Effectiveness of virtual and augmented reality-enhanced exercise on physical activity, psychological outcomes, and physical performance: A systematic review and meta-analysis of randomized controlled trials

Ten-Minute Physical Activity Breaks Improve Attention and Executive Functions in Healthcare Workers

Occupational health is a major problem in modern work environments. Physical activity breaks (PABs), short exercise periods delivered during working hours, incorporating exergames or outdoor activities, have emerged as a novel approach that could be used to improve work efficiency and workplace wellbeing. Therefore, this study aimed to investigate the impact of PABs on attention levels and executive functions in healthcare workers. A total of 27 healthcare workers (M = 14, W = 13; 49.55 ± 12.46 years), after 4 h of work, randomly performed one of three 10 min conditions weekly in a counterbalanced order: No Physical Activity Break (NPAB); Outdoor Physical Activity Break (OPAB); Physical Activity Break with Exergame (PABEx). After the conditions, executive functions and selective attention were assessed by the Stroop Color and Word Test (SCWT), and the Trail Making A,B test (TMT A,B), respectively. Significant differences between OPAB and NPAB as well as between PABEx and NPAB in the TMT-A test χ2(2) = 44.66 (p < 0.001) and TMT-B test χ2(2) = 48.67 (p < 0.001) were found, respectively. TMT-A and SCWT interference/time scores of the PABEx and OPAB conditions were significantly lower than those of NPAB (p < 0.001). In the SCWT interference/error score, no significant difference was found between the PABEx and NPAB (p > 0.05), but the score was statistically lower in the OPAB condition than PABEx (p = 0.001) and PABEx condition compared to OPAB for TMT-A (p = 0.001). Findings showed that the OPAB and PABEx conditions are effective in improving selective attention and executive functions in healthcare workers. Employers can foster a healthier and more productive workforce by promoting a culture of movement and prioritizing employee health, which in turn can enhance patient care outcomes.

Enhancing Physical Activity with Immersive Virtual Reality: A Systematic Review

The aim of this article is to review how immersive virtual reality-enhanced physical activity (IVR-PA) can be used to improve psychological, physiological, and performance outcomes linked to exercising and to compare it with non-immersive virtual reality-enhanced physical activity (nIVR-PA) and with traditional physical activity (TR-PA). We also aimed to explore the effectiveness of IVR-PA in promoting psychological well-being and engagement in physical activity. A systematic literature review (Prospero CRD42022330572) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. OVID (including Medline, Embase, GlobalHealth, and APA PsychInfo), Web of Science, and Sport Discuss were searched. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment. The search identified 26,548 titles. After screening, 20 studies (the total number of participants was 798) published between 2009 and 2023 were included in this systematic review. The quality of the studies was rated as weak (n = 9), moderate (n = 10), or strong (n = 1). Overall, the reviewed studies indicated that, compared with TR-PA and nIVR-PA, IVR-PA was associated with an increase in enjoyment of physical activity, a reduction in perceived exertion, and increased rates of self-efficacy, intrinsic motivation, and exercise intention. Furthermore, some studies showed higher muscular strength and aerobic increase after an IVR-PA intervention compared with TR-PA. The findings suggest that IVR-PA can improve psychological, physiological, and performance outcomes linked to exercising, as well as improving psychological well-being and engagement in physical activity. However, owing to the methodological limitations of the reviewed studies, further research is encouraged.

Breaking the Isolation: Exploring the Impact of Passthrough in Shared Spaces on Player Performance and Experience in VR Exergames

VR exergames offer an engaging solution to combat sedentary behavior and promote physical activity. However, challenges emerge when playing these games in shared spaces, particularly due to the presence of bystanders. VR's passthrough functionality enables players to maintain awareness of their surrounding environment while immersed in VR gaming, rendering it a promising solution to improve users' awareness of the environment. This study investigates the passthrough's impact on player performance and experiences in shared spaces, involving an experiment with 24 participants that examines Space (Office vs. Corridor) and Passthrough Function (With vs. Without). Results reveal that Passthrough enhances game performance and environmental awareness while reducing immersion. Players prefer an open area to an enclosed room, whether with or without Passthrough, finding it more socially acceptable. Additionally, Passthrough appears to encourage participation among players with higher self-consciousness, potentially alleviating their concerns about being observed by bystanders. Our findings provide valuable insights for designing VR experiences in shared spaces, underscoring the potential of VR's passthrough to enhance user experiences and promote VR adoption in these environments.

