Revitalizing Dementia Care: Empowering Lives Through Personalized Exercise and Advanced Technologies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Reviewer Comments

The author drafted an article on how exercise and modern tools can be suitable for PwD in different environments. The authors wrote a good article, but it needs minor revision before it can be considered for publication.

Abtract

1. Under methods, include any basic statistical analysis, even if your study used quantitative methods.
2. Check if keywords exist in the MeSH database (physical activity, ICT, and AI in dementia care); if not, revise the keywords list.
3. Add the conclusion part.

Introduction

1. Please write a brief background about dementia, its types, and how it affects global health in the first paragraph.
2. Figure 1 can be improved in text fonts and design.
3. Write the caption and abbreviations for Figure 1 for a clear view and understanding of the figure.

Methods

1. Table 1 can be revised to include the mean and SD of the age and include more demographics like years of education and other variables relevant to the study.

 

 

Discussion

1. Line 101, the abbreviation for AI was already mentioned; there is no need to abbreviate it again. Please double-check all abbreviations to avoid any potential reputation issues.

 

 

Author Response

The author drafted an article on how exercise and modern tools can be suitable for PwD in different environments. The authors wrote a good article, but it needs minor revision before it can be considered for publication.

Abtract

1. Under methods, include any basic statistical analysis, even if your study used quantitative methods

Answer: Thank you for your comment. In response, we have expanded the Methods section in the Abstract to clarify that descriptive statistics (frequencies, means and standard deviations) were used to summarize participant demographics. Given the qualitative nature of the study and the small sample size, the emphasis was on qualitative data that were analyzed thematically.

1. Check if keywords exist in the MeSH database (physical activity, ICT, and AI in dementia care); if not, revise the keywords list.

Answer: thank you, we changed keywords: Physical Activity – Exercise; ICT – Technology, Information; AI – Artifical Intelligence; Dementia; Patient Care Planning

1. Add the conclusion part.

Thank you for your comment – it is written more clearly now.

Introduction

1. Please write a brief background about dementia, its types, and how it affects global health in the first paragraph.

Answer: thank you, we added the paragraph:

Dementia is a progressive neurological syndrome characterised by a decline in cognitive function — including memory, reasoning, language and the ability to perform everyday activities — that significantly impairs daily life. The most common form is Alzheimer’s disease, which accounts for 60–70% of cases, followed by vascular dementia, Lewy body dementia and frontotemporal dementia (WHO, 2023). More than 55 million people worldwide live with dementia, and nearly 10 million new cases are reported each year, making it one of the leading causes of disability and care dependency in older adults (World Health Organisation, 2023). The condition places a significant burden not only on healthcare systems, but also on informal carers, who often experience emotional, physical and financial stress (Prince et al., 2015). As the global population ages, dementia has become an urgent public health challenge, with estimated costs exceeding US$1.3 trillion annually and expected to rise sharply in the coming decades (Alzheimer’s Disease International, 2022).

 

1. Figure 1 can be improved in text fonts and design.

Answer – we improved the figure.

1. Write the caption and abbreviations for Figure 1 for a clear view and understanding of the figure.
2. Answer – thank you, it was added.

With the help of smart technologies such as wearable devices, virtual assistants, AI platforms, networks, etc., we can promote different forms of movement for people with disabilities. The use of smart technologies has several advantages: In addition to encouraging regular exercise, it also enables greater safety, location monitoring, body functions and interactive training (Figure 1).

 

Methods

1. Table 1 can be revised to include the mean and SD of the age and include more demographics like years of education and other variables relevant to the study.

Answer: Thank you for the suggestion. We have additionally included the mean and SD deviation for age.

 

Discussion

1. Line 101, the abbreviation for AI was already mentioned; there is no need to abbreviate it again. Please double-check all abbreviations to avoid any potential reputation issues.

Answer: Thank you, we checked and corrected.

