CA20104 – Ne wo k on e idence-based
physical ac i i y in old age (PhysAgeNe )
Deli e able D3.2
Guidelines and amewo k o designing echnology-assis ed PA
in e en ions including app op ia e assessmen s anda ds
RCO 8 De elop guidelines and amewo k o echnology-assis ed
PA in e en ions in old age.
Con ibu o s -
Wo king G oup 3
Nadja Scho , Uni e si y o S u ga , Ge many
Da id Beckwée, V ije Uni e si ei B ussel & Uni e si ei An we pen, Belgium
Niha ika Banda u, O o- on-Gue icke Uni e si y Magdebu g, Ge many
Ra ael A. Be na des, Uni e sidade Ca ólica Po uguesa, Lisboa, Po ugal
A ben Boshnjaku, Uni e si y "Fehmi Agani" Gjako a, Koso o
Rosema y Dubbeldam, Müns e Uni e si y, Ge many
Pa ick Esse , Ox o d B ookes Uni e si y, Uni ed Kingdom
Ele he ia Giannouli, ETH Zü ich, Swi ze land
An oine Langea d, Uni e si y o Caen No mandy, F ance
Ch is ophe McC um, Maas ich Uni e si y, The Ne he lands
Jana Pelclo a, Palacký Uni e si y Olomouc, Czech Republic
1.
INTRODUCTION
Ad ancemen s in many echnologies ha e opened new possibili ies o p omo ing physical
ac i i y (PA) in olde adul s. PA is c ucial o main aining heal h and unc ional independence
in olde adul s. Howe e , pa icipa ion a es in s uc u ed exe cise p og ams emain low due
o a ious ba ie s, such as mobili y limi a ions, lack o mo i a ion, and di icul y accessing i -
ness acili ies. The ad en o wea able echnology, sma i ness equipmen , li e s eaming
classes, in e ac i e gaming, and clien apps p o ides new oppo uni ies o engage olde adul s
in egula physical ac i i y. These inno a ions ep esen a powe ul echnology push, ye adop-
ion emains une en. “Technology push” e e s o inno a ions d i en p ima ily by echnological
ad ances a he han by use o clinical needs. In o he wo ds, de elope s c ea e new de ices,
apps, o sys ems because he echnology makes i possible, and only a e wa ds seek ways o
apply hem in p ac ice, bu hey a e no always aligned wi h olde adul s’ capabili ies, clinicians’
equi emen s, o e idence-based guidelines. As a esul , hei adop ion and sus ained use can
lag behind he pace o echnological inno a ion.
A cen al challenge lies in b idging wo wo lds: he echnology sec o and he clinical ield.
De elope s o en emphasize echnical capabili ies, while clinicians ocus on e idence, guide-
lines, and pa ien ou comes. This di e ence in language and p io i ies can hinde he e ec i e
ansla ion o p omising ools in o daily p ac ice. Building a sha ed ocabula y and os e ing
mu ual unde s anding a e essen ial o ensu e ha new echnologies a e bo h clinically mean-
ing ul and p ac ically usable.
The PhysAgeNe Cos Ac ion ne wo k was es ablished o add ess speci ic challenges ela ed
o e idence-based PA in e en ions in old age, including hose associa ed wi h using echnol-
ogy (PhysAgeNe , 2021; B ach e al., 2023). In his con ex , he cu en deli e able p esen s a
posi ion s a emen a icula ing a sha ed ision o he de elopmen , esea ch, and clinical use
o echnology-assis ed PA in e en ions o olde adul s. By in eg a ing insigh s om echnol-
ogy, heal h sciences, and clinical p ac ice, i aims o guide esea che s, de elope s, and p ac i-
ione s owa ds co-c ea ed solu ions ha a e e idence-based, accep able, and impac ul.
The ollowing sec ions p o ide concise guidance o key s akeholde s, co e ing an o e iew o
echnologies and key de ini ions, in eg a ing e idence-based guidelines in o digi al solu ions,
and essen ial echnological ac o s such as accu acy, connec i i y, in e ace design, secu i y,
and sys em in eg a ion. They also add ess de e minan s o echnology accep ance and sus-
ained use, he ole o beha iou change heo y and use -cen ed design, and speci ic consid-
e a ions o de elope s, esea che s, and clinicians. Toge he , hese sec ions o m a oadmap
o ensu e ha digi al inno a ions ansla e in o meaning ul, equi able, and e idence-based
imp o emen s in he heal h and well-being o olde adul s.
2.
THEORETICAL FRAMEWORKS FOR TECHNOLOGY-ASSISTED
PA INTERVENTIONS
In ecen decades, scien is s ha e used a ious models o heal h beha io o explain echnol-
ogy accep ance and use among olde people (see Figu e 1). Mos o hese models a e based
on he es ablished Theo y o Reasoned Ac ion (TRA) de eloped by Fishbein and Ajzen (1975).
This heo y o p edic ing human beha iou assumes ha ac ual beha iou is p eceded by an
in en ion o beha e in a ce ain way. This in en ion is, in u n, in luenced by wo ac o s: he
a i ude owa d he beha iou and he subjec i e no m. While he a i ude owa d he beha -
iou depends on posi i e o nega i e belie s and assump ions abou he ac ion and i s ou -
come (e alua i e a ec ), he subjec i e no m is based on no ma i e assump ions (social desi -
abili y) and he mo i a ion o li e up o hese assump ions.