Impact of Coastal Walking Outdoors and Virtual Reality Indoor Walking on Heart Rate, Enjoyment Levels and Mindfulness Experiences in Healthy Adults

Outdoor exercise is beneficial for psychophysical well-being. Limited studies have compared outdoor and virtual reality (VR) indoor physical activities, especially in coastal settings. Therefore, this study aimed to assess the impact of outdoor coastal walking and indoor walking in a VR simulation with a similar environment on physiological and psychological variables in healthy adults. A total of 26 subjects (14 M and 12 F, age 25.2 ± 2.5 years) voluntarily participated in this crossover randomized controlled and counterbalanced study and were allocated under three conditions: VR indoor walking (INVR), outdoor walking (OUT) and standard indoor walking (IN). IN and INVR conditions were performed on a treadmill (speed 4.5 km/h) and the OUT was performed on a seaside pedestrian road. The same outdoor environment was displayed in the visor during the INVR. Heart rate (HRmean/max), physical activity enjoyment (PACES-It) and state of mindfulness for physical activity (SMS-PA) were assessed at the end of each condition. The OUT condition showed significantly greater PACES-It scores and HRmean than IN and INVR (p < 0.001) and greater SMS-PA scores and HRmax than IN (p < 0.01 and p < 0.05, respectively). No significant differences were found between OUT and INVR regarding HRmax and SMS-PA scores (p > 0.05). Findings suggest that physical activity in an immersive technology may lead to physiological loads comparable to the outdoor environment. OUT is more enjoyable than IN and INVR but exhibits a mindfulness response comparable to INVR. Therefore, INVR could be an alternative to OUT for those who cannot engage in outdoor activities for various reasons.

Anonymizing at-home fitness: enhancing privacy and motivation with virtual reality and try-on

Introduction

This study aimed to address privacy concerns associated with video conferencing tools used in home-based exercise training. To that end, a method that could anonymize participants' appearances and exercise environments during at-home fitness sessions was proposed.

Methods

This method combines virtual reality for 3-D human-model rendering using key-points tracking with a virtual try-on system enhanced by UV mapping and instance segmentation. To validate the proposed method, we conducted a user study by recruiting participants to assess effectiveness of virtual reality and virtual try-on in terms of privacy protection, self-confidence, and coaching satisfaction.

Results

Experimental results demonstrated the effectiveness and improved user experience of using virtual reality or virtual try-on in remote fitness, particularly in enhancing privacy protection and self-confidence with statistical significance. However, no significant differences were noted in coaching satisfaction.

Discussion

These findings confirmed the efficacy of our proposed approach. We believe that the proposed approach can significantly contribute to the future of remote fitness training, offering a more secure and engaging environment for users, thereby potentially increasing adherence to fitness regimens and overall physical wellbeing.

The Efficacy and Therapeutic Alliance of Augmented Reality Exposure Therapy in Treating Adults With Phobic Disorders: Systematic Review

BACKGROUND

Phobic disorders are characterized by excessive fear of a stimulus that can affect the quality of a patient's life. The lifetime prevalence in adults is 7.7% to 12.5%. The current literature provides evidence-based inferences about the effectiveness of in-vivo exposure therapy (IVET) in treating phobia. However, this method can put the therapist and the client in danger, with high drop out and refusal rates. A newer approach for exposure therapy using augmented reality technology is under assessment.

OBJECTIVE

This systematic review investigated the novel technology's efficacy, cost-efficacy, and therapeutic alliance in treating adults with phobia.

METHODS

An extensive search was conducted using 4 major databases (MEDLINE, PsycINFO, Embase, and Scopus) using a comprehensive list of synonyms for augmented reality exposure therapy (ARET) and phobic disorders. The search targeted any randomized control trial testing ARET in adults with phobic disorders up to August 8, 2022.

