable solution, enabling

remote delivery of training programs via digital

platforms. These tools integrate physical and

cognitive exercises through sequential, simultaneous,

or gamified approaches, making training more

engaging and accessible (Vozzi et al., 2022; Gavelin

et al., 2021).

The ACTIVAS project addresses these challenges

by integrating a tailored physical exercise module

into COGWEB, an existing cognitive training

platform (Baptista et al., 2023; Cruz et al., 2014).

Following guidelines for progression and

individualization, ACTIVAS offers functional,

Guadagno, V., Martins, A. I., Schneegass, C., Dingler, T., Pais, J., Rocha, N. P. and Kraal, J.

Design of a Digital Solution to Motivate Older Adults to Follow Cognitive and Physical Training for an Active and Healthy Ageing.

DOI: 10.5220/0013434300003938

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 11th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2025), pages 343-351

ISBN: 978-989-758-743-6; ISSN: 2184-4984

343

aerobic, muscle-strengthening, and balance exercises

to support older adults at risk of decline.

Despite its potential, prior research highlighted

motivation as a key barrier to engagement. This study

presents the redesign of the digital platform, focusing

on enhancing user motivation through a participatory

design approach, where users and stakeholders were

engaged in an iterative process of prototype

evaluation and improvement. The final evaluation

results offer insights into usability and engagement,

informing future improvements.

2 METHODS

The study followed a user-centered iterative design

process across four stages to refine and validate the

digital platform aimed at motivating older adults to

engage in cognitive and physical training.

Each iteration involved the development of a

digital platform prototype with specific elements, and

tested a specific hypothesis related to the motivational

features of the prototype, assessing the potential

impact of various design components on user

engagement.

Additionally, each session included a

conversation with participants to explore potential

barriers to engaging in remote physical exercises, as

well as factors that could enhance their motivation,

which provided insights to shape the subsequent

prototype.

2.1 Iteration 1: Testing the Interaction

The first iteration aimed to evaluate the

communication features of the platform, specifically

identifying which methods of interaction, instruction

delivery, and feedback were most motivating for

users. This test focused on the hypothesis that

effective communication and interaction methods

between the user and the platform are essential for

enhancing user motivation. An interactive prototype

of the platform was created using mockups (Figure 1).

A simulated session consisted of three exercises, each

designed to test different approaches to delivering

instructions, feedback, and tone of communication. In

this session, the first exercise utilized a step-by-step

explanation with 2D animations, a neutral tone, and

an audio feedback mechanism, allowing participants

to record their responses. The second exercise was led

by a dynamic gym instructor presented in a single

video format, enhanced by background music to

encourage engagement. The third exercise combined

a step-by-step explanation with a video of a

physiotherapist and supportive text, using a kind yet

scientific tone to emphasize the health benefits and

necessary information. Figure 2 illustrates the setup

for this test.

During the procedure, participants were asked to

simulate the exercise session by following the on-

screen instructions while engaging in a think-aloud

protocol, voicing their actions and thoughts to

provide real-time feedback. They were then asked to

evaluate each communication approach, assessing

which methods of instruction delivery, feedback, and

communication tone they found most motivating and

explaining the reasons behind each preference.

Figure 1: Prototype mock-ups from Iteration 1 representing

the three exercises shown during the test.

Figure 2: Set-up for the Iteration 1 test.

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344

2.2 Iteration 2: Integrating Cognitive

and Physical Activities

The second iteration aimed to test the hypothesis that

pairing physical exercise with an additional engaging

cognitive activity would make the exercise more

motivating compared to performing the exercises

alone. This iteration was structured to present three

different types of activities alongside physical

exercises: games (including cognitive tasks, quizzes,

and riddles), sports (such as tennis, baseball, bowling,

and dancing), and hobby-based activities (like

reading, painting, or playing music). An

unaccompanied physical exercise was also included

to assess whether this added element truly enhanced

motivation. The goal was to determine which of these

activity categories participants found most engaging

and why, while also assessing whether users could

successfully perform both the physical and cognitive

tasks simultaneously. The participants were asked to

rate the exercise’s engagement, enjoyment, and ease

of understanding on a Likert scale from 1 to 5. A score

of '1' indicated 'not engaging or enjoyable at all' or

'not easy at all,' while '5' represented 'very engaging

and enjoyable' or 'very easy to understand and

perform'. These ratings provided a framework for

identifying which activity types resonated most with

participants and clarified their preferences.