A)
B)
Figu e 1. A) O e iew o beha iou change heo ies & echnology accep ance models; B) Using
he Technology Accep ance Model o iden i y ac o s ha p edic he likelihood o inc eased
physical ac i i y among olde adul s ( e ised a e Chan e al. (2023), Da is (1989))
This chap e is di ided in o wo main pa s o cap u e he mul i ace ed p ocesses in luencing
echnology-assis ed PA in e en ions. Sec ion 2.1 p esen s key beha iou change heo ies,
which help explain how in e en ions can e ec i ely mo i a e and sus ain physical ac i i y.
Sec ion 2.2 in oduces echnology accep ance models, which cla i y whe he and why olde
adul s a e likely o adop and main ain he use o digi al ools. Toge he , hese pe spec i es
p o ide a complemen a y ounda ion: beha iou change heo ies explain he p ocesses o sus-
ained engagemen , while accep ance models highligh he de e minan s o adop ion. In e-
g a ing bo h is key o designing in e en ions ha a e e ec i e and accep able in p ac ice.
2.1.
Beha iou change heo ies
Technology-assis ed physical
‑
ac i i y (PA) and exe cise in e en ions mus be g ounded in o-
bus beha iou
‑
change heo y o maximize adhe ence and e ec i eness. This ounda ion
spans (a) adi ional models de eloped o ace
‑
o
‑
ace o communi y p og ammes, (b) mo e
in eg a i e amewo ks ailo ed o echnology
‑
media ed con ex s, and (c) p ac ical oolki s
ha ansla e heo y in o design ea u es. In addi ion o hese well-es ablished models, eme g-
ing dual-p ocess pe spec i es such as he A ec i e-Re lec i e Theo y a e inc easingly ecog-
nized as impo an o unde s anding he emo ional dimension o exe cise engagemen ,
pa icula ly in con ex s like exe gaming. Re lec ing his e olu ion, a ecen scoping e iew calls
o an o e a ching, modula me a
‑
amewo k ha in eg a es sha ed cons uc s ac oss heo-
ies and cap u es hei dynamic in luence o e ime (Simpson e al., 2025).
2.1.1.
FOUNDATIONAL MOTIVATIONAL AND SOCIAL THEORIES
Theo y o Reasoned Ac ion (TRA; (Fishbein and Ajzen, 1975)) p esen s he ounda ional ame-
wo k o p edic heal h beha iou s, which asse s ha ac ual beha iou is de e mined by be-
ha iou al in en ion. Beha iou al in en ion, on he o he hand, depends on he indi idual’s a -
i udes owa ds beha iou and pe cei ed social no ms. Wi hin he con ex o PA in e en ions,
TRA explains how olde adul s' willingness o adop digi al ools is shaped by pe cei ed expec-
a ions om pee s, amily membe s, and heal hca e p o ide s, and no by pe sonal belie s
alone.
Theo y o Planned Beha iou (TPB; (Ajzen, 1991)) is a heo y ha ex ended TRA by adding
pe cei ed beha iou al con ol as a de e minan o in en ion and beha iou . The ounda ion o
TPB is especially ele an o olde adul s, wi h he abili y o de ec bo h con idence o manage
PA and he abili y o use digi al echnologies. This way, imp o emen s in olde adul s’ PA ad-
he ence o PA we e obse ed by TPB-in o med in e en ions (S ol e e al., 2017).
Heal h Belie Model (HBM; Rosens ock, 1990) is a model ha aims o explain he heal h be-
ha iou s in he unc ion o indi idually pe cei ed suscep ibili y o illness, se e i y o conse-
quences, bene i s om ac ion, and ba ie s o engagemen , while mode a ed owa ds indica-
ions o ac ions and sel -e icacy. In ou con ex , HBM can be used o be e unde s and why
some olde adul s emb ace echnology in con as o o he s who hesi a e due o cos , usabili y,
o p i acy conce ns.
Sel -Regula ion Theo y (SRT; (Ca e and Scheie , 1982)), o en known as Con ol Theo y, em-
b aces a a he dis inc pa hway, while no ing he cycle o goal se ing, sel -moni o ing, eed-
back, and indi idual adjus men s as a c ucial measu emen o sus ain beha iou . Th ough his
heo y, PA in e en ions can use wea able ins umen s, e alua e p og ess, and adjus based
on he ecei ed eedback owa ds achie ing he se goals.
Sel -De e mina ion Theo y (SDT; (Ryan and Deci, 2018)). A he mo i a ional le el, SDT holds
ha sus ained engagemen is ela ed o sa is ying h ee psychological needs: au onomy, com-
pe ence, and ela edness. Technology
‑
assis ed PA p og ams can mee hese needs by allow-
ing use s o ailo goals and in ensi y (au onomy), o e ing adap i e challenges and eal
‑
ime
eedback (compe ence), and embedding pee communi ies o i ual coaches ( ela edness). A
me a
‑
analysis o 166 SDT
‑
based in e en ions epo ed he s onges PA gains when all h ee
needs we e add essed by N oumanis e al. (2021). Recen Human
‑
Compu e In e ac ion wo k
ansla es hese p inciples in o ac ionable guidelines such as au onomy
‑
suppo i e pe sonali-
za ion, compe ence
‑
enhancing eedback loops, and socially ich ea u es (Albe s e al., 2024).