RESULTS

A total of 6 studies were included, with 208 participants providing results. Studies investigating the efficacy of ARET compared to no intervention showed significant results (P<.05) in the ARET group improvement. Head-to-head comparative studies comparing ARET to IVET showed no significant difference (P>.05) in the effectiveness and therapeutic alliance between both therapies. Further, the results demonstrated that the ARET group had a better long-term effect than IVET, with the ability to put the patients in more situations to face the feared object.

CONCLUSIONS

The current data suggest clinically significant efficacy and a promising therapeutic alliance of ARET. However, no data are available investigating the cost-effectiveness of ARET. Further research is warranted to ascertain ARET's cost-effectiveness and examine its efficacy in other populations and anxiety conditions.

"There are endless areas that they can use it for": speech-language pathologist perspectives of technology support for aphasia self-management

BACKGROUND

Aphasia is a debilitating acquired language disorder that often persists as a chronic condition. However, long-term support options are scarce, necessitating the consideration of alternative approaches. Chronic condition self-management approaches, which aim to build self-efficacy and empower people to take responsibility for the day-to-day management of their health condition, may benefit people with aphasia (PwA). Technology is widely used in chronic condition self-management and investigation is required to determine whether it could play a role in aphasia self-management.

OBJECTIVE

This study aimed to explore speech-language pathologist (SLP) perspectives on the potential use of technology to support aphasia self-management.

METHODS

A qualitative study was conducted with 15 SLPs using semi-structured interviews. Qualitative content analysis was applied to verbatim transcripts to identify codes, categories, and sub-themes which were developed into themes.

RESULTS

Three themes were identified: (1) technology supports holistic aphasia self-management by providing additional avenues for service delivery, overall communication, and learning opportunities thus enhancing independence and life participation; (2) SLP and communication partner (CP) assistance can support PwA to use technology for aphasia self-management; (3) considerations and potential barriers to PwA use of technology for aphasia self-management.

CONCLUSIONS

Technology can support aphasia self-management by expanding service delivery options, allowing for increased frequency and intensity of therapy practise, and facilitating communication and participation. Personal, professional, and organizational barriers should be addressed in the development of technology-enabled aphasia self-management approaches. SLPs and CPs can offer PwA assistance with technology but may themselves need additional support. Solutions for identified barriers should be considered, such as providing training in the use of technology and implementing aphasia-friendly modifications.IMPLICATIONS FOR REHABILITATIONSelf-management approaches are being explored in the area of aphasia management as a means of offering a holistic, sustainable intervention option that meets the long-term needs of people with aphasia.A range of technology-based resources are currently used in chronic condition self-management and in aphasia therapy, and there are many possibilities for the use of technology in aphasia self-management approaches.Speech-language pathologists identified that technology could facilitate aphasia self-management by expanding service delivery options (e.g., real-time and asynchronous telepractice), enabling increased frequency and intensity of therapy through providing a means of independent practise, offering options for augmentative alternative communication, and enhancing life participation by supporting social communication and daily tasks.,Speech-language pathologists are interested in using technology for aphasia self-management; however, barriers related to organizational policies, individual experience and confidence using technology, and technology itself must be addressed.

The effects of virtual reality-based exercise in adults receiving haemodialysis treatment: A systematic review and meta-analysis of randomized controlled studies

This meta-analysis aimed to synthesize the effects of virtual reality-based exercise on physical function, depression symptoms and quality of life in adults receiving haemodialysis. Data were analysed using Comprehensive Meta-Analysis Version 3. The random-effects meta-analysis was performed to pool intervention effects. A total of five studies were included. The majority of included studies compared intervention with passive control group. This meta-analysis showed with a moderate to high quality of evidence that virtual reality-based exercise has positive medium effect on improving physical function such as gait speed (g = .40, 95% CI 0.00 to 0.81), sit to stand 10 times (g = -.41, 95% CI -0.825 to -0.009), sit to stand in 60 s (g = .56, 95% CI 0.151 to 0.974), 6-min walk test (g = .66, 95% CI 0.247 to 1.079), not affect time up and go and sit to stand five times. The study indicated with moderate quality of evidence that virtual reality-based exercise had no effect on depression symptoms. The study also showed with a moderate quality of evidence that the intervention had a positive medium effect on improving physical function (g = .64, 95% CI 0.20 to 1.09). In conclusion, virtual reality-based exercise can be performed to improve physical function and quality of life of adults receiving haemodialysis for health professionals.