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Peer Review Report

1. Abstract

• The abstract outlines the general aim of the study; however, it lacks sufficient detail regarding the research design, data collection procedures, and analytical methods.
• The claim that physical activity contributes to improved well-being in persons with dementia (PwD) is not adequately substantiated in the main text, nor is the concept of “well-being” clearly defined.
• Although the abstract emphasizes the relevance of ICT and AI, these tools were marginally referenced in the results and do not appear to have been significantly integrated into the study design or analysis.

2. Introduction

• The literature review is overly extensive and detracts from the clarity of the research focus.
• The objectives of the study and its distinctive contribution are not sufficiently emphasized.
• Key terms such as "personalized exercise," "advanced technology," and "well-being" are repeatedly invoked but remain undefined, which undermines conceptual clarity.

3. Methods

• Ethical considerations, including IRB approval and informed consent procedures, are briefly mentioned at the end of the manuscript but should be clearly stated within the methods section.
• The description of the focus group methodology is vague. Critical details such as question design, rationale for participant selection, and group facilitation processes are lacking.
• There are inconsistencies in reporting the number of participants (e.g., four vs. six PwD), and errors in demographic tables (e.g., "70–70" instead of "70–80") undermine credibility.
• No information is provided regarding the severity of dementia among participants or their previous experience with physical activity or technology.

4. Results

• The findings are presented thematically but lack transparency in the coding and categorization processes.
• Verbatim quotations from participants are used, but their representativeness is unclear due to the absence of frequency or salience indicators.
• Subsections 3.2 through 3.4 contain redundant content, and ICT-related responses would be better integrated into section 3.5.
• The results are presented descriptively, with insufficient analytical depth typical of a qualitative study.

5. Discussion

• The discussion does not systematically engage with the empirical findings; rather, it reiterates points from prior literature or offers general interpretations.
• Phrases such as "pilot intervention" are misleading, as no actual intervention was conducted.
• The discussion overstates the role and potential of ICT and AI despite the limited data on these aspects.
• The structure of the discussion does not mirror the categories identified in the results, making it difficult to trace conclusions back to empirical evidence.

6. Conclusion

• The claim that physical activity is a “core element” in dementia care overstates the study’s findings, which primarily reflect maintenance rather than improvement in functioning.
• The final paragraph lists key barriers (e.g., cognitive limitations, lack of professional guidance), but these were not clearly integrated or developed in earlier sections.
• Policy recommendations are abstract and lack actionable specificity, weakening their potential practical impact.

 

7. Overall Assessment

• While the study sets out to explore the integration of physical activity and advanced technologies in dementia care, the execution falls short of scholarly standards in several critical areas. The methodological framework is insufficiently articulated, and the qualitative analysis lacks the necessary rigor, with no clear coding strategy or transparent reporting of how themes were derived. The discussion and conclusion sections present interpretive leaps that are not grounded in the empirical data. The core concepts central to the study are invoked without operational definitions, contributing to a lack of conceptual coherence. Most notably, the emphasis on AI and ICT is not supported by participant accounts or data, but rather by generalized expectations. As it stands, the manuscript requires substantial revision to meet the criteria for publication in a peer-reviewed journal.

Comments on the Quality of English Language

The manuscript shows generally competent academic English. Grammar and vocabulary are mostly appropriate, and the text reads fluently. However, the meaning is sometimes unclear due to the repeated use of key terms without clear definitions—such as “well-being” and “personalized exercise.” In addition, several claims in the discussion and conclusion are broader than what the data can support. While the structure is acceptable, better consistency between the results and the main arguments is needed. Careful academic editing is advised before publication.

Author Response

Peer Review Report

1. Abstract

• The abstract outlines the general aim of the study; however, it lacks sufficient detail regarding the research design, data collection procedures, and analytical methods.
• The claim that physical activity contributes to improved well-being in persons with dementia (PwD) is not adequately substantiated in the main text, nor is the concept of “well-being” clearly defined.
• Although the abstract emphasizes the relevance of ICT and AI, these tools were marginally referenced in the results and do not appear to have been significantly integrated into the study design or analysis.