The test setup involved a session consisting of 11

tasks, each integrating a physical exercise or an

activity from one of the categories, as shown in

Figure 3. The tasks were divided into (4) game tasks,

(4) sport-based tasks, (3) hobby-based tasks, and (1)

physical exercise alone. The prototype for this test

session, along with detailed descriptions of each task,

is illustrated in Figure 4.

Both physical and cognitive tasks were kept at a

low difficulty level to ensure that participants of

varying skills and abilities could easily perform them.

At the end of the session, participants were asked to

indicate their preferred category and provide

feedback on their experiences, particularly in terms of

motivation.

Figure 3: Set-up for the Iteration 2 test.

Figure 4: Prototype screens from Iteration 2 representing

the four kind of exercises shown during the test.

2.3 Iteration 3: Converging the Insights

into One Concept

The third iteration aimed to converge and test the

most effective motivational elements identified in

previous iterations, examining how they could be

applied in a cohesive design, integrating aspects of

communication and interaction with the activities that

were found to enhance motivation, and assessing how

these elements could be combined in an actual

exercise session. This iteration also focused on

gathering feedback to refine the final design.

Although the final design featured various

exercise activities, this test was designed to refine the

integration of communication, feedback, and activity

engagement within one exercise to ensure its

effectiveness. The prototype, shown in Figure 5,

simulated a session that included the following

components:

• An introduction outlining essential

information, such as exercise details,

duration, required materials, and expected

benefits

• Step-by-step instructions for the exercise,

supported by examples

• The exercise itself

The chosen exercise for this prototype was

"Remember the Sequence," a game introduced in the

second iteration. In this game, users watched videos

showing a sequence of movements, each new video

adding an additional movement to the previous

sequence. After each video, users were asked to

repeat the sequence from memory, with the task

becoming progressively more challenging as the

number of movements increased. Figure 6 illustrates

the test setup. After completing the session,

participants were asked to provide open feedback on

the integration of motivational elements and the

overall concept and also to rate the prototype based

on how well it embodied motivational qualities

Design of a Digital Solution to Motivate Older Adults to Follow Cognitive and Physical Training for an Active and Healthy Ageing

345

identified from previous iterations: engaging and

guiding, along with a new quality introduced in this

phase, in control. Participants rated each aspect on a

Likert scale from 1 to 5, with '1' indicating 'not at all'

and '5' indicating 'very much'.

Figure 5. Prototype screens from Iteration 3 representing

the three components of the session.

Figure 6. Set-up for the Iteration 3 test.

2.4 Final Evaluation: Testing the

Complete Platform

The final evaluation involved testing the ultimate

version of the platform prototype. As part of the

evaluation to understand whether the design

successfully motivated users to perform the exercises,

the evaluation also aimed to uncover critical aspects

related to designing digital platforms for older adults,

particularly those with potential cognitive

impairments. Special attention was given to ensuring

that the instructions were clear, and the tasks were

easily understood and executed without confusion.

The test setup, shown in Figure 7, involved a

session with four tasks that combined cognitive

activities with corresponding physical exercises.

To accommodate different skill levels, two

difficulty settings were incorporated into both

cognitive and physical tasks. This approach ensured

that participants encountered an appropriate level of

challenge, avoiding boredom from tasks that were too

easy or frustration from tasks that were too difficult—

following the principles of Flow Theory (Csíkszent-

mihályi, 1975).

Participants followed the tasks while verbalizing

their thoughts, and their actions were closely

observed to gain insights into potential errors or

patterns of behaviour. After completing the session,

participants provided open feedback on the overall

experience and rated a Likert scale ranging from 1 to

5, focusing on three factors: engagement, challenge,

and clarity.

Figure 7. Set-up for the final evaluation test.

3 RESULTS

This study included a total of 13 participants across

four iterations. In the first iteration, three participants

(two females and one male) with a mean age of 74.33

years (SD = 6.5) were included. The participants had

varying levels of physical activity: one with low, one

with moderate, and one with high levels. Two

participants were cognitively healthy older adults,

while one had a diagnosis of Alzheimer’s disease at

its first stage and was a COGWEB user.

In the second iteration, three participants (one

female and two males) with a mean age of 61.7 years

(SD = 4.2) participated. Their physical activity levels

were distributed as follows: one engaged in moderate

activity, one in low activity, and one did not engage

in any physical activity. Two participants were

cognitively healthy older adults, and one had

experienced a stroke in 2010.