Role of Immersive Virtual Reality in Motor Behaviour Decision-Making in Chronic Pain Patients

Primary chronic pain is a major contributor to disability worldwide, with an estimated prevalence of 20-33% of the world's population. The high socio-economic impact of musculoskeletal pain justifies seeking an appropriate therapeutic strategy. Immersive virtual reality (VR) has been proposed as a first-line intervention for chronic musculoskeletal pain. However, the growing literature has not been accompanied by substantial progress in understanding how VR exerts its impact on the pain experience and what neurophysiological mechanisms might be involved in the clinical effectiveness of virtual reality interventions in chronic pain patients. The aim of this review is: (i) to establish the state of the art on the effects of VR on patients with chronic pain; (ii) to identify neuroplastic changes associated with chronic pain that may be targeted by VR intervention; and (iii) to propose a hypothesis on how immersive virtual reality could modify motor behavioral decision-making through an interactive experience in patients with chronic pain.

Storytelling and user experience in the cultural metaverse

Enthusiasm for the metaverse is intensifying in academia and industries. The metaverse is a complex concept, combining many technologies to create many different types of user experiences (UX), depending on the intended use. The cultural metaverse was first introduced in this study. This study is an initial attempt to fill the gaps in the practical research and storytelling research in the metaverse. Augmented reality (AR) technology is an applicative tool in cultural experience, which displays computer - generated virtual information on a real-world scene. AR displays digital information realistically, making it appear to be part of the actual environment, deepening or expanding the user's understanding of "reality". This study constructed a cultural metaverse using the innovative AR storytelling. The cultural metaverse is a new cultural ecology in which advanced information technologies are deeply integrated with cultural spaces and exhibits. It combines digital technologies and cultural industries, mixing virtual space and physical space to facilitate the UX in cultural experiences. In this study, the existing AR e-book and the innovative AR version were compared while measuring multiple aspects of UX, including presence, flow, enjoyment, education, and engagement. By analyzing questionnaire data from two groups with a total of 368 participants, the results indicated that the innovative AR storytelling produced a better UX across all variables compared to the AR e-book application. Overall, innovative AR storytelling allows visitors to transition between real and virtual spaces, enriches their interactive experience, and improves user engagement with the metaverse exhibition of cultural experience. Therefore, practitioners can construct a primary cultural metaverse through innovative AR storytelling.

Effects of Health Education Using Virtual Reality for Adolescents: A Systematic Review and Meta-Analysis

PURPOSE

This study aimed to evaluate the effects of health interventions using virtual reality (VR) on improving knowledge, attitudes, and skills; and inducing behavioral change among adolescents.

METHODS

This study is a systematic review and meta-analysis following PRISMA guidelines. We searched Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Korean databases between database inception and April 10, 2021. Based on heterogeneity, a random- or fixed-effects model was used, as appropriate, to calculate effect sizes in terms of the standardized mean difference (SMD) and odds ratio (OR). Studies were selected if they verified the effects of health education using VR on adolescents; there was an appropriate control group; and if the effects of education were reported in terms of changes in knowledge, attitudes, skills, or behaviors.

RESULTS

This analysis included six studies (n = 1,086). The intervention groups showed greater responses in knowledge and attitudes (SMD = 0.57, 95% confidence interval (CI) [0.12 to 1.02]), skills related to health behavior (SMD = -0.45, 95% CI [-0.71 to -0.19]), and behavioral change after 12 months (OR = 2.36, 95% CI [1.03 to 5.41]).

CONCLUSION

The results confirm the effectiveness of health interventions using virtual reality (VR). Although the analysis include a small number of studies, a case can be made for health interventions using VR to be utilized as educational methods and strategies to prevent risky behaviors among adolescents.

Virtual reality for public health: a study on a VR intervention to enhance occupational injury prevention

BACKGROUND

Agriculture is one of the most hazardous occupations in the USA. Especially, tractor rollover incidents are the leading cause of farming-related injuries or deaths. This study examines the effect of a VR intervention (Virtual Reality Intervention for Safety Education; VRISE) on behavioral intentions for occupational safety and identifies a psychological mechanism that shows how the immersive technology works.