• Answer: Thank you for this helpful suggestions. We have revised the Abstract to include clearer detail on the research design and methods by noting the qualitative focus group approach used for data collection, the use of descriptive statistics to summarize participant demographics, and thematic analysis applied to qualitative data. This enhancement hopefully adds clarity for readers about how the study was conducted and analyzed. We corrected also statements about the relevance of ICT and AI – in this study we explored possibilities and actual use of smart technology.

 

1. Introduction

• The literature review is overly extensive and detracts from the clarity of the research focus.
• The objectives of the study and its distinctive contribution are not sufficiently emphasized.
• Key terms such as "personalized exercise," "advanced technology," and "well-being" are repeatedly invoked but remain undefined, which undermines conceptual clarity.

Answer: Thank you for your suggestions – we shortened the literature review, the objective of the study is more clearly presented and we checked  to improve the clarity of manuscript.

 

1. Methods

• Ethical considerations, including IRB approval and informed consent procedures, are briefly mentioned at the end of the manuscript but should be clearly stated within the methods section.

Answer: Thank you for your meticulous review. We have added at the beginning of the Materials and methods section the following text: The study was approved by the Management Committee of DEOS (approval number 01/2024) on September 17th, 2024. All participants provided informed consent prior to participation. The research was conducted following relevant local legislation and institutional guidelines.

• The description of the focus group methodology is vague. Critical details such as question design, rationale for participant selection, and group facilitation processes are lacking.

Answer: Thank you for this valuable comment. We have now added a detailed description of the focus group methodology in the Materials and methods section to address the design of the question guides, the rationale for selecting participant groups through purposive sampling, and the facilitation processes employed to ensure rich and ethical data collection. This addition hopefully clarifies how the focus groups were structured and conducted to enhance the rigor and transparency of our qualitative approach.

• There are inconsistencies in reporting the number of participants (e.g., four vs. six PwD), and errors in demographic tables (e.g., "70–70" instead of "70–80") undermine credibility.

Answer: We apologize for the mistakes. We have corrected the mistakes in the revised version of the text.

• No information is provided regarding the severity of dementia among participants or their previous experience with physical activity or technology.

Answer: We explicitly state that it is the early stage of dementia and that people are still able to live independently. In addition, thank you for highlighting the importance of participants’ prior experience with physical activity and technology. We acknowledge that such background can influence perspectives and engagement. However, due to the exploratory and qualitative nature of our study, we did not systematically collect detailed information on participants’ previous experience (they are very different for every individual). Our approach sought to capture the unique, individual experiences and views related to physical activity and ICT/AI usage as they currently stand, recognizing significant variability among participants. We agree that future work could benefit from more detailed assessment of prior experience to understand its impact on intervention uptake and effectiveness.

1. Results

• The findings are presented thematically but lack transparency in the coding and categorization processes.

Answer: Thank you for your helpful comment regarding transparency in our coding and categorization procedures. We have now included a detailed description of our thematic analysis process in the Results section. Specifically, we clarify that three researchers independently coded transcripts using NVivo software, developed codes inductively, and met regularly to reach consensus on code categories and emerging themes.

• Verbatim quotations from participants are used, but their representativeness is unclear due to the absence of frequency or salience indicators.

Answer: Thank you for the insightful comment regarding the representativeness of verbatim quotations. In response, we have revised the manuscript to clarify that the participant quotes included are illustrative examples selected to exemplify common or salient themes identified in the data. Where applicable, we have added frequency descriptors (e.g., “many,” “several,” “some”) to provide readers with a sense of how widespread certain perspectives were among participants. These enhancements increase transparency about how quotations relate to overall findings while respecting the exploratory, qualitative nature of our study.

• Subsections 3.2 through 3.4 contain redundant content, and ICT-related responses would be better integrated into section 3.5.