In the third iteration, three participants (two

females and one male) with a mean age of 66.3 years

(SD = 5.8) took part. Among them, one engaged in

high levels of physical activity, one in moderate

activity, and one did not engage in any physical

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activity. Two participants were cognitively healthy,

while one had a stroke in 1988.

The final iteration consisted of the final

evaluation, with four participants aged 51 to 74 years

(mean age = 61.5, SD = 9.7). These participants had

either moderate or low physical activity levels. Three

participants were cognitively healthy older adults,

while one had a brain injury and was a COGWEB

user.

3.1 Iteration 1: Testing the Interaction

The results of the first test iteration revealed key

preferences and needs among participants regarding

the platform’s communication features. Participants

expressed a clear preference for instructions delivered

by a real person, ideally a familiar physiotherapist, as

this enhanced trust and credibility. As one participant

stated, “I like the way she talks; she is nice, clear, and

slow. I can follow her and do the exercises while she

explains”. Video instructions were generally

preferred over step-by-step formats, though

participants appreciated visual animations with

concise explanations for their clarity.

Instructions were most effective when

straightforward, avoiding abstract language or

excessive detail, and when paired with an overview

that included necessary materials and session

duration. Participants favoured a tone that was kind

but concise, as opposed to overly energetic

encouragement. They also responded positively to a

sense of accomplishment from progress-tracking

features, and found the feedback modalities more

clear and understandable when conveyed with a

diversity of media, such as visuals paired with text

and graphics. Simple, closed questions were easier to

process than open-ended prompts, highlighting the

need for clear guidance using multimedia formats

(e.g., voice, images, and video) to accommodate

potential sensory impairments. Additionally, they

preferred linear navigation over screens requiring

multiple selections, and found practical information

about exercise benefits to be more motivating than

scientific explanations.

This feedback provided insights into the

communication strategies that most effectively

encourage users to engage in physical exercises

within the platform.

3.2 Iteration 2: Integrating Cognitive

and Physical Activities

Results showed that exercises combining physical

exercise with cognitive tasks, like bingo paired with

movement, received the highest average scores in the

'engaging and enjoyable' category, suggesting that

integrating mental challenges alongside physical

activity offered a more motivating experience

compared to exercises alone. Conversely, purely

physical exercises were rated highly only by

participants with active lifestyles, while sedentary or

less active individuals scored these activities lower,

indicating the need for additional interactive elements

to sustain engagement for these users.

Activities simulating participants' hobbies, such

as mimicking tasks while performing movements,

received lower scores in 'ease of understanding,'

reflecting the difficulty participants encountered

when required to focus on two simultaneous tasks. As

one participant noted, “Now I find the bingo fun and

easy enough. But when I was recovering from the

stroke, I would have never been able. It’s important

that this exercise is adapted for every condition”. The

quantitative insights from this evaluation, detailed in

Figure 8, highlight that participants rated exercises

incorporating cognitive challenges, interactive

elements, and a combination of physical movement

with non-physical tasks as the most engaging

(exercises 5, 6, 7 and 10). Conversely, exercises

perceived as less engaging, typically those relying on

simple imitation or tasks, deemed too easy received

lower scores (exercises 2, 3, 8, 9 and 11). Despite this

variation in engagement, most exercises scored well

(>3) in terms of ease of understanding and clarity,

with the exceptions of exercise 8 and exercise 10

which received comparatively lower scores in these

categories.

These findings informed the refinement of the

platform's design.

Figure 8. Bar chart representing the average participants’

score for each exercise.

3.3 Iteration 3: Converging the Insights

into One Concept

After integrating the insights from the steps above

into one prototype exercise, users scored the

prototype highest in control (5/5) and guiding (4.5/5)

indicating that participants felt well-supported and

capable of following and performing the exercises

Design of a Digital Solution to Motivate Older Adults to Follow Cognitive and Physical Training for an Active and Healthy Ageing

347

correctly. Participants appreciated the clear overview,

the use of multimedia formats such as words, images,

and animations during explanations, and the sample

examples provided. As one participant mentioned,

“The instructions were clear to me only when the

example was provided. I understood in that moment

what I had to do”. However, the prototype scored low

in engagement (2/5), with feedback suggesting that

the physical exercises were too easy for most users,

making them less stimulating and engaging.

Participants expressed a desire for more challenging

physical activities and emphasized the importance of

tailoring exercise difficulty to individual abilities: “I

like the idea of playing with physical exercises, but

these ones are too easy. I’d like more challenging

exercises”.