METHODS

VRISE was developed by a multidisciplinary team of agricultural educators, computer scientists and communication specialists. It was designed to provide a virtual environment where users practice tractor operation and try to avoid several rollover hazards. The participants (291 high school students) were recruited at the 2019 National Future Farmers Association Convention & Expo and randomly assigned to one of three conditions: two different types of control groups (Control1: No treatment group and Control2: 2D Screen group) and the treatment group.

RESULTS

Findings show that, through the immersive VR experience, the VR intervention enhanced perceived threat of tractor-related accidents which in turn, led to improved behavioral intentions for tractor safety.

CONCLUSIONS

Findings shed light on the effectiveness of a VR intervention to improve public health outcomes, especially in occupational safety education, where unsafe practices often result in injury and fatality.

Rehabilitation Is the Main Topic in Virtual and Augmented Reality and Physical Activity Research: A Bibliometric Analysis

Researchers' interest in finding practical applications for virtual reality (VR) and augmented reality (AR) technologies has increased as new devices have become cheaper and more accessible, being used in entertainment, healthcare, and rehabilitation fields, among others. This study aims to provide an overview of the current state of scientific literature related to VR, AR, and physical activity (PA). A bibliometric analysis of studies published between 1994 and 2022 was conducted using The Web of Science (WoS), applying the traditional bibliometric laws and using the VOSviewer software for data and metadata processing. The results revealed an exponential increase in scientific production between 2009 and 2021 (R² = 94%). The United States (USA) was the country/region with the most relevant co-authorship networks (72 papers); the most prolific author was Kerstin Witte, and the most prominent was Richard Kulpa. The most productive journal's core was composed of high-impact and open access journals. A great thematic diversity was found according to the most used keywords by the co-authors, highlighting concepts such as rehabilitation, cognition, training, and obesity. Then, the research related to this topic is in an exponential development phase, with great interest in the rehabilitation and sports sciences fields.

Breathlessness and exercise with virtual reality system in long-post-coronavirus disease 2019 patients

Long-post-coronavirus disease-2019 (COVID-19) patients tend to claim residual symptomatology from various systems, most importantly the respiratory and central nervous systems. Breathlessness and brain fog are the main complaints. The pulmonary function pattern is consistent with restrictive defects, which, in most cases, are self-resolved, while the cognitive profile may be impaired. Rehabilitation is an ongoing field for holistic management of long-post-COVID-19 patients. Virtual reality (VR) applications may represent an innovative implementation of rehabilitation. We aimed to investigate the effect of exercise with and without the VR system and to assess further breathlessness and functional fitness indicators in long-post-COVID-19 patients with mild cognitive impairment after self-selected exercise duration using the VR system. Twenty long-post-COVID-19 patients were enrolled in our study (age: 53.9 ± 9.1 years, male: 80%, body mass index: 28.1 ± 3.1 kg/m²). Participants' anthropometric data were recorded, and they underwent pulmonary functional test evaluation as well as sleep quality and cognitive assessment. The participants randomly exercised with and without a VR system (VR vs. no-VR) and, later, self-selected the exercise duration using the VR system. The results showed that exercise with VR resulted in a lower dyspnea score than exercise without VR. In conclusion, VR applications seem to be an attractive and safe tool for implementing rehabilitation. They can enhance performance during exercise and benefit patients with both respiratory and cognitive symptoms.

Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study

BACKGROUND

Depression is a severe illness that has accelerated with the spread of COVID-19 and associated lockdowns. As a result, reported physical activity has substantially decreased, further increasing depressive symptoms.

OBJECTIVE

This study aims to explain the use of gamification principles to develop content for an interactive physical activity game for depression based on clinically proven depression diagnostic criteria.

METHODS

We discuss related work in this field, the game design framework, the users' depression severity, how we customize the contents accordingly, the gradual progression of the game to match exercise principles, and user flow optimization.

RESULTS

We provide a brief description of each of the games developed, including instructions on how to play and design aspects for flow, audio, and visual feedback methods. Exergames (interactive physical activity-based games) stimulate certain physical fitness factors such as improving reaction time, endurance, cardiovascular fitness, and flexibility. In addition, the game difficulty progresses based on various factors, such as the user's performance for successful completion, reaction time, movement speed, and stimulated larger joint range of motions. Cognitive aspects are included, as the user has to memorize particular movement sequences.