Social Cogni i e Theo y (SCT; (Bandu a, 2004)). SCT highligh s he ole o sel -e icacy, obse -
a ional lea ning, and social suppo in shaping and main aining heal h beha iou s. Technol-
ogy-assis ed PA in e en ions le e aging SCT can inco po a e i ual pee modelling, online
g oup sessions, and pe sonalized goal-se ing ea u es o boos sel -e icacy. E idence sup-
po s his app oach: a pedome e -based p og am explici ly g ounded in SCT signi ican ly im-
p o ed mobili y- ela ed sel -e icacy and unc ional ou comes in communi y-dwelling olde
adul s (Richeson e al., 2006). Complemen ing his, a ecen sys ema ic e iew o beha iou
change echniques in long- e m ca e iden i ied s a egies such as goal se ing, eedback, sel -
moni o ing, and social suppo as e ec i e o inc easing PA (Shi e al., 2025), which a e widely
ecognized as mechanisms h ough which SCT s eng hens sel -e icacy, he eby suppo ing
sus ained engagemen in physical ac i i y.
T ans heo e ical Model (TTM; (P ochaska and Velice , 1997). TTM iews beha iou change as
i e successi e s ages (p e
‑
con empla ion, con empla ion, p epa a ion, ac ion, and main e-
nance) so in e en ions can ailo con en o a pe son’s eadiness. In olde adul s, he com-
pu e
‑
ailo ed p og amme Ac i e
Plus p oduced s age
‑
speci ic gains in daily s eps ( an S alen
e al., 2011), and a e iew o ≥
60
‑
yea
‑
olds con i med ha TTM ailo ing boos s mode a e
‑
o
‑
ig-
o ous PA and speeds s age p og ession (Jiménez e al., 2020). A me a
‑
analysis o 35 andom-
ised ials ound ha in e en ions explici ly ma ched o TTM s ages achie ed la ge PA e ec s
han non
‑
ma ched con ols (Romain e al., 2018). Ne e heless, only abou one
‑
hi d o eHeal h
s udies include s age
‑
based con en (Muellmann e al., 2018, Jonkman e al., 2018), highligh ing
an implemen a ion gap. Concise s age sc eene s, pe sonalised p omp s, and in eg a ed
sel
‑
moni o ing, he e o e, emain p omising ea u es o echnology
‑
assis ed PA p og ammes
aimed a olde adul s.
A ec i e-Re lec i e Theo y (ART; (B and and Ekkekakis, 2018, B and and Ekkekakis, 2021). Be-
yond hese es ablished heo ies, he A ec i e-Re lec i e Theo y o e s an eme ging dual-p o-
cess pe spec i e. ART posi s ha physical-ac i i y beha iou is shaped by he in e -play o im-
media e a ec i e esponses (impulsi e sys em) and e lec i e e alua ions ( e lec i e sys em).
While ART has no ye been widely applied in olde adul s, ini ial wo k in adul s shows p omise.
The WalkToJoy p oo -o -concep s udy, o example, used ART p inciples in a mobile in e en-
ion o adul s aged 40+, enhancing a ec i e associa ions wi h walking and in insic mo i a-
ion (Choi e al., 2025). This illus a es how ART complemen s es ablished models by highligh -
ing he emo ional dimension o exe cise engagemen .
2.1.2.
INTEGRATIVE FRAMEWORKS
COM-B Model (Capabili y, Oppo uni y, Mo i a ion – Beha iou ; (Michie e al., 2011, Wes and
Michie, 2020)): COM
‑
B diagnoses whe he beha iou is cons ained p ima ily by capabili y
(physical and psychological), oppo uni y (physical and social en i onmen ), and mo i a ion
(au oma ic and e lec i e p ocesses) a any gi en momen . Technology
‑
assis ed in e en ions
can hus aise capabili y (ins uc ional ideos, g aded plans), expand oppo uni y ( lexible
scheduling, con ex
‑
awa e p omp s), and s eng hen mo i a ion (jus
‑
in
‑
ime sugges ions,
digi al badges, e lec i e jou nals).
Heal h Ac ion P ocess App oach (HAPA; (Schwa ze , 2008)) in eg a es mo i a ional and oli-
ional phases, emphasizing bo h he o ma ion o in en ions and hei ansla ion in o ac ion
h ough de ailed planning, ac ion con ol, and coping s a egies. In he con ex o echnology,
his app oach en ails he implemen a ion o he HAPA model's p inciples o enginee applica-
ions, in e en ions, and digi al ins umen s ha acili a e he ansi ion om he ini ial in en-
ion o ac , o ins ance, a goal o engage in inc eased physical ac i i y, o he ac ual pe o -
mance and sus ained main enance o he desi ed beha iou .
2.1.3.
DESIGN FRAMEWORKS
Beha iou Change Wheel (BCW; (Michie e al., 2011)): p o ides a s uc u ed way o design be-
ha iou change in e en ions. A i s co e is he COM-B model (Capabili y, Oppo uni y, Mo i a-
ion), which helps iden i y he main ba ie s o beha iou . The BCW hen links hese de e mi-
nan s o b oad in e en ion unc ions (e.g., educa ion, aining, modelling, pe suasion) and
speci ic beha iou change echniques (BCTs), such as goal se ing, eedback, o social suppo .