The insights and ratings from this test highlight

the value of integrating cognitive challenges with

varied and adequately challenging physical activities.

The feedback further suggests that instructional

clarity should remain a priority to maintain a sense of

control for users at different ability levels. These

insights informed the final design’s refinement.

Quantitative results can be viewed in Figure 9.

Figure 9. Bar chart representing the average scores given by

participants’ score for each quality.

3.4 Final Evaluation: Testing the

Complete Platform

The final prototype design, resulting from the four

iterations and shown in Figure 10, incorporates a

dual-task component featuring a series of cognitive

tasks in the form of exergaming, requiring physical

responses from users. Each session begins with an

overview provided by the patient’s physiotherapist,

who remains present throughout to guide the

exercises. Clear and instructive videos accompany

each activity, ensuring ease of understanding.

The sessions include four games designed to

target specific cognitive and physical skills:

1. Remember the Sequence: Patients observe

and memorize a sequence of movements

displayed on the screen, then replicate them.

As the sequence lengthens, the cognitive and

physical challenges increase, enhancing

memory and coordination.

2. Bingo: This game combines traditional

bingo with physical exercise, focusing on

attention and processing speed. Patients

interact with a digital bingo table,

performing a specific movement whenever a

called number matches one on their table.

3. Follow the Arrow: Patients respond to

arrows displayed on the screen, each

indicating a specific movement. As arrows

light up, users perform the corresponding

actions, sharpening executive functions and

processing speed.

4. Follow the Rhythm: Patients tap their feet in

rhythm with a piano melody, guided by

visual cues—right foot for green keys and

left foot for red keys. This activity improves

coordination and rhythm while supporting

executive function development.

At the end of each session, patients provide

feedback through a survey, enabling personalized

adjustments to future exercises. A progress report

summarizes their activities, celebrating achievements

and identifying areas for improvement.

Figure 10. Screens from the final prototype design.

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Figure 10. Screens from the final prototype design (cont.).

The final evaluation’s results, illustrated in Figure

11, indicated that participants rated the concept

highly for both engagement (mean of 4,75 out of 5)

and guiding (mean of 4.68 out of 5), reflecting a

generally positive experience with the platform.

However, the average score for clarity was notably

lower (mean of 4.01 out of 5), indicating room for

improvement in effectively conveying instructions to

ensure participants fully understood the tasks at hand.

Despite some initial confusion leading to mistakes,

participants were able to correct these errors by

reviewing the instructions or during the exercise

itself. One participant noted, “I’d love it if this was

implemented into COGWEB®. I’d feel even prouder

to complete the sessions if I am also improving my

physical abilities besides the cognitive ones”,

highlighting the value of integrating physical and

cognitive tasks.

The combination of physical exercises and

cognitive challenges was particularly well-received,

as participants reported a satisfactory level of

engagement where the difficulty level matched their

abilities, fostering eagerness to continue. The

presence of a physiotherapist in the instructional

videos further enhanced participants’ sense of

guidance, trust, and credibility. Although some

usability issues were identified, such as unclear

animations and repetitive movements in specific

exercises, these did not significantly detract from the

overall positive feedback. The findings suggest that

the final design effectively embodies the motivational

qualities, providing a dual challenge that could make

physical exercise more appealing to a broader

audience, especially for sedentary users who may be

motivated by the cognitive elements.

Figure 11. Bar chart representing the average participants’

score for each exercise considering engagement, challenge

and clarity factors.

4 DISCUSSION

The findings from this study highlight several key

insights for designing digital solutions aimed at

motivating older adults to engage in physical and

cognitive training for active and healthy ageing.

Across all iterations, engagement was identified as a

critical factor for sustained participation in the

platform. Activities combining physical and

cognitive challenges, such as movement-based bingo,

were consistently rated as the most enjoyable and

motivating. This supports existing research that

shows gamified elements and dual-task activities can

enhance motivation in older adults by creating a sense

of purpose and enjoyment during exercise (Lister et

al. 2014). However, purely physical exercises

received mixed responses, with more active

participants finding them engaging while sedentary

users required additional interactive elements.

A key finding of the study was the positive

reception of exercises that integrated physical and

cognitive tasks. Participants valued the dual

challenge, which not only made the exercises more

enjoyable but also contributed to a sense of

accomplishment. This aligns with evidence

suggesting that combining physical and cognitive

training can have synergistic benefits for brain health

and overall well-being in older adults (Eggenberger

et al. 2015).