CONCLUSIONS

Mental health issues are linked to behavior and movement; therefore, future physical activity-based interactive games may provide excellent stimulation for inducing user flow, while physical activity can help train various physical fitness factors linked to depression.

Handheld Weights as an Effective and Comfortable Way To Increase Exercise Intensity of Physical Activity in Virtual Reality: Empirical Study

Background

In recent years, there has been a growing interest in active virtual reality games (AVRGs) that provide entertainment and encourage more physical activity (PA). Since playing AVRGs involves primarily arm movements, the intensity of this form of PA may not be sufficient for health benefits. Therefore, it is worth looking for virtual entertainment solutions that are comfortable for users and at the same time increase physical exercise.

Objective

The main objective of this study was to evaluate the effect of external loading of the arms in the form of handheld weights (HHWs) on exercise intensity in users playing a popular AVRG. The results obtained in the study were compared with the PA recommendations for health. The study also assessed the perceptions of the users about the attractiveness and usefulness of this type of exercise and discomfort caused by additional load on the arms.

Methods

The study covered 17 young adults aged 18 to 25 years playing an AVRG (Beat Saber) with no arm load and with HHWs (0.5 kg). A PlayStation 4 PRO console (Sony) with accessories including a head-mounted display and controllers was used in the study. PA intensity was evaluated using a heart rate monitor based on the percentage of maximal heart rate (% HRmax). The usability, attractiveness, and comfort perceived during exercise by users were evaluated using a survey questionnaire.

Results

The measurements showed that the mean % HRmax in participants playing Beat Saber without HHWs was significantly lower (P<.001; Cohen d=1.07) than that observed when playing with HHWs. It should be emphasized that with no additional load, the intensity of PA was low (mean 63.7% HRmax, SD 9.3% HRmax), while with the upper limb load, it increased to a moderate level (mean 67.1% HRmax, SD 10.3% HRmax), which is recommended for health benefits. The survey conducted in the study showed that HHWs (0.5 kg) attached to the wrists did not disturb Beat Saber players.

Conclusions

Since PA in most of the modern AVRGs primarily involves upper limb movements, the use of HHW seems to be a simple and effective way to increase exercise intensity, especially because, as reported by the study participants, such a procedure does not cause discomfort while using the application.

Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions

Objective

The use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies.

Methods

To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being.

Results

The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions.

Conclusion

This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.

How the physical appearance of companions affects females with high or low social physique anxiety: a virtual reality exercise study

Technologies such as virtual reality (VR), an immersive computer-based environment that induces a feeling of mental and physical presence, are becoming increasingly popular for promoting participation in exercise. The purpose of this study was to explore changes in motivation and other psychological states when the physique of an exercise companion was altered during a VR-based exercise task, and whether trait social physique anxiety (SPA) altered these effects. Using a mixed experimental design, female participants (N = 43) categorised as high or low in SPA participated in two counterbalanced 10-min running tasks within a VR environment where the exercise companion was either overweight or in-shape. Across both running tasks, individuals with high SPA reported higher negative affect, pressure and tension, and lower perceived competencies, than those with low SPA. Pressure and tension were also higher when exercising with an in-shape companion than with an overweight companion for all participants. In addition, participants with high SPA reported a stronger preference to exercise with an overweight companion than those with low SPA in a real exercise setting, but not in a VR setting. The findings suggest that the physique of an exercise companion and the SPA of an exerciser have important, but independent, psychosocial effects during exercise. That an in-shape physique of a virtual exercise companion was not a deterrent among those with high SPA has provided preliminary evidence that VR-based exercise may be helpful among females who worry about their appearance or feel self-conscious while exercising.

