Nature in virtual reality improves mood and reduces stress: evidence from young adults and senior citizens

Evaluation of a nature-based virtual reality intervention to support hospice caregivers: a pilot feasibility study

OBJECTIVES

Hospice family caregivers (CGs) may experience poor emotional health and diminished quality of life (QOL) secondary to stressors that accompany home-based end-of-life caregiving. Innovative flexible strategies are needed to support hospice CGs in their homes. Being outdoors in nature enhances well-being but is often not accessible to home-based CGs. The purpose was to evaluate the feasibility/acceptability, and preliminary emotional health and QOL outcomes of a 5-day nature-based virtual reality (VR) intervention.

METHODS

A pre-post design was used. Hospice CGs engaged in self-selected 10 min nature experiences via VR headset over 5 days. Preintervention surveys included demographics and the PROMIS-29 QOL measure (physical/social function, anxiety/depressive symptoms, fatigue, sleep and pain). Postintervention surveys included acceptability/feasibility surveys, PROMIS-29 and a VR-related symptom checklist. Data analysis included descriptives and paired t-tests.

RESULTS

15 CGs (mean 61.13±12.47 years; 12 females) completed the study. Findings demonstrated high acceptability (14.46±1.77; range 0-16); feasibility (13.93±2.43;range 0-16). Adverse VR symptoms were minimal. PROMIS-29 overall scores were significantly improved following the 5-day intervention (pre: 66.33±8.47; post: 61.07±7.83,p=0.01). Paired t-tests showed significant pre-post changes in anxiety (t=2.206, p<0.05) and favourable trends on other QOL dimensions.

CONCLUSIONS

Feasibility/acceptability and QOL data support further testing of VR nature immersive experiences in the home environment with larger more diverse representative samples.

Income and Sex Moderate the Association Between Population Density and Reproduction: A Multilevel Analysis of Life History Strategies Across 23 Nations

While previous studies guided by evolutionary life history theory have revealed several important socioecological moderators of the influence of population density (PD) on reproduction, absent is an understanding of how individual-level factors such as personal resources and sex differences might interact and play a role. Using data from a large sample of clients (N = 4,432,440) of an online dating company spanning 317 states nested within 23 countries, we contributed a robust multilevel analysis of life history effects by assessing the interaction between state-level PD and individual-level income on offspring quantity, and we further qualified this analysis by sex. Consistent with previous research, PD was negatively correlated with having children. Consistent with our novel hypotheses, this negative relationship was moderated by income such that the link between PD and low fertility became weaker with increasing levels of income and these patterns were stronger for men than for women. These results held despite controlling for a variety of country-level, state-level, and individual-level confounds. Findings are discussed together with theoretical and practical implications for the management of fertility based on evolutionary life history perspectives.

Age-related differences in subjective and physiological emotion evoked by immersion in natural and social virtual environments

Age-related changes in emotional processing are complex, with a bias toward positive information. However, the impact of aging on emotional responses in positive everyday situations remains unclear. Virtual Reality (VR) has emerged as a promising tool for investigating emotional processing, offering a unique balance between ecological validity and experimental control. Yet, limited evidence exists regarding its efficacy to elicit positive emotions in older adults. Our study aimed to explore age-related differences in positive emotional responses to immersion in both social and nonsocial virtual emotional environments. We exposed 34 younger adults and 24 older adults to natural and social 360-degree video content through a low immersive computer screen and a highly immersive Head-Mounted Display, while recording participants' physiological reactions. Participants also provided self-report of their emotions and sense of presence. The findings support VR's efficacy in eliciting positive emotions in both younger and older adults, with age-related differences in emotional responses influenced by the specific video content rather than immersion level. These findings underscore the potential of VR as a valuable tool for examining age-related differences in emotional responses and developing VR applications to enhance emotional wellbeing across diverse user populations.