Answer: Thank you for your suggestion. We have revised subsections 3.2 through 3.4 to omit the redundant content and we have also opted to remove any ICT-related responses from these subsections as you mention as they are already covered in subsection 3.5.

• The results are presented descriptively, with insufficient analytical depth typical of a qualitative study.

Answer: Thank you for this important observation. We recognize that qualitative research benefits from not only rich descriptive data but also clear analytical depth that elucidates underlying patterns, meanings, and interpretations. In response, we have carefully revised the Results section to strengthen its analytical dimension. We have moved beyond purely descriptive accounts by explicitly linking participant quotes and observations to broader themes and subthemes that were inductively derived through rigorous thematic analysis of focus groups and added frequency descriptors. We reduced repetitive narrative details and focused on synthesizing findings in a clearer manner. In addition, we included information on the coding and thematic development process in the Methods section to demonstrate rigor and depth of analysis.

1. Discussion

• The discussion does not systematically engage with the empirical findings; rather, it reiterates points from prior literature or offers general interpretations.
• Phrases such as "pilot intervention" are misleading, as no actual intervention was conducted.
• The discussion overstates the role and potential of ICT and AI despite the limited data on these aspects.
• The structure of the discussion does not mirror the categories identified in the results, making it difficult to trace conclusions back to empirical evidence.

Answer: We changed the focus  of discussion – to raise awareness of potential use of ICT and AI for increasing exercises with potential to monitor  and motivate to activities.

 

1. Conclusion

• The claim that physical activity is a “core element” in dementia care overstates the study’s findings, which primarily reflect maintenance rather than improvement in functioning.
• The final paragraph lists key barriers (e.g., cognitive limitations, lack of professional guidance), but these were not clearly integrated or developed in earlier sections.
• Policy recommendations are abstract and lack actionable specificity, weakening their potential practical impact.

1. Overall Assessment

• While the study sets out to explore the integration of physical activity and advanced technologies in dementia care, the execution falls short of scholarly standards in several critical areas.
• The methodological framework is insufficiently articulated, and the qualitative analysis lacks the necessary rigor, with no clear coding strategy or transparent reporting of how themes were derived.

Answer: Thank you for your insightful comment. In our revised manuscript, we have clearly articulated the methodological framework by detailing the use of thematic analysis approach conducted independently by multiple researchers, with discrepancies resolved through discussion. We also transparently report the coding process, use of NVivo software, and other measures such as member checking to ensure rigor and credibility in how themes were systematically derived.

• The discussion and conclusion sections present interpretive leaps that are not grounded in the empirical data – to težje odgovorim, ker prej se noben del, ki sem ga popravljal ni nanašal na discussion in conclusion.
• The core concepts central to the study are invoked without operational definitions, contributing to a lack of conceptual coherence. Most notably, the emphasis on AI and ICT is not supported by participant accounts or data, but rather by generalized expectations. As it stands, the manuscript requires substantial revision to meet the criteria for publication in a peer-reviewed journal.

Comments on the Quality of English Language

The manuscript shows generally competent academic English. Grammar and vocabulary are mostly appropriate, and the text reads fluently. However, the meaning is sometimes unclear due to the repeated use of key terms without clear definitions—such as “well-being” and “personalized exercise.” In addition, several claims in the discussion and conclusion are broader than what the data can support. While the structure is acceptable, better consistency between the results and the main arguments is needed. Careful academic editing is advised before publication.

 

 

 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This paper presents a qualitative study exploring how physical activity along with ICT and AI tdols, can improve the live s of people with dementia. Through focus group interviews in Slovenia, the authors identify the benefits, barriers, and opportunities in promoting PA for PWD in both home and institutional settings.

My comments about article are below

1- The small number of participants n=17 across three focus groups limits the generalizability of findings. While qualitative, authors should further explain how this small sample still ensures credibility and depth

2-The paper suggests ICT-AI is underused but does not critically analyze specific solutions or their implementation barriers. A deeper look at usability, cost, or training requirements would help.