Improvements of Physical Activity Performance and Motivation in Adult Men through Augmented Reality Approach: A Randomized Controlled Trial

The COVID-19 pandemic had a global impact, increasing the prevalence of physical inactivity, which is mostly due to the lockdown and social distancing measures adopted during the pandemic. Hence, this study aimed to compare the efficacy of augmented reality-based training on physical activity performance and motivation in healthy adults to mirror visual feedback training and conventional physical therapy. This study used the randomized control trial pretest-posttest research design. Forty-eight healthy men aged 18–35 years who were engaged in recreational physical activities were enrolled and randomly divided into four groups: augmented reality-based training reality (ART), mirror visual feedback training (MVFT), therapist-based training (TBT), and control group. The total training program was held for four weeks. The isokinetic dynamometer, sit-and-reach test, Y balance test, and the intrinsic motivation inventory-22 were used to measure the outcomes before and after the intervention. Paired sample t-test was used to compare the changes before and after the intervention within groups, while the one-way ANOVA was used for the comparison between the groups. Results of the study showed that, after four weeks of intervention, balance, muscle strength, and muscle endurance in all groups significantly improved except for the control group. The ART group showed the highest increase in muscle strength, muscle endurance, and balance compared to the other groups. The motivation level increased in all three feedback groups and was observed in the following order: ART group > MVFT group > TBT group > control group. This study highlighted the most effective method that may be applied for home training during and after this period of the pandemic. The findings revealed that training while receiving real-time feedback via AR devices improves both physical performance and motivation. Augmented reality-based training can be used as an effective training option for improving physical activity and motivation and can be suggested for home training programs.

Applicability of an Immersive Virtual Reality Exercise Training System for Office Workers during Working Hours

Virtual reality is a computer-generated simulation of a real or imaginary three-dimensional environment that has entered our lives, particularly for gaming. Lately, it has been permeating into many aspects of our everyday life, such as exercise. It is important to ascertain whether exercise in an immersive virtual reality environment can be accepted from employees and lead to positive outcomes for them. The aim of this exploratory study was to examine the acceptance, future adoption, interest/enjoyment and usability of an immersive virtual reality system for exercise training by office workers during breaks within their working hours. A total of 40 female employees participated in the study with a mean age of 42.58 years (SD 10.77). Participants were requested to complete two sequential 15-min dual task cycling sessions corresponding to two experimental conditions. The first, condition A, involved cycling in a virtual environment, wearing a virtual reality head mounted display, and responding to cognitive tasks by answering multiple choice questions—on a screen, using a joystick. The second, condition B, involved cycling on a static bicycle and simultaneously responding to cognitive tasks by answering multiple choice questions in a real environment. After completion of the two conditions, participants responded to a series of scales regarding each of the experimental conditions and to a semi-structured interview. The results showed that participants noted a significant preference for the immersive virtual reality exercise, condition A, compared to condition B (bike only); and their acceptance, interest/enjoyment, usability and intention for future use were high. The qualitative data showed increased intention for future use, feelings of control and presence and most of the participants did not encounter any difficulties or require extra help to understand the immersive virtual reality system. Overall, exercising during working hours with an immersive virtual reality exercise system was well perceived by office workers and applicable. However, the effects of the immersive virtual reality training system on physical and mental health and the employees’ adherence to the exercise program should be tested with a longer intervention program.

The Effect of Augmented Reality-Based Proprioceptive Training Program on Balance, Positioning Sensation and Flexibility in Healthy Young Adults: A Randomized Controlled Trial

This study investigates whether Augmented Reality (AR)-based interventions can be as effective as physical therapists (PT) regarding balance, positioning sensation, and flexibility. A sample of 39 regular people who voluntarily participated in this study were randomly distributed into two groups. Then AR was applied in the experimental group and PT was applied in the control group. Variables were measured by Tetrax (static balance), Y-balance test (dynamic balance), CSMI (proprioception), and sit and reach test (flexibility). All measurements were analyzed using paired t-test and independent t-test. The exercise program of this study improved the stability index (ST) of the static balance in both groups after the intervention, and there was a significant difference (p < 0.05) at normal eye close (NC) and Pillow with eye close (PC) positions. Moreover, regarding the case of dynamic balance, there were significant differences in AR and PT groups to reach in all directions (p < 0.05). In the case of positioning sensation, there was no significant difference in both groups (p > 0.05), and there was a significant difference in flexibility (p < 0.05). When comparing the two groups, there was no significant difference in all categories (p > 0.05). As a result, AR can be considered an effective form of therapy and can be selected according to individual conditions.