This s epwise s uc u e makes i possible o mo e om unde s anding ba ie s o speci ying
conc e e in e en ion componen s. The BCW is aluable o echnology-assis ed PA because
i ensu es ha digi al ea u es like eminde s, gami ica ion, o pee suppo a e explici ly
g ounded in beha iou al heo y. Recen e iews ha e con i med ha in eg a ing BCTs in ech-
nology-assis ed PA in e en ions imp o es ou comes (Ahmed e al., 2024, Ben lage e al., 2023,
Dugas e al., 2020). While combining mul iple BCTs emains limi ed in p ac ice (An ezana e
al., 2020), hei b oade adop ion should be encou aged. Ideally, his should in ol e co-design
wi h olde adul s o AI-suppo ed pe sonaliza ion, gi en he he e ogenei y o use p e e ences
and he limi ed unde s anding o he speci ic e ec s o indi idual BCTs (F iel e al., 2025, Janols
e al., 2022, Ku u, 2024).
Theo e ical Domains F amewo k (TDF; (Cane e al., 2012)): syn hesises cons uc s om mo e
han 30 beha iou al heo ies in o a se o 14 psychological domains, including knowledge,
skills, belie s abou capabili ies, belie s abou consequences, social in luences, en i onmen al
con ex , and beha iou al egula ion. I is o en used as a diagnos ic ool o iden i y he main
de e minan s o beha iou in a gi en con ex . In digi al PA in e en ions, he TDF helps de el-
ope s unde s and why olde adul s may o may no engage (e.g., lack o con idence, limi ed
digi al li e acy, o absence o social encou agemen ) and guides he selec ion o ele an BCTs.
I s s eng h lies in p o iding a b oad bu s uc u ed checklis ha ensu es no majo de e mi-
nan is o e looked.
Fogg Beha io Model (FBM; (Fogg, 2009)): o e s a simple bu powe ul p inciple: a beha iou
will occu only when mo i a ion, abili y, and a p omp con e ge simul aneously. I one elemen
is missing (e.g., oo li le abili y, no imely p omp ), he beha iou does no happen. Fo digi al
heal h design, his means ha apps o exe games should p o ide jus -in- ime p omp s when
use s a e bo h able and mo i a ed, and ensu e ha he beha iou is easy enough o pe o m.
This migh mean lowe ing he echnical h eshold (clea ins uc ions, in ui i e design) and de-
li e ing eminde s a con enien imes o olde adul s. The FBM is pa icula ly a ac i e o
echnology de elope s because o i s simplici y and di ec applicabili y.
Pe suasi e Sys em Design (PSD; (Oinas-Kukkonen and Ha jumaa, 2009)): ocuses on how dig-
i al sys ems can be designed o in luence beha iou posi i ely. I iden i ies key pe suasi e de-
sign p inciples such as ailo ing (cus omising con en o he use ), pe sonalisa ion, eedback,
sel -moni o ing, eminde s, ewa ds, and social suppo . In he con ex o PA, PSD is especially
ele an o apps, wea ables, and exe games ha aim o mo i a e use s h ough engaging
in e aces and in e ac i e ea u es. Fo olde adul s, PSD encou ages de elope s o combine
usabili y wi h pe suasi e s a egies ha os e enjoymen , us , and sus ained adhe ence.
2.1.4.
GENERAL AND CONTEXTUAL FRAMEWORKS
PICOTS
‑
ComTeC amewo k (Z ubka e al., 2024) o e s a complemen a y gene al model o
de ining, designing, and epo ing digi al PA in e en ions. I ensu es ha all c i ical dimen-
sions—Popula ion, In e en ion, Compa a o , Ou comes, Timing, Se ing, Communica ion,
Technology, and Con ex —a e sys ema ically speci ied and aligned wi h beha io al heo y. By
inco po a ing PICOTS-ComTeC, de elope s can explici ly documen he heo e ical basis,
mechanisms o ac ion, echnological ea u es, and implemen a ion con ex , enhancing bo h
scien i ic alidi y and p ac ical applica ion.
Ecological models (Sallis and Owen, 2015; Sallis e al., 2008) emphasise ha physical ac i i y is
shaped no only by indi idual ac o s (skills, mo i a ion, heal h) bu also by social ela ionships,
o ganisa ional se ings, communi y en i onmen s, and public policy. They highligh he in e -
ac ion be ween people and hei su oundings a he han ocusing solely on indi idual psy-
chology. Fo echnology-assis ed PA, his pe spec i e eminds us ha e en well-designed dig-
i al ools equi e suppo i e social and en i onmen al con ex s o be e ec i e.
2.1.5.
KEY TECHNIQUES ACROSS FRAMEWORKS
Consis en wi h hese amewo ks, e idence syn heses show ha ce ain beha iou
‑
change
echniques (BCTs) epea edly d i e success in echnology
‑
assis ed PA p og ammes o olde
adul s. As also illus a ed in Table 1, umb ella and sys ema ic e iews highligh a co e clus e ,
sel
‑
moni o ing, goal
‑
se ing, eedback, p omp s o cues, and social suppo , as he mos po-
en componen s (Alley e al., 2024; S ockwell e al., 2019).