Effects of simulated multi-sensory stimulation integration on physiological and psychological restoration in virtual urban green space environment

Virtual urban green environment images and audio stimuli had been proven to have restorative effects on subjects' physical and mental health. In this area, researchers predominantly focused on visual, auditory and olfactory aspects, while tactile and gustatory senses have been minimally explored. However, the optimal combination of sensory stimuli for promoting physical and mental recovery remains unclear. Therefore, a simulated sensory stimulation approach involving 240 participants was employed, with 30 individuals included in each of the eight experimental groups: the visual-auditory (VA), visual-auditory-olfactory (VAO), visual-auditory-tactile (VAT), visual-auditory-gustatory(VAG), visual-auditory-olfactory-tactile (VAOT), visual-auditory-olfactory-gustatory (VAOG), visual-auditory-tactile-gustatory (VATG), and visual-auditory-olfactory-tactile-gustatory (VAOTG) groups. This study aimed to explore the differences in participants' physiological and psychological health recovery after exposure to different combinations of simulated sensory stimuli in virtual UGSs. The results indicated that the following: (1) In terms of physiological recovery, the blood pressure of the 8 experimental groups decreased significantly after the experiment, indicating that the virtual urban green space environment has a certain recovery effect on physiological state. The combination of VAOTG stimuli in the multisensory group resulted in the best blood pressure recovery (p < 0.05). Tactile is an important sense to enhance the physiological recovery effect. Olfactory-tactile or tactile-gustatory stimuli interactions significantly enhance physiological recovery, emphasizing the importance of tactile stimulation in improving physiological recovery. (2) In terms of psychological recovery, the common trigger of olfactory-gustatory is the most key element to enhance psychological recovery through multi-sensory stimulation of virtual urban green space environment. VAOG stimulation had the best effect on psychological recovery (p < 0.05), followed by VAOTG stimulation (p < 0.05). Gustatory is an important sense to enhance the psychological recovery effect, and both the tactile-gustatory interaction and the olfactory-gustatory interaction significantly enhance the recovery effect. At the same time, the psychological recovery effect obtained by four or more sensory combinations was higher than that obtained by two or three sensory stimulation groups. This study confirms more possibilities for ways to restore physical and mental health through virtual natural environments. It expands the research on the benefits of virtual nature experience and provides theoretical support for the application of this method.

The use of Virtual Reality (VR) to assess the impact of geographical environments on walking and cycling: a systematic literature review

BACKGROUND

Geographical environments influence people's active mobility behaviors, contributing to their physical and mental health. The use of Virtual Reality (VR) in experimental research can unveil new insights into the relationship between exposure to geographic environments and active mobility behaviors. This systematic review aims to (1) identify environmental attributes investigated in relation with walking and cycling, using VR, (2) assess their impacts on active mobility behaviors and attitudes, and (3) identify research gaps, strengths and limitations in VR-based experimental research.

METHODS

Articles published between January 2010 and February 2022 within five databases (PubMed, Scopus, EBSCO, IEEE Xplore, and Cochrane Library) were explored using three keywords and their synonyms: Virtual Reality, Active mobility behavior, and Geographical environments. Studies focusing on indoor environments, driving simulation, disease-specific groups, non-relevant disciplines (e.g. military, emergency evacuation), VR methodology/software optimization, and those with static participants' involvement were excluded. The full protocol is available from PROSPERO (ID = CRD42022308366).

RESULTS

Out of 3255 articles, 18 peer-reviewed papers met the selection criteria, mostly focusing on walking (83%). Most studies used head-mounted displays (94%) and relied on convenience sampling (72% below 100 participants). Both static (33%) and dynamic (45%) environmental attributes have been investigated, with only 22% of them simultaneously in the same virtual environment. Greenness and crowd density were the most frequent attributes, rather consistently associated with emotional states and movement behaviors. Few studies have taken into account participant's previous VR experience (33%) and cybersickness (39%) while both are likely to affect an individual's perception and behavior.

CONCLUSIONS

Future research should explore a broader range of environmental attributes, including static and dynamic ones, as well as a more complex integration of these attributes within a single experiment to mimic the effect of realistic environments on people's active mobility behaviors and attitudes. Larger and more diverse population samples are deemed required to improve result generalizability. Despite methodological challenges, VR emerges as a promising tool to disentangle the effect of complex environments on active mobility behaviors.

Breathing Uneasily: Employees' Stories of Coping With Poor Indoor Air Quality in the Workplace

OBJECTIVES

This phenomenological study aimed to elucidate the lived experiences of employees suffering from poor indoor air quality (IAQ) in their university workplace. It addresses gaps in understanding IAQ's personal impacts from occupants' perspectives.

BACKGROUND

Prior research on sick building syndrome and indoor air pollution utilized quantitative methods to assess physical health outcomes. However, few studies have adopted qualitative approaches to uncover the meanings ascribed to adverse IAQ experiences and their influences on psychosocial well-being.