3-Please revise Figure 1. Currently, it is not explained in the text and lacks proper captioning.

4-Literature is comprehensive, but recent AI/ICT studies in similar EU contexts could be added (post-2022)

Author Response

Comments and Suggestions for Authors

This paper presents a qualitative study exploring how physical activity along with ICT and AI tdols, can improve the live s of people with dementia. Through focus group interviews in Slovenia, the authors identify the benefits, barriers, and opportunities in promoting PA for PWD in both home and institutional settings.

My comments about article are below

1- The small number of participants n=17 across three focus groups limits the generalizability of findings. While qualitative, authors should further explain how this small sample still ensures credibility and depth

Answer: Thank you for your valuable comment. We have addressed it in the limitations section with the following text: A weakness of the study is that the number of participants in the focus groups was quite limited, which limits the generalizability of the findings. However, the purposive sampling strategy enabled the inclusion of diverse stakeholder perspectives directly relevant for our explored topics. Additionally, methodological rigor was maintained through in-depth thematic analysis and researcher checking, which together enhance the credibility and richness of study results despite the limited sample.

2-The paper suggests ICT-AI is underused but does not critically analyze specific solutions or their implementation barriers. A deeper look at usability, cost, or training requirements would help.

3-Please revise Figure 1. Currently, it is not explained in the text and lacks proper captioning.

Answer: Thank you for your comment – we implemented the figure. The Figure 1 was already briefly mentioned, but now we explained it more clearly.

4-Literature is comprehensive, but recent AI/ICT studies in similar EU contexts could be added (post-2022)

Answer: Thank you for your suggestion. In the study, we found that concerns about safety and basic care (e.g. food, personal hygiene) are predominant - while people with dementia can be completely overlooked in activities that could positively contribute to their well-being. Unfortunately, we find that smart technologies are only minimally used in the care of people with dementia in Slovenia, which is what we want to draw attention to with the study and promote the use of smart technologies in the lives and care of people with dementia.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have clearly addressed all comments. I have no other obligations or comments for this manuscript. It can be accepted in this form.

Reviewer 2 Report

Comments and Suggestions for Authors

1. Introduction
   

   The manuscript states an ambition to explore how personalized exercise and digital technologies (ICT/AI) might enhance the quality of life of people with dementia (PwD). The introduction does not yet build a persuasive pathway to that aim. Epidemiology and general background occupy too much space, while the case for why personalization is necessary in dementia remains underdeveloped. Prior work on digital tools is presented as a catalog rather than a focused argument that leads to specific research questions. The title phrase “empowering lives” lacks an operational definition; readers are not told whether empowerment refers to autonomy, affect, social participation, perceived safety, or another dimension, nor how such dimensions will be identified in data. The section would be stronger if it offered working definitions for personalized exercise (e.g., FITT parameters adapted to cognitive load, supervision level, and context), ICT/AI functions (e.g., sensing, prompting, adaptation, safety, engagement), and empowerment/quality-of-life domains, and then linked these definitions to explicit questions or a simple conceptual frame.

2. Methods
   

   The methods show welcome improvements—ethics moved into the Methods section, three independent coders with consensus procedures, NVivo use—but they still do not give a reproducible account of an FGI-centered design. The paper needs group-specific interview guides with example questions and the rationale for their selection; details of the participant observation (setting, number of sessions, what was observed); and a clear account of how interview, observation, and field notes were integrated during analysis. Sampling criteria require more than a statement of purposive sampling: inclusion/exclusion thresholds, verification of diagnosis and severity, communication ability, and baseline digital literacy should be stated, along with the logic for the number and size of focus groups and the stopping rule (saturation). The analysis pipeline would benefit from a codebook snapshot and a short flow from initial codes to themes, plus concrete descriptions of member checking and peer debriefing and how feedback altered the analysis. As written, key constructs—personalized exercise, digital technology use, and quality-of-life—are not mapped to question domains or to the coding structure, which makes it difficult to see how the study interrogates its own central variables.