Table 1. O e iew o beha iou change heo ies and amewo ks ele an o echnology-as-
sis ed PA in e en ions in olde adul s
Sec ion F amewo k / Theo y Co e p inciple Rele ance o echnology-as-
sis ed PA in olde adul s (exam-
ples)
2.1.1 Founda ional
mo i a ional and so-
cial heo ies
SDT (Ryan & Deci, 2018) Au onomy, compe-
ence, ela edness
Apps can pe sonalise goals, gi e
adap i e eedback, p o ide pee
communi ies
SCT (Bandu a, 2004) Sel -e icacy, model-
ling, social suppo
Digi al ea u es can enhance sel -
e icacy ia eedback, g oup ses-
sions, pee modelling
TTM (P ochaska & Velice ,
1997)
S ages o change P og ammes can ailo con en and
eedback o eadiness s age
ART (B and & Ekkekakis,
2018)
Dual-p ocess: impul-
si e a ec + e lec i e
e alua ion
Explains ole o enjoymen in exe -
gaming, highligh s a ec i e d i e s
2.1.2 In eg a i e
amewo ks
COM-B (Michie e al., 2011) Capabili y, Oppo -
uni y, Mo i a ion →
Beha iou
Diagnos ic model o iden i y ba i-
e s, guides design ea u es
HAPA (Schwa ze , 2008,
2022)
Mo i a ion– oli ion,
planning, coping
Suppo s ac ion planning, coping
s a egies in digi al in e en ions
2.1.3 Design ame-
wo ks
BCW (Michie e al., 2011) COM-B linked o in e -
en ion unc ions and
BCTs
P o ides s epwise s uc u e o de-
sign digi al ea u es
TDF (Cane e al., 2012) 14 psychological do-
mains
Helps iden i y ba ie s/enable s in
ech adop ion
FBM (Fogg, 2009) Beha iou = Mo i a-
ion × Abili y × P omp
Highligh s impo ance o simplici y
and imely p omp s
PSD (Oinas-Kukkonen &
Ha jumaa, 2009)
Pe suasi e design
p inciples
Guides design o apps, wea ables,
exe games
2.1.4 Gene al and
con ex ual ame-
wo ks
PICOTS-ComTeC (Z ubka
e al., 2024)
S uc u ed epo ing
ac oss dimensions
Ensu es sys ema ic speci ica ion o
digi al in e en ions
Ecological models (Sallis
e al., 2008; Sallis & Owen,
2015)
Mul i-le el in luences
on beha iou
Emphasise ole o social and en i-
onmen al con ex
2.2.
Technology Accep ance Models
Technology accep ance is ypically cha ac e ized as he beha iou al in en ion o u ilize o ac-
qui e knowledge ega ding he use o echnology, and i can be ega ded as a p ecu so o i s
p ac ical implemen a ion ( echnology adop ion) (Roge s e al., 2020). Al e na i ely, i can be
de ined mo e b oadly as app o al, a ou able ecep ion, and ongoing use o newly in oduced
de ices and sys ems (A ning and Zie le, 2009). A ho ough examina ion o he cons uc and
i s in luencing ac o s enables he o mula ion o conclusions ega ding he mo i a ions be-
hind an indi idual's u iliza ion o non-u iliza ion o a speci ic echnology.
Unde s anding echnology accep ance de e minan s is c i ical o p edic ing bo h ini ial adop-
ion and long- e m engagemen in echnology-assis ed physical ac i i y (PA) in e en ions in
olde adul s. Models like he Technology Accep ance Model (TAM) (Da is, 1989), he Uni ied
Theo y o Accep ance and Use o Technology (UTAUT) (Venka esh e al., 2003), and he Senio
Technology Accep ance Model (STAM) (Chen and Chan, 2014) p o ide aluable amewo ks o
iden i ying key de e minan s ha shape olde adul s’ in en ions o adop and use echnology.
All models emphasize Pe cei ed Use ulness (PU) and Pe cei ed Ease o Use (PEOU) as c i ical
o in luencing Beha iou al In en ion (BI) o use echnology, which is essen ial in p omo ing
physical ac i i y in e en ions (O'Dea, 2025).
TAM, one o he oldes and mos widely used models, emphasizes how sys em use is a e-
sponse de i ing om use mo i a ion o use he sys em, which is di ec ly in luenced by an
ex e nal s imulus om he sys em’s ea u es and capabili ies (Da is, 1989). Fu he mo e, TAM
iden i ies Pe cei ed Ease o Use, Pe cei ed Use ulness, and A i ude Towa d Using as p ima y
p edic o s o use s’ mo i a ion o use echnology (Da is, 1989), which is essen ial in p omo ing
PA in e en ions (O'Dea, 2025). An upda ed e sion o TAM was p o ided by Venka esh and
Da is (Venka esh and Da is, 2000), which ex ended he o iginal TAM by in eg a ing social in-
luence p ocesses (like subjec i e no ms, olun a iness, and image) as well as cogni i e ins u-
men al ac o s (like job ele ance, ou pu quali y, esul demons abili y). This way, TAM2 ex-
plains how ex e nal alida ion and pe o mance expec a ions highly in luence he pe cei ed
unc ionali y and he aims o adop ing echnology. Then Venka esh and Bala (2008) wen u -
he by in oducing ano he e sion (TAM3), which u he in eg a ed de e minan s o pe -
cei ed simplici y o use (like compu e sel -e icacy, pe cep ions o ex e nal con ol, compu e
anxie y, and pe cei ed enjoymen ), his way making i especially ele an o olde adul s’
adap abili y owa ds echnology.