METHODS

In-depth semi-structured interviews were conducted with five university employees who attributed their chronic illnesses to poor IAQ in their 60-year-old office building with a history of IAQ concerns. Verbatim transcripts were analyzed using qualitative techniques including thematic coding to extract key themes conveying shared experiences.

RESULTS

Employees depicted the building itself as fundamentally "sick" and stigmatized, compelling complex coping behaviors hindering productivity. Communication breakdowns, mistrust in leadership, and strained workplace relationships were prevalent. A sense of betrayal, powerlessness, and a sense of detachment from the workplace emerged with home as a refuge.

CONCLUSIONS

Although technically adequate, poor IAQ profoundly damaged perceived health, quality of life, relationships, and satisfaction. The accounts emphasize IAQ's psychosocial dimensions, advancing theoretical links between indoor environments and well-being. Supportive policies, transparency, communication, participatory processes, and human-centered strategies emerge as ways to nurture productivity, well-being, and organizational health.

Effects of immersive virtual nature on nature connectedness: A systematic review and meta-analysis

Objective

This study systematically summarizes the extant literature on the impacts of immersive virtual nature (IVN) on nature connectedness in the general population.

Methods

Papers were considered eligible if peer-reviewed, in English language, comprising experimental or quasi-experimental trials, including at least one outcome relative to nature connectedness in the general population. Database search was conducted on Scopus, Web of Science, Google Scholar, Medline, and GreenFILE (22-28 November 2021). Risk of bias was established by the Cochrane RoB 2 tool. Data synthesis was conducted through meta-analysis according with the Cochrane Consumers and Communication Group guidelines.

Results

Six eligible papers (9 studies; n = 730) were selected, in which IVN was compared to (i) non-immersive virtual nature, (ii) immersive virtual built environments, (iii) non-immersive virtual built environments, and (iv) actual nature. The risk of bias was predominantly "low" or of "some concerns." Meta-analyses showed a statistically significant overall effect for the first (g = 0.26; 95% CI = 0.06-0.45; I2 = 35%) and fourth group (g = -1.98; 95% CI = -3.21 to -0.75; I2 = 96%), the former in favor of IVN and the latter in favor of actual nature. Subgroup analyses were conducted for the first and second groups of studies to explore possible sources of heterogeneity. The small number of studies available limits the validity of the outcomes of the meta-analyses.

Conclusion

The findings indicate that IVN may be an effective tool for the promotion of nature connectedness, although the evidence in this field is still limited and largely mixed. Recommendations for future research are discussed.

Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic

Background

The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool.

Objective

The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany.

Methods

The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers.

Results

In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05).

Conclusion

A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients.

Clinical trial registration

https://clinicaltrials.gov/, DRKS00027911.

Elucidating and Expanding the Restorative Theory Framework to Comprehend Influential Factors Supporting Ageing-in-Place: A Scoping Review

Exposure to stress and attention fatigue resulting from changes in capabilities and residing in environments that do not align with individual needs can adversely impact older adults' mental health and complicate ageing-in-place. Research into the psychological restoration process can help assist in alleviating these issues. Existing research on restoration perspectives has predominantly centred on university students and lacks comprehensive insights into older adults. Consequently, this study seeks to acquire a deeper understanding of the restorative theory framework within the context of ageing populations. We identified and analysed thirty-nine papers on the restoration process of older adults employing the scoping review method. Our findings indicate that adjustments to the general restorative theory framework are imperative for ageing populations. By incorporating additional features-such as being with and familiarity-the framework can more effectively support the development of age-inclusive neighbourhoods that enhance the mental health of the older population and facilitate healthy ageing-in-place. While more in-depth research is required on the restoration process of older adults, this research marks the initial in adapting the general framework to ageing populations. Furthermore, insight is given into how the adapted framework can contribute to help address the challenges of global ageing and support ageing-in-place.