3. Results
   

   The Results section blends reporting with interpretation and recommendations. Section 3.1 opens with analytic procedures that belong in Methods, and several passages adopt a prescriptive tone (“it would be beneficial to promote…”, “we advise addressing…”). Results should present what participants said or what was observed, using neutral language and consistent frequency qualifiers (“many,” “several,” “some”) and, where possible, indicating which stakeholder group is speaking. Redundancy across subsections can be reduced, and ICT-related responses should be consolidated in the designated subsection for coherence. If the authors wish to retain a synopsis of the main themes, it fits better at the end of Results or at the start of the Discussion as a brief “principal findings” paragraph that remains descriptive.

4. Discussion & Conclusion
   

   The Discussion and the concluding remarks are the most problematic areas. Across all three groups, the data depict limited exercise participation even among individuals in the early stages of dementia, frequent difficulty with attention and motivation, safety and stigma concerns, and very low awareness and use of digital tools. Against that backdrop, the manuscript moves to endorse personalized exercise and greater use of ICT/AI as if their feasibility and value had been demonstrated. The present design—exploratory FGIs with observation—supports conclusions about readiness, acceptability, and contextual barriers, not about the advisability or effectiveness of specific approaches. The argument should be reframed accordingly. Rather than recommending implementation, the paper should articulate the preconditions that must be in place before implementation is sensible: support for basic participation, caregiver capacity, accompaniment/supervision for safety, simple prompting and onboarding for technology, and staff time. The title term “empowering lives” also needs either an operational definition tied to the data (autonomy, mood, social engagement, perceived safety) or a softening of claims so that they match what the study actually observed.

5. Suggestions
   

   Future work suggestions would carry more weight if they directly address the gap between aspiration and current readiness. Short pilots that test usability and acceptability of specific tools (onboarding success, response to prompts, days of sustained use) and small feasibility trials comparing personalized protocols versus usual activity (with adherence, safety events, caregiver burden, and selected quality-of-life subdomains) would generate evidence to justify any practical recommendations. Program-level comparisons in care homes could follow, ideally with process evaluation to identify the contextual factors that drive success or failure.

6. Overall Assessment
   

   As it stands, the revised manuscript does include constructive steps—clearer ethics reporting, more detail on coding and consensus—but the introduction still lacks a crisp rationale for personalization in dementia, key constructs remain undefined, and the methods fall short of a transparent FGI design. The Results section mixes analysis with advice, and the Discussion and Conclusion step beyond the evidence by advocating personalized exercise and digital technology despite data that show low participation and minimal technology use. The study has real value in documenting the barriers and the low level of readiness; if the Discussion and Conclusion shift from endorsement to a careful account of feasibility, acceptability, and prerequisites for implementation, the contribution will be sharper and better aligned with the data. That shift should be the emphasis of the revision.

Comments on the Quality of English Language

The manuscript communicates its main ideas, but the English needs careful editing before publication. Several issues reduce readability and credibility: (1) long, repetitive sentences; (2) errors in grammar, tense, and subject–verb agreement; (3) inconsistent terminology and spelling; and (4) visible typesetting leftovers (line-break splits, duplicated phrases, stray journal headers). I strongly recommend professional copyediting.