UTAUT ex ends TAM by p oposing pe o mance expec ancy, e o expec ancy, and social in-
luence o p edic beha iou al in en ion owa ds accep ing in o ma ion echnology
(Venka esh e al., 2003). The impo ance o his model lies in he con ex o he in luence ha
con idence in using echnology and en i onmen al suppo plays in sus ained engagemen .
UTAUT is cha ac e ized by a wide alida ion in mul iple popula ions and se ings, hus p o id-
ing a consis en amewo k o p edic ing echnology accep ance amongs di e en popula-
ion g oups (e.g., Wu and Lim (2024)). A la e ex ended e sion o UTAUT(2) was p o ided by
Venka esh e al. (2012), which inco po a ed h ee addi ional de e minan s: hedonic mo i a ion,
p ice alue, and habi . The UTAUT2 p o ides ano he aluable heo y ha can help design PA
in e en ions o olde adul s. Conside ing he unique needs o olde popula ions, STAM u he
ex ended hese heo ies by in eg a ing ac o s like ge on echnology sel -e icacy, echnology
anxie y, and pe cei ed physical o cogni i e ba ie s (Chen and Chan, 2014). Typical examples
a e seen when olde adul s decline ying o pe sis in no using new echnological ools due
o ea s o e o s o e en da a p i acy conce ns. This may happen e en i hey ecognize he
po en ial heal h- ela ed bene i s.
A complex in e play o pe sonal, cogni i e, emo ional, and en i onmen al ac o s shapes ech-
nology use among olde adul s (Chan e al. (2023)). Key ba ie s include limi ed access, low sel -
e icacy, pe cei ed isks, and nega i e emo ional esponses, while pe cei ed bene i s, social
suppo , and posi i e a ec i e expe iences can acili a e use. Add essing hese issues equi es
measu e pe cei ed use ulness, ease o use, and openness o new echnologies. The p e-in e -
en ion discussion should also include ques ions ega ding p e ious expe iences wi h simila
ools, p i acy conce ns, o pe cei ed ba ie s.
Finally, unc ional cons ain s ela ed o senso y o cogni i e impai men s should be e alua ed.
Visual acui y, hea ing abili y, and basic cogni i e unc ion can signi ican ly a ec he abili y o
use echnological ools and ollow exe cise ins uc ions. Simple sc eening ools like he Mini-
Cog (Abayomi e al., 2024) o MoCA-Blind, along wi h ision and hea ing sel - epo ques ions
o basic es s (e.g., Snellen cha (McG aw e al., 1995), whispe es (Pi ozzo e al., 2003)), can
guide necessa y adap a ions o he in e ace (e.g., la ge on s, audio p omp s) o deli e y
me hod.
Al oge he , he p e-in e en ion assessmen should p o ide a de ailed p o ile o he olde pa -
icipan ’s needs, capaci ies, and p e e ences, enabling he esea ch o clinical eam o design
an in e en ion ha is bo h sa e and accep able, maximizing po en ial bene i s.
5.2.
Pe i-in e en ion
Clinicians should add ess common accessibili y challenges by p o iding clea guidance, use -
iendly manuals, and mul ilingual suppo . This is essen ial no only o p omo e echnology
adop ion bu also o sus ain use engagemen o e ime, he eby enhancing adhe ence o he
he apeu ic p og am.
E idence sugges s ha in e en ions ha include aining sessions on echnology usage,
echnical assis ance du ing he p og am, and ongoing suppo om amily membe s o
heal hca e p o essionals lead o be e engagemen and adhe ence (Cole a e al., 2025; Haase
e al., 2021; Gell e al., 2021). Speci ically, c ea ing indi idualized o ien a ion sessions can equip
olde adul s wi h he necessa y skills and con idence, hus enhancing hei sel -e icacy o-
wa ds echnology use (Haase e al., 2021; Gell e al., 2021).
Also, p o iding ongoing echnical suppo is essen ial o olde adul s na iga ing new ech-
nologies. Resea ch indica es ha many olde adul s ace challenges wi h echnology usage,
leading o a desi e o immedia e and accessible suppo when issues a ise. Fo ins ance, s ud-
ies sugges ha in o mal suppo mechanisms, such as amily and iends, play a signi ican
ole in helping olde adul s oubleshoo echnological issues (Gee s e al., 2023, Po z e al.,
2019). I is common o g andchild en o adul child en o assis olde ela i es in adop ing new
echnologies, including de ices and applica ions ha p omo e physical ac i i y (Ele s e al.,
2018, Luijkx e al., 2015). This amilial suppo ne wo k is c i ical, as i helps b idge he gap be-
ween olde adul s and complex echnologies, enhancing hei con idence and educing eel-
ings o inadequacy ela ed o echnology use (Tsai e al., 2016). Mo eo e , s uc u ed suppo
sys ems should be es ablished ha o e o mal echnical assis ance, ei he h ough dedica ed
helpdesks o eal- ime suppo wi hin he applica ions hemsel es. Encou aging o ganiza ions
and se ice p o ide s o de elop dedica ed esou ces, such as u o ials o FAQs ailo ed o olde
adul s, will bols e use con idence and minimize us a ion (Heinz e al., 2013). The design o
use - iendly in e aces ha include accessible help op ions can acili a e smoo he in e ac-
ions, helping olde adul s o manage any echnological di icul ies ha may a ise (Blocke e
al., 2020; Cieme e al., 2025).