The role of connection with nature in empirical studies with physiological measurements: a systematic literature review

It is well described that exposure to nature reduces physiological stress, and connectedness to nature can have a moderating effect. However, few studies have so far examined the construction of the connection with nature in relation to physiological processes. In this systematic review, we collected studies that used a physiological measure and included a scale to measure connectedness to nature. Our aim was to assess the role of nature relatedness at the level of physiological processes and to summarize the results published so far. Our review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature search was conducted in 3 different databases (PubMed, ScienceDirect and Google Scholar). As keywords, we used all the different questionnaires that measure connectedness to nature, combined with terms related to physiological measures. After final screening, 28 articles met the inclusion criteria for the review. The studies were very diverse in terms of purpose, intervention and methods, so narrative synthesis was conducted without measures of effect. We found evidence for a mediating effect of nature connectedness on the associations between nature exposure and cognitive function, brain activity, blood pressure, cortisol level and mental health. Studies investigating nature relatedness as state-like characteristics have shown that exposure to nature increases the level of connection to nature. Eye-tracking studies have confirmed that this measurement method can be used to investigate nature relatedness at a physiological level, which could be a useful complement to self-report questionnaires in future studies.

Immersive virtual reality as support for the mental health of elderly women: a randomized controlled trial

Several forms of virtual reality (VR) have shown promise in treating mental disorders. However, there is a lack of research investigating the use of multicomponent immersive VR. Therefore, this study aimed to evaluate the effectiveness of an immersive virtual reality (IVR) intervention that incorporated Japanese garden aesthetics, relaxation, and elements of Erickson's psychotherapy in alleviating depression and anxiety symptoms among elderly women. Sixty women with depressive symptoms were randomly assigned to one of two treatment groups. Both groups received eight (twice a week for four weeks) low-intensity general fitness training sessions. The IVR group (n = 30) received eight additional VR-based relaxation sessions, whereas the control group (n = 30) received eight group relaxation. As outcome measures, the geriatric depression scale (GDS; primary) and Hospital Anxiety and Depression Scale (HADS; secondary) were administered before and after the interventions. The protocol was registered in the ClinicalTrials.gov PRS database (Registration number: NCT05285501). Patients receiving IVR therapy exhibited a greater significant reduction in the GDS (adjusted mean post-difference of 4.10; 95% CI = 2.27-5.93) and HADS (2.95; 95% CI = 0.98-4.92) scores than those receiving the control intervention. In conclusion, IVR with elements of psychotherapy, relaxation, and garden aesthetics may alleviate the severity of depression and anxiety symptoms in elderly women.

Sensory emotion regulation

Decades of evidence reveal intimate links between sensation and emotion. Yet, discussion of sensory experiences as tools that promote emotion regulation is largely absent from current theorizing on this topic. Here, we address this gap by integrating evidence from social-personality, clinical, cognitive-neuroscience, and animal research to highlight the role of sensation as a tool that can be harnessed to up- or downregulate emotion. Further, we review evidence implicating sensation as a rapid and relatively effortless emotion regulation modality and highlight future research directions. Notably, we emphasize the need to examine the duration of sensory emotion regulation effects, the moderating role of individual and cultural differences, and how sensory strategies interact with other strategies.

Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran

BACKGROUND

The COVID-19 pandemic. In this framework, digital self-help interventions have the potential to provide flexible and scalable solutions for delivering evidence-based treatments that do not necessitate face-to-face meetings.

OBJECTIVE

as part of a multicentric project, the purpose of the current randomized controlled trial was to evaluate the efficacy of a Virtual-Reality-based self-help intervention (namely, COVID Feel Good) in lowering the psychological distress experienced during the COVID-19 pandemic in Iran.

METHODS

60 participants were randomly assigned to the experimental (COVID Feel Good intervention group) or the control (no-treatment control group) condition. At the beginning of the intervention (Day 0), at the end of the intervention (Day 7), and after a 2-week follow-up (Day 21), measurements of depressive and anxiety levels, general distress, perceived levels of stress, hopelessness (primary outcome measures), perceived interpersonal closeness with the social world, and fear of COVID-19 (secondary outcome measure) were collected. The protocol consists of two integrated parts: the first part includes a relaxing 10-min three-hundred-sixty-degree (360°) video, while the second one includes social tasks with specified objectives.

RESULTS

In terms of the primary outcomes, participants in the COVID Feel Good intervention group improved in depression, stress, anxiety, and perceived stress but not hopelessness. Secondary outcome results showed an improvement in perceived social connectedness and a substantial decrease in fear of COVID-19.

CONCLUSIONS

these findings on the efficacy of COVID Feel Good training add to the growing body of evidence demonstrating the feasibility of digital self-help interventions in promoting well-being during this unique period.