Author Response

Answer: Thank you for your comment. We did changes in Introduction – shortened part about epidemiology; added the part of why is important to make personalized exercise regarding living environments of PwD (home/institutional environment). We clarified the part regarding ICT/AI in correlation with personalized exercise and benefits of use of ICT/AI. 2. Methods The methods show welcome improvements—ethics moved into the Methods section, three independent coders with consensus procedures, NVivo use—but they still do not give a reproducible account of an FGI-centered design. Answer: Thank you for your encouraging words on the improvement of the manuscript. The paper needs group-specific interview guides with example questions and the rationale for their selection. Answer: Semi-structured interview guides were developed specifically for each participant group, namely people with dementia (PwD), informal caregivers, and physiotherapists. The intent was to capture their unique perspectives on physical activity and the use of ICT and AI in dementia care. The guides were informed by a comprehensive literature review on physical activity and dementia care, consultation with experts in dementia care and digital health technologies to ensure clarity and appropriateness for each group. An example question for the focus group with physiotherapists: “How much time per day is allocated to physical exercise for residents with dementia?” An example question for the focus group with informal caregivers: “How does exercise take place for a relative with dementia?” An example question for the focus group with PwD: “What effects of physical exercise do you observe on your mental and physical health?” The rationale for tailoring these guides was to ensure that questions resonated with each group’s experiences and responsibilities, enabling rich, relevant data collection while respecting participants' cognitive and communication abilities, especially in the case of the focus group with PwD. Details of the participant observation (setting, number of sessions, what was observed); and a clear account of how interview, observation, and field notes were integrated during analysis. Answer: Thank you again for your meticulous review. We have added some clarification on participant observation “Participant observation and field notes were conducted during a regular physical exercise session only in one care home where some of the physiotherapists work and PwD reside. The observation took place in one session, lasting approximately 45 minutes. During the session, researchers systematically noted participant engagement, interaction dynamics and behavioral responses that influenced physical activity participation.” And on data integration “Data from focus groups, participant observation and field notes were integrated during the thematic analysis process. Themes emerged inductively from the combined data.” We hope that this improves the manuscript. Sampling criteria require more than a statement of purposive sampling: inclusion/exclusion thresholds, verification of diagnosis and severity, communication ability, and baseline digital literacy should be stated, along with the logic for the number and size of focus groups and the stopping rule (saturation). Answer: Thank you for this important feedback. We have expanded the description of our sampling criteria to include clear inclusion thresholds: participants with a verified clinical diagnosis of early-stage (first and second stage) dementia were included, with severity assessed via medical opinion, ensuring they had sufficient communication abilities to participate meaningfully. People with more advanced stages of dementia were excluded from the focus groups. Baseline digital literacy was considered informally during recruitment to ensure basic familiarity with the topics of AI and ICT. The number and size of focus groups were determined based on practical considerations and real-life limitations of the researchers and the aim to capture diverse perspectives across key stakeholder groups. Saturation occurred when no new substantial themes emerged in the focus group discussions. The analysis pipeline would benefit from a codebook snapshot and a short flow from initial codes to themes, plus concrete descriptions of member checking and peer debriefing and how feedback altered the analysis. As written, key constructs—personalized exercise, digital technology use, and quality-of-life—are not mapped to question domains or to the coding structure, which makes it difficult to see how the study interrogates its own central variables. Answer: Thank you for your valuable suggestion. We have now included a detailed overview of our analysis pipeline, starting from the generation of initial inductive codes through independent coding by three researchers, followed by iterative grouping of codes into a structured codebook that mapped clearly onto central question domains such as personalized exercise, digital technology use, and quality of life. This codebook guided further thematic development, ensuring that key constructs were explicitly interrogated throughout the analysis. Member checking involved inviting some focus group participants to provide their feedback, which led to minor theme adjustments. Peer debriefing within the research team entailed in-depth discussions that challenged interpretations and helped resolve ambiguities, resulting in a more robust and nuanced final thematic framework. In addition, we have included the requested codebook snapshot in the manuscript. Theme Code Definition Example 