Mois e al. (2024) ou lined bes p ac ices o implemen ing echnology-based in e en ions,
including adap i e aining p og ams, ongoing echnical suppo , and pe sonalized eedback
mechanisms (see Table 3). These elemen s should be inco po a ed in o PA in e en ions o
op imize long- e m adhe ence. Mo eo e , psychological, physical, educa ional, and economic
ac o s a ec ing he olde adul should be conside ed when implemen ing echnology-as-
sis ed physical ac i i y in e en ions.
Table 3: Guidelines and applica ions o applica ion o echnology-based in e en ions,
adap ed om Mois e al. (2024)
A ea Guidelines and Recommenda ions
Use Needs • Ca e ully conside he sys em equi emen s o he in e en ion o suppo success ul
pa icipa ion.
• Unde s and he a ge use in he design phase o he in e en ion o in o m he de el-
opmen o aining ma e ials ha accoun o di e ences in use p e e ences and needs.
T aining Design • Adap and cus omize o mee he needs and p e e ences o he a ge use .
• Le e age a ious me hods o deli e aining con en (e.g., ideos, Powe Poin p esen a-
ion, handou s) o ensu e pa icipan s ha e easy access o in o ma ion sha ed ia ain-
ings.
Pe sonnel Respon-
sibili ies
• Suppo use au onomy by in o ming and educa ing on he use and unc ionali y o he
echnology.
• Unde s and he use and hei needs o ensu e he p ope esou ces a e a ailable o sup-
po pa icipa ion.
S uc u ing he De-
li e y/Con en
• Unde s and he bene i s and challenges o he echnology ools used o deli e he in e -
en ion.
• Adap and op imize suppo p o ided o pa icipan s h oughou he du a ion o an in-
e en ion o suppo and mee he needs o he a ge popula ion.
E alua ing Success • Du ing he in e en ion op imiza ion phase, and o analyze he bene i s and challenges
o a ious ypes o deli e y me hodology and hei implica ion on he a ge popula ion.
• Types o suppo p o ided o pa icipan s du ing he du a ion o an in e en ion should
be adap able and le e aged o suppo in e en ion deli e y.
5.3.
Pos in e en ion
The e alua ion ollowing he in e en ion se es se e al essen ial pu poses: i documen s
changes in physical and psychological ou comes, iden i ies any ad e se e ec s o challenges
encoun e ed, and p o ides insigh s in o he olde adul ’s expe ience wi h he echnology. To
ensu e consis ency and allow he assessmen o indi idual change, pos -in e en ion e alua-
ions should e lec he domains assessed a baseline while also add essing pe cei ed usabili y
and impac .
5.3.1.
PHYSICAL OUTCOMES AND ADHERENCE
Physical imp o emen s should be e alua ed using he same ools used a baseline ha align
wi h he goals o he in e en ion. These allow objec i e moni o ing o unc ional gains and
help de e mine whe he he exe cise modali y was app op ia e and e ec i e. Adhe ence mus
be ca e ully documen ed, pa icula ly in echnology-based in e en ions whe e app- o de ice-
based ac i i y logs can o e p ecise da a on equency and du a ion o pa icipa ion. Sel - e-
po ed adhe ence and pe cei ed ba ie s should also be collec ed o in e p e a iabili y in ou -
comes. Moni o ing o ad e se e en s, musculoskele al pain, dizziness, a igue, o any heal h
inciden s ela ed o ei he he physical ac i i y p og am o he echnology used is essen ial o
de e mine he sa e y o he in e en ion.
5.3.2.
PSYCHOLOGICAL AND MOTIVATIONAL ASPECTS
Pos -in e en ion mo i a ion and a ec i e esponses should be explo ed using ins umen s
consis en wi h he p e-in e en ion phase, such as he PACES (Physical Ac i i y Enjoymen
Scale) and BREQ (Beha iou al Regula ion in Exe cise Ques ionnai e). In addi ion o cap u ing
shi s in emo ional and mo i a ional esponses, hese da a help de e mine he po en ial o
long- e m beha iou change. Open-ended ques ions o sho in e iews may be used o ex-
plo e pa icipan s' pe cep ions o pe sonal bene i , sa is ac ion, and likelihood o con inuing
he ac i i y independen ly.
5.3.3.
TECHNOLOGY USABILITY AND ACCEPTANCE
E alua ing he olde adul ’s expe ience wi h he echnological componen s is c ucial o unde -
s anding bo h indi idual engagemen and he b oade accep abili y o he in e en ion. Fol-
lowing Lund’s amewo k (Lund, 2001), pos -in e en ion assessmen should speci ically exam-
ine use ulness, sa is ac ion, and ease o use— h ee co e dimensions o use expe ience.
Valida ed ins umen s such as he Sys em Usabili y Scale (SUS) o sho Like -based ques ions
adap ed om usabili y models (e.g., TechPH, STAM) can help quan i y hese pe cep ions. Qual-
i a i e eedback may u he en ich his unde s anding, especially when pa icipan s epo
echnical challenges, lack o cla i y, o ba ie s ela ed o senso y o cogni i e limi a ions.