Health Implications of Virtual Architecture: An Interdisciplinary Exploration of the Transferability of Findings from Neuroarchitecture

Virtual architecture has been increasingly relied on to evaluate the health impacts of physical architecture. In this health research, exposure to virtual architecture has been used as a proxy for exposure to physical architecture. Despite the growing body of research on the health implications of physical architecture, there is a paucity of research examining the long-term health impacts of prolonged exposure to virtual architecture. In response, this paper considers: what can proxy studies, which use virtual architecture to assess the physiological response to physical architecture, tell us about the impact of extended exposure to virtual architecture on human health? The paper goes on to suggest that the applicability of these findings to virtual architecture may be limited by certain confounding variables when virtual architecture is experienced for a prolonged period of time. This paper explores the potential impact of two of these confounding variables: multisensory integration and gravitational perception. This paper advises that these confounding variables are unique to extended virtual architecture exposure and may not be captured by proxy studies that aim to capture the impact of physical architecture on human health through acute exposure to virtual architecture. While proxy studies may be suitable for measuring some aspects of the impact of both physical and virtual architecture on human health, this paper argues that they may be insufficient to fully capture the unintended consequences of extended exposure to virtual architecture on human health. Therefore, in the face of the increasing use of virtual architectural environments, the author calls for the establishment of a subfield of neuroarchitectural health research that empirically examines the physiological impacts of extended exposure to virtual architecture in its own right.

Effects of immersion in a simulated natural environment on stress reduction and emotional arousal: A systematic review and meta-analysis

Background

Although the mental health benefits of exposure to simulated natural environments are well established by researchers from environmental psychology, landscape architecture, and public health, it is unclear whether and to what extent technological immersion affects these benefits.

Methods

Systematical literature searches were conducted in May 2022 from six databases. The risk of bias was evaluated using the Cochrane's Risk of Bias tool 2.0 and the Risk of Bias in Non-randomized Studies of Interventions tool. We performed a random-effects meta-regression to investigate the heterogeneity. The immersion levels of included studies were classified by projection devices and motion capture, and then subgroup analysis was conducted.

Results

Twenty-six publications were included. Exposure to simulated nature was confirmed to be associated with increased positive affect 0.40 [95% confidence interval (CI): 0.22, 0.58], vigor 0.58 (95% CI: 0.30, 0.86), calmness 0.54 (95% CI: 0.17, 0.92) and decreased perceived stress -0.38 (95% CI: -0.71, -0.06), total mood disturbance -0.87 (95% CI: -1.17, -0.57), tension -0.70 (95% CI: -0.99, -0.41), fatigue -0.60 (95% CI: -0.91, -0.28), anxiety -0.72 (95% CI: -1.43, -0.02), depression -0.33 (95% CI: -0.52, -0.14), confusion -0.79 (95% CI: -1.19, -0.40), and anger -0.54 (95% CI: -0.76, -0.31). Gender, health status, study design, mean age, and single exposure duration were not significant when entered in a meta-regression. For positive affect, medium immersion was observed to produce a larger effect than low and high immersion. All included studies had a moderate to high risk of bias.

Conclusion

Audio-visual exposure to simulated nature contributes to stress relief and emotional arousal. The immersion level explains the heterogeneity of positive affect triggered by simulated nature. Focusing on the technical features will open up new possibilities for combining actual and simulated nature's mental health benefits.

A modified mental state assessment tool for impact analysis of virtual reality-based therapeutic interventions in patients with cognitive impairment

Objectives

This work has developed a modified mental state assessment tool for impact analysis of therapeutic interventions for patients with cognitive impairment. This work includes a pilot study to validate the proposed tool and assess the impact of virtual reality-based interventions on patient well-being, which includes assessment of cognitive ability and mood.

Methods

The suggested tool's robustness and reliability are assessed in care home facilities with elderly residents over the age of 55. Because of the repetitive nature of the pilot study, test-retest strategy for Cronbach's alpha coefficient is employed to validate the internal consistency of the proposed tool over time. Qualitative and quantitative analyses are performed on the collected data to draw inferences on the impact of virtual reality-based interventions on patients with cognitive impairments.

Results

The Cronbach's alpha coefficient value shows that the proposed tool's resilience is comparable to that of its pre-intervention counterparts. The Cronbach's alpha coefficient values are determined for Pre-virtual reality and Post-virtual reality interventions, which include 116 virtual reality sessions for 52-participant, and three cohorts of virtual reality sessions for 21 participants. These values for a majority of the interventions remained within the acceptable range of 0.6-0.8.