3. Results The Results section blends reporting with interpretation and recommendations. Section 3.1 opens with analytic procedures that belong in Methods, and several passages adopt a prescriptive tone (“it would be beneficial to promote…”, “we advise addressing…”). Results should present what participants said or what was observed, using neutral language and consistent frequency qualifiers (“many,” “several,” “some”) and, where possible, indicating which stakeholder group is speaking. Redundancy across subsections can be reduced, and ICT-related responses should be consolidated in the designated subsection for coherence. If the authors wish to retain a synopsis of the main themes, it fits better at the end of Results or at the start of the Discussion as a brief “principal findings” paragraph that remains descriptive. Answer: We have relocated part of the text in section 3.1 that belongs to Methods and we have omitted the other parts of section 3.1 based on your valuable suggestion. We have checked the text to get rid of its prescriptive tone and focused on a more neutral language and added some additional frequency qualifiers and indications of which stakeholder group is speaking in several places in the manuscript. We have modified ICT-related responses and based on your thorough review excluded the general descriptive findings, thank you again for your valuable insight. 4. Discussion & Conclusion The Discussion and the concluding remarks are the most problematic areas. Across all three groups, the data depict limited exercise participation even among individuals in the early stages of dementia, frequent difficulty with attention and motivation, safety and stigma concerns, and very low awareness and use of digital tools. Against that backdrop, the manuscript moves to endorse personalized exercise and greater use of ICT/AI as if their feasibility and value had been demonstrated. The present design—exploratory FGIs with observation—supports conclusions about readiness, acceptability, and contextual barriers, not about the advisability or effectiveness of specific approaches. The argument should be reframed accordingly. Rather than recommending implementation, the paper should articulate the preconditions that must be in place before implementation is sensible: support for basic participation, caregiver capacity, accompaniment/supervision for safety, simple prompting and onboarding for technology, and staff time. The title term “empowering lives” also needs either an operational definition tied to the data (autonomy, mood, social engagement, perceived safety) or a softening of claims so that they match what the study actually observed. Answer: Thank you for all your comments. We have corrected the conclusion and the discussion, as it is true that we did not identify the use of ICT/AI in the focus group interviews, but many obstacles to planning a regular exercise. The chapter has been amended accordingly. We have also added the concept of PwD empowerment for greater clarity. 5. Suggestions Future work suggestions would carry more weight if they directly address the gap between aspiration and current readiness. Short pilots that test usability and acceptability of specific tools (onboarding success, response to prompts, days of sustained use) and small feasibility trials comparing personalized protocols versus usual activity (with adherence, safety events, caregiver burden, and selected quality-of-life subdomains) would generate evidence to justify any practical recommendations. Program-level comparisons in care homes could follow, ideally with process evaluation to identify the contextual factors that drive success or failure. Answer: Thank you for your valuable opinion and suggestions. We have included more detailed suggestions for further research in the field of exercise for PwD using smart technologies in Conclusion. 6. Overall Assessment As it stands, the revised manuscript does include constructive steps—clearer ethics reporting, more detail on coding and consensus—but the introduction still lacks a crisp rationale for personalization in dementia, key constructs remain undefined, and the methods fall short of a transparent FGI design. The Results section mixes analysis with advice, and the Discussion and Conclusion step beyond the evidence by advocating personalized exercise and digital technology despite data that show low participation and minimal technology use. The study has real value in documenting the barriers and the low level of readiness; if the Discussion and Conclusion shift from endorsement to a careful account of feasibility, acceptability, and prerequisites for implementation, the contribution will be sharper and better aligned with the data. That shift should be the emphasis of the revision. Answer: The authors sincerely thank for the careful review and comments on the text. The comments have been taken into account. Comments on the Quality of English Language The manuscript communicates its main ideas, but the English needs careful editing before publication. Several issues reduce readability and credibility: (1) long, repetitive sentences; (2) errors in grammar, tense, and subject–verb agreement; (3) inconsistent terminology and spelling; and (4) visible typesetting leftovers (line-break splits, duplicated phrases, stray journal headers). I strongly recommend professional copyediting. Answer: Thank you for your comment, the manuscript was reviewed again by Mr. Murray Bales, a native speaker.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This article can be accepted for publication in its current form.