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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JMIR</journal-id>
      <journal-id journal-id-type="nlm-ta">J Med Internet Res</journal-id>
      <journal-title>Journal of Medical Internet Research</journal-title>
      <issn pub-type="epub">1438-8871</issn>
      <publisher>
        <publisher-name>JMIR Publications</publisher-name>
        <publisher-loc>Toronto, Canada</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">v27i1e72565</article-id>
      <article-id pub-id-type="pmid">40153783</article-id>
      <article-id pub-id-type="doi">10.2196/72565</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Letter to the Editor</subject>
        </subj-group>
        <subj-group subj-group-type="article-type">
          <subject>Letter to the Editor</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Authors’ Reply: Addressing the Digital Divide Among the Older Population Presents a Substantial Challenge</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Leung</surname>
            <given-names>Tiffany</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib id="contrib1" contrib-type="author">
          <name name-style="western">
            <surname>Kannan</surname>
            <given-names>Lakshmi</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0001-8230-7273</ext-link>
        </contrib>
        <contrib id="contrib2" contrib-type="author" corresp="yes">
          <name name-style="western">
            <surname>Bhatt</surname>
            <given-names>Tanvi</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff2" ref-type="aff">2</xref>
          <address>
            <institution>Department of Physical Therapy</institution>
            <institution>University of Illinois Chicago</institution>
            <addr-line>1919 W Taylor Street</addr-line>
            <addr-line>Room 415</addr-line>
            <addr-line>Chicago, IL, 60612</addr-line>
            <country>United States</country>
            <phone>1 3123554443</phone>
            <email>tbhatt6@uic.edu</email>
          </address>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0001-6417-1018</ext-link>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution>Department of Psychology</institution>
        <institution>Bouve College of Health Sciences</institution>
        <institution>Northeastern University</institution>
        <addr-line>Boston, MA</addr-line>
        <country>United States</country>
      </aff>
      <aff id="aff2">
        <label>2</label>
        <institution>Department of Physical Therapy</institution>
        <institution>University of Illinois Chicago</institution>
        <addr-line>Chicago, IL</addr-line>
        <country>United States</country>
      </aff>
      <author-notes>
        <corresp>Corresponding Author: Tanvi Bhatt <email>tbhatt6@uic.edu</email></corresp>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2025</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>28</day>
        <month>3</month>
        <year>2025</year>
      </pub-date>
      <volume>27</volume>
      <elocation-id>e72565</elocation-id>
      <history>
        <date date-type="received">
          <day>12</day>
          <month>2</month>
          <year>2025</year>
        </date>
        <date date-type="accepted">
          <day>25</day>
          <month>2</month>
          <year>2025</year>
        </date>
      </history>
      <copyright-statement>©Lakshmi Kannan, Tanvi Bhatt. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 28.03.2025.</copyright-statement>
      <copyright-year>2025</copyright-year>
      <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
        <p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.</p>
      </license>
      <self-uri xlink:href="https://www.jmir.org/2025/1/e72565" xlink:type="simple"/>
      <related-article related-article-type="commentary-article" id="v26i1e56810" ext-link-type="doi" xlink:href="10.2196/56810" vol="26" page="e56810" xlink:type="simple">http://www.jmir.org/2024/1/e56810/</related-article>
      <related-article related-article-type="commentary-article" id="v27i1e69482" ext-link-type="doi" xlink:href="10.2196/69482" vol="27" page="e69482" xlink:type="simple">https://www.jmir.org/2025/1/e69482/</related-article>
      <kwd-group>
        <kwd>exergame training</kwd>
        <kwd>Matter of Balance</kwd>
        <kwd>MOB</kwd>
        <kwd>pre-frail</kwd>
        <kwd>tele-exergame</kwd>
        <kwd>tele-rehabilitation</kwd>
        <kwd>gaming-based</kwd>
        <kwd>tele-exercise</kwd>
        <kwd>physical function</kwd>
        <kwd>frailty</kwd>
        <kwd>older adults</kwd>
        <kwd>aging</kwd>
        <kwd>physical activity</kwd>
        <kwd>dementia</kwd>
        <kwd>CogXergaming</kwd>
        <kwd>telehealth</kwd>
        <kwd>dynamic balance</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <p>We appreciate the insightful commentary on our study, “Gaming-Based Tele-Exercise Program to Improve Physical Function in Frail Older Adults: Feasibility Randomized Controlled Trial,” published in the <italic>Journal of Medical Internet Research</italic> [<xref ref-type="bibr" rid="ref1">1</xref>], in the letter by Xie [<xref ref-type="bibr" rid="ref2">2</xref>]. The feedback highlights critical issues regarding the digital divide and the role of older adults in co-designing interventions, which are pivotal for ensuring inclusive and effective digital health solutions.</p>
    <p>We agree that addressing the digital divide remains an ongoing challenge, particularly for frail and prefrail older populations. As noted, a lack of interest in the content was a significant contributor to attrition in our study. While we ensured technological accessibility by using familiar platforms (Zoom; Zoom Communications) and step-by-step onboarding, engagement requires more than access—it necessitates meaningful content aligned with participants’ preferences and needs.</p>
    <p>The suggestion to include older adults as co-designers in the development process is compelling and aligns with the principles of participatory design. Actively involving older adults can ensure interventions are relevant, engaging, and user-friendly. This participatory approach could facilitate a shift from a passive to an active role, empowering older adults to shape technologies that serve them. We acknowledge that future iterations of CogXergaming can benefit from such collaborative input, especially from frail individuals, to improve generalizability and user satisfaction.</p>
    <p>Due to the nature of the commercial platforms used in our study, which were chosen for their cost-effectiveness and broad accessibility, tailoring the protocol based on participant feedback was not feasible. However, participants were provided with a choice of games to ensure some degree of personalization within the constraints of the available technology. To enhance the scalability, accessibility, and adoptability of CogXergaming interventions, future efforts should focus on developing cost-effective, customized platforms that allow for greater adaptability and responsiveness to participant preferences and needs. Such platforms could provide more tailored interventions while maintaining affordability, thus bridging gaps in engagement and accessibility.</p>
    <p>The commentary further underscores the importance of exploring education levels and their relationship with learning curves. Although we reported participants’ education in the section on demographic characteristics, we did not conduct correlation analyses with intervention outcomes. This is an important direction for future research. Investigating the interplay between education, digital literacy, and intervention effectiveness may yield valuable insights into overcoming barriers imposed by the digital divide.</p>
    <p>In conclusion, we appreciate the recognition of CogXergaming’s potential to bridge the digital divide among older adults. Future work will focus on integrating participatory design principles, exploring the role of education in digital adoption, and refining interventions to address engagement barriers. This collective effort will contribute to more inclusive and equitable technological solutions for older adults.</p>
  </body>
  <back>
    <app-group/>
    <fn-group>
      <fn fn-type="conflict">
        <p>None declared.</p>
      </fn>
    </fn-group>
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            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://www.jmir.org/2024//e56810/"/>
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</article>