Conclusions

The proposed modified mental state assessment tool is observed to be a reliable tool for investigating the impact of virtual reality-based interventions on patients with cognitive impairments. One of the notable significance of the proposed tool is that this allows for resource allocation for such interventions to be tailored to the needs of the patient, leading to greater therapeutic efficacy and resource efficiency.

A social VR-based collaborative exergame for rehabilitation: codesign, development and user study

Immersive virtual reality (VR)-based exercise video games (exergames) are increasingly being employed as a supportive intervention in rehabilitation programs to promote engagement in physical activity, especially for elderly users. A multifaceted and iterative codesign process is essential to develop sustainable exergaming solutions. The social aspect is considered one of the key motivating factors in exergames; however, research on the social aspect of VR exergames has been limited. Previous studies have relied on competitiveness in exergames, but research has shown that competition can lead to adverse effects on users. With the aim of motivating elderly individuals to participate in physical exercise and improving social connectedness during rehabilitation, this work presents a social VR-based collaborative exergame codesigned with elderly participants and therapists. This exergame stimulates full-body exercise and supports social collaboration among users through a collaborative game task. Furthermore, this article presents a user study based on a mixed-methods approach to gather user feedback on exergame design and the effect of social collaboration versus playing alone in a VR exergame in terms of physical exertion and motivation. This study spanned five weeks (99 exergaming sessions) with 14 elderly participants divided into two groups, one playing collaboratively and the other playing individually. Between-group comparisons were performed at baseline (first week) and in the fourth week, and within-group comparisons were performed in the fifth week, when the participants played the exergame in counterbalanced order. In contrast to the first week, the participants exergaming collaboratively in the fourth week reported significantly higher intrinsic motivation on all subscales (enjoyment: p < 0.02, effort: p < 0.002, usefulness: p < 0.01) and physical exertion (p < 0.001) than those playing alone. Thereafter, exergaming in counterbalanced order during the fifth week resulted in significant differences (medium to large effect size) within groups. The participants found the social VR gameplay enjoyable and agreed that collaboration played a vital role in their motivation. They reported various health benefits, a minimal increase in symptoms of simulator sickness, and excellent usability scores (83.75±13.3). In this work, we also identify various key design principles to support healthcare professionals, researchers and industrial experts in developing ergonomic and sustainable VR-based exergames for senior citizens.

Examining the potential of VR program Tilt Brush in reducing anxiety

Recent advancement in technology has made virtual reality (VR) more accessible and immersive than ever before, resulting in its increasing utility in various industries. Despite this, VR has remained an underutilised tool within clinical psychology. This study aimed to explore the potential of using VR for therapeutic benefits through examining the level of flow and anxiety-reducing effects of freeform drawing in real life (on paper) versus drawing in VR (using Tilt Brush) via a randomised-controlled trial with 40 participants. State and trait anxiety was measured using the State-Trait Anxiety Inventory, level of flow was measured using the Long Flow State Scale, and level of presence was measured using the iGroup Presence Questionnaire. Overall level of flow was not significantly different between both groups, implying drawing in VR induces as much flow as drawing in real life. Level of flow was positively correlated to level of presence experienced in the VR group (p < .01). Although there was no significant interaction effect, both groups experienced an overall decrease in state anxiety, with the VR group experiencing a significant reduction of state anxiety from pre- to post-test (p < .01).

Taking real steps in virtual nature: a randomized blinded trial

Studies show that green exercise (i.e., physical activity in the presence of nature) can provide the synergistic psychophysiological benefits of both physical exercise and nature exposure. The present study aimed to investigate the extent to which virtual green exercise may extend these benefits to people that are unable to engage in active visits to natural environments, as well as to promote enhanced exercise behavior. After watching a video validated to elicit sadness, participants either performed a treadmill walk while exposed to one of two virtual conditions, which were created using different techniques (360° video or 3D model), or walked on a treadmill while facing a blank wall (control). Quantitative and qualitative data were collected in relation to three overarching themes: "Experience," "Physical engagement" and "Psychophysiological recovery." Compared to control, greater enjoyment was found in the 3D model, while lower walking speed was found in the 360° video. No significant differences among conditions were found with respect to heart rate, perceived exertion, or changes in blood pressure and affect. The analysis of qualitative data provided further understanding on the participants' perceptions and experiences. These findings indicate that 3D model-based virtual green exercise can provide some additional benefits compared to indoor exercise, while 360° video-based virtual green exercise may result in lower physical engagement.