Augmented Reality exergames for patients with Osteoporosis: Results of an exploratory Clinical Trial On Exergame Design and Participation

Background Osteoporosis affects millions of Europeans resulting in skeletal fractures, which can have devastating health and economic consequences. Exercise helps maintain bone and muscle strength, reducing fracture risk, but adherence is a challenge. In recent years, virtual rehabilitation, using virtual reality (VR) and augmented reality (AR), has emerged as a viable solution for improving motivation and participation. However, studies of AR-based rehabilitation in osteoporosis remains unexplored. This study explores AR-rehabilitation for women with osteoporosis, focusing on personalised exercise and engagement. Method We developed four AR-exergames based on traditional physical exercises for adults with osteoporosis. A six-week intervention was conducted twice weekly among 41 participants (20 in the intervention group using the AR-based exergames and 21 in the control group doing a traditional training programme) aged 60–86 years. Exergames were progressively modified during the study informed by participant feedback collected at each session. Results Both groups reported high levels of enjoyment from study participation, knowledge gained, and willingness to be more active and engaged in regular exercise. Exergame participants reported feeling more engaged and motivated to participate in training. Feedback emphasised the importance of clear, written instructions, the positive impact of music and individual exercise preferences. Participants’ comfort with and confidence in their use of the technology improved throughout the study. Conclusions Adaptive, interactive exergames are well tolerated and may enhance motivation and engagement in physical therapy in women with osteoporosis. Clear instructions, immersive visuals, and structured progression are important aspects to consider when designing AR-based exergames for this target audience.