The user’s feedback indicates that these dual-task

exercises may be particularly effective for sedentary

Design of a Digital Solution to Motivate Older Adults to Follow Cognitive and Physical Training for an Active and Healthy Ageing

349

individuals, who might be more motivated by

cognitive aspects than by physical activity alone.

However, it is essential to ensure that such tasks

remain accessible and understandable, especially for

users with lower baseline capabilities or cognitive

impairments.

Clear and concise instructions were also essential

to ensure participants could easily understand and

follow the exercises. Feedback from all iterations

emphasized the importance of using multimedia

formats, such as videos, images, and animations, to

accommodate sensory impairments and different

learning preferences. Participants consistently

reported that providing examples of the exercises

enhanced their comprehension and confidence, which

is consistent with the results of Yang et al. (2022)

study.

However, the lower clarity ratings during the final

evaluation suggest room for improvement in

conveying instructions. Issues such as unclear

animations and overly simplistic instructions for

certain tasks may hinder user comprehension,

particularly for older adults with cognitive

impairments. This reinforces the need for iterative

usability testing to refine the instructional design,

ensuring accessibility and ease of use, which will be

conducted in future work.

The final iteration also demonstrated that

participants were most motivated when the difficulty

level of activities aligned with their abilities,

influencing positively their level of engagement. This

finding underscores the importance of adaptive

systems that dynamically adjust the challenge level

based on the user’s physical and cognitive abilities to

maintain engagement over time.

The study revealed significant variability in

preferences and capabilities among participants,

highlighting the need for personalized approaches.

Participants expressed a strong preference for tailored

exercises, both in terms of physical and cognitive

difficulty. The variability in engagement levels

observed in this study, particularly between more

active and sedentary participants, suggests that a one-

size-fits-all approach is insufficient. Instead, adaptive

difficulty levels and tailored content are critical for

sustaining motivation. Personalization and adaptation

emerged as a key requirement in our study, reflecting

broader trends in the literature (Laukka et. Al. 2024).

The inclusion of physiotherapists in the

platform’s instructional videos enhanced trust and

credibility, further motivating participants to engage

with the program. The same was verified in the

studies of Boucher & Railer (2024) and Wiśniewska

et.al (2021). This study also contributes to the

growing literature on participatory design in digital

health solutions. The iterative design process used in

this study aligns with best practices outlined by

Sanders & Stappers (2020), which stress the

importance of actively involving users and

stakeholders throughout every phase of product

development. By addressing usability and

engagement issues through iterative refinement, this

study demonstrates how participatory design methods

can lead to solutions that meet the specific needs of

older adults. Despite these contributions, several

limitations should be noted. The small group of

participants limits the generalizability of the findings,

and most participants were cognitively healthy, while

the platform component is intended for integration

into a software system aimed at individuals with

cognitive impairments. Additionally, all tests were

conducted face-to-face, which may have positively

influenced engagement and motivation. These

conditions differ from the intended remote use of the

platform, where user interaction dynamics could vary

significantly. Future studies should address these

limitations by including a larger and more diverse

sample, incorporating users with varying degrees of

cognitive impairment, and testing the platform in a

remote setting.

5 CONCLUSIONS

This study demonstrates the feasibility and potential

benefits of a digital platform designed to motivate

older adults to engage in cognitive and physical

training. The iterative design process revealed several

key principles for creating an effective and engaging

solution, including clear, concise, and multimodal

instructions, tailored exercises and adaptive difficulty

levels, and the inclusion of instructions provided by

trusted professionals, such as physiotherapists. While

the platform showed promise in fostering engagement

and motivation, further improvements are needed to

address usability issues and refine the design. Future

work should focus on validating the platform's

effectiveness, as well as exploring long-term

adherence. The study contributes to the growing field

of digital health interventions for ageing populations

and provides a foundation for developing solutions

that promote active and healthy ageing through

combined cognitive and physical training.

ICT4AWE 2025 - 11th International Conference on Information and Communication Technologies for Ageing Well and e-Health

350

ACKNOWLEDGEMENTS

The authors acknowledge the use of generative AI,

specifically OpenAI's ChatGPT, to support the

refinement of the text.

FUNDING

This study was funded by the PRR—Plano de

Recuperação e Resiliência, and by the

NextGenerationEU funds at the University of Aveiro,

through the scope of the Agenda for Business

Innovation “HfPT—Health from Portugal” (Project

no. 41 with the application C644937233-00000047).

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