Compa ison o p e- and pos -in e en ion usabili y and accep ance sco es o e s aluable in-
o ma ion on whe he exposu e o he echnology imp o ed con idence, au onomy, o in e es
in con inuing use. A en ion should be paid o any e olu ion in a i udes, including educing
echnophobia o inc easing sel -e icacy in using digi al ools.
5.3.4.
GLOBAL PERCEIVED IMPACT
To complemen s anda dized measu es, pa icipan s should also be in i ed o e lec on he
b oade impac o he in e en ion on hei daily li es. This may include pe cei ed imp o e-
men s in au onomy, sel -con idence, mobili y, o social pa icipa ion. B ie s uc u ed ques-
ions o in e iews can help cap u e hese subjec i e e ec s, o en cen al o eal-wo ld ele-
ance and long- e m adop ion.
6.
DISCUSSION AND CONCLUSIONS
In eg a ing echnology in o physical ac i i y (PA) p og ams o ageing popula ions is an
eme ging ield, d i en by he po en ial o o e come common ba ie s like limi ed mobili y and
low mo i a ion. This s a egy employs a ious "digi al heal h" ools, such as wea ables, sma
i ness equipmen , and emo e coaching, o connec wi h a popula ion ha is inc easingly
com o able wi h digi al media. Howe e , he e ec i eness o hese in e en ions depends no
jus on he echnology bu on a ca e ul design p ocess based on beha iou al and psychological
heo ies.
As shown abo e, key p inciples use es ablished beha iou -change models, such as Sel -De e -
mina ion Theo y (SDT), ocusing on ul illing needs o au onomy, compe ence, and ela ed-
ness o p omo e ongoing engagemen . Technology can suppo au onomy h ough pe sonal-
ized ea u es, boos compe ence wi h eedback, and os e social connec ion. The Social Cog-
ni i e Theo y (SCT) is also ele an , as ech ea u es like i ual pee models and cus omized
goal se ing can inc ease sel -e icacy. The T ans heo e ical Model (TTM) helps ailo con en
based on a pe son's s age o eadiness o change, hough many digi al heal h s udies do no
ully implemen his app oach, highligh ing an "implemen a ion gap". These heo ies p o ide
essen ial guidance o designing digi al in e en ions ha do mo e han o e con enience-
hey ac i ely suppo habi o ma ion.
In addi ion o beha iou al heo ies, unde s anding echnology accep ance is i al. Models such
as he Technology Accep ance Model (TAM), he Uni ied Theo y o Accep ance and Use o
Technology (UTAUT), and he Senio Technology Accep ance Model (STAM) iden i y ac o s like
pe cei ed use ulness and ease o use as d i e s o adop ion. Olde adul s may ace ba ie s like
echnological anxie y, low sel -con idence, and p i acy conce ns, which can hinde use e en i
heal h bene i s a e ecognized. The documen no es ha accep ance models o en o e look
emo ional and cul u al ac o s and ecommends combining hem wi h beha iou al heo ies
o a mo e comple e app oach. Use -cen ed and pa icipa o y co-design a e also emphasized,
as in ol ing olde adul s in he design p ocess helps align solu ions wi h hei eal expe iences
and expec a ions, educing ba ie s and inc easing ele ance. Finally, he p ac ical deploy-
men o echnology depends on ac o s such as in e ne access, physical design, and in e ac-
ion usabili y. Technologies should be sa e, eliable, and accessible, wi h ea u es like eal- ime
eedback ha adap o use s' physical abili ies o p e en inju y. E hical issues like ageism in
AI a e also conside ed- biased algo i hms and unequal ca e can occu i olde adul s a e un-
de ep esen ed in da a se s. This unde sco es he need o age-inclusi e da a collec ion and
di e se de elopmen eams.
In conclusion, designing e ec i e echnology-assis ed physical ac i i y in e en ions o olde
adul s equi es a comp ehensi e app oach ha exceeds me e me hodological con enience
and inco po a es a a ie y o heo e ical and p ac ical conside a ions. The discussion su ound-
ing beha iou change heo ies and echnology accep ance models wi hin his deli e able p o-
ides an essen ial amewo k o his p ocess. To op imize engagemen and ensu e sus ained
adhe ence, esea che s mus e i y ha in e en ions a e use - iendly and pe cei ed as ben-
e icial and e ec i ely add ess undamen al psychological needs, including au onomy and sel -
e icacy.
One also has o ecognize ha he e is an inc easing need o a use -cen ed design philoso-
phy. This means in ol ing olde adul s and s akeholde s in e e y s age o de elopmen , om
ini ial concep o inal implemen a ion and dissemina ion o esul s. This app oach helps o
o e come key ba ie s like echnological anxie y and low sel -e icacy, ensu ing he inal p od-
uc aligns wi h he use s' ac ual needs, p e e ences, and physical o cogni i e limi a ions.
Finally, his deli e able emphasizes he impo ance o p ac ical and e hical conside a ions. This
includes ensu ing obus echnical suppo , p omo ing da a secu i y, and ac i ely comba ing
ageism in AI design. By hough ully combining beha iou al science, echnology accep ance
p inciples, and a use - i s design app oach, s akeholde s can c ea e uly e ec i e and equi-
able digi al heal h solu ions ha empowe olde adul s o main ain hei heal h and inde-
pendence.
7.
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