Can Avatar Appearance Influence Physical Activity? User-Avatar Similarity and Proteus Effects on Cardiac Frequency and Step Counts

This study combined user-avatar similarity and Proteus effect predictions to incentivize physical activity. 305 participants ran while wearing accelerometers and a heart rate monitor. They were randomly assigned to onscreen motion-capturing avatars displaying either participant or stranger faces dressed in sports or formal clothes. Participants assigned to avatars displaying their own face showed increased cardiac frequency compared with those exposed to avatars with a stranger's face. Relative to the remaining conditions, participants assigned to avatars with their own face also wearing sports clothes showed increased cardiac frequency but participants assigned to avatars with a stranger's face wearing formal clothes showed decreased cardiac frequency. The results imply that user-avatar similarity and the Proteus effect can be harnessed to influence physical activity.

Applying Game-Based Approaches for Physical Rehabilitation of Poststroke Patients: A Systematic Review

Objective

A large number of patients need critical physical rehabilitation after the stroke. This study aimed to review and report the result of published studies, in which newly emerged games were employed for physical rehabilitating in poststroke patients.

Materials and Methods

This systematic review study was performed based on the PRISMA method. A comprehensive search of PubMed, Scopus, IEEE Xplore Digital Library, and ISI Web of Science was conducted from January 1, 2014, to November 9, 2020, to identify related articles. Studies have been entered in this review based on inclusion and exclusion criteria, in which new games have been used for physical rehabilitation.

Results

Of the 1326 retrieved studies, 60 of them met our inclusion criteria. Virtual reality-oriented games were the most popular type of physical rehabilitation approach for poststroke patients. “The Nintendo Wii Fit” game was used more than other games. The reviewed games were mostly operated to balance training and limb mobilization. Based on the evaluation results of the utilized games, only in three studies, applied games were not effective. In other studies, games had effective outcomes for target body members.

Conclusions

The results indicate that modern games are efficient in poststroke patients' physical rehabilitation and can be used alongside conventional methods.

Real-time interactive digital healthcare system for post-operative breast cancer patients: study protocol for a randomized controlled trial

BACKGROUND

After receiving breast cancer surgery or reconstruction, shoulder dysfunctions including weakness, post-operative pain, shoulder joint instability, and limited range of motion (ROM) often occur. Due to limited ROM, patients may suffer difficulty in activities of daily living, and quality of life may be reduced. The objective of this study is to compare the effects on shoulder ROM of a real-time interactive digital healthcare system and brochure-based home rehabilitation program in post-operative breast cancer patients.

METHODS

This study is a prospective, multi-center, assessor-blinded randomized controlled trial. The study aims to recruit 100 breast cancer patients exhibiting limited shoulder ROM after undergoing axillary lymph node dissection or breast reconstruction following mastectomy. Patients will be randomly assigned to two groups for 8 weeks of rehabilitation: a digital healthcare system rehabilitation (intervention) group and a brochure-based rehabilitation (control) group. The primary outcome is the change in ROM of the affected shoulder between baseline and 12 weeks after enrollment. Secondary outcomes include pain in the affected shoulder, as measured using a numerical rating scale, functional outcomes (QuickDASH scores), and quality of life (FACT-B and EQ-5D-5L scores), all of which will be measured on enrollment and 4, 8, and 12 weeks thereafter.

DISCUSSION

This study will compare the effectiveness of a newly developed, augmented reality-based real-time interactive digital healthcare system with that of brochure-based home rehabilitation for improving the shoulder ROM, pain, functional outcomes, and quality of life of post-operative breast cancer patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04316156 . Registered on 20 March 2020.

Acute VR competitive cycling exercise enhanced cortical activations and brain functional network efficiency in MA-dependent individuals

BACKGROUND

Methamphetamine (MA) dependence is associated with elevated rates cognitive impairment in MA users. The objective of the present study was to investigate the effects of virtual reality (VR) competitive cycling excise on the neurocognitive functions and on negative affectivity of MA-dependent individuals.

METHODS

Thirty MA-dependent individuals performed a colour-word Stroop task and underwent a profile of mood states (POMS) scale assessment both before and after a 10 min VR competitive cycling exercise. Functional near-infrared spectroscopy (fNIRS) were recorded during the pre-and post-exercise Stroop tasks and during rest.

RESULTS

After acute exercise, neural activity, along with improved Stroop performance, was enhanced significantly in the dorsolateral prefrontal cortex. Also observed during post-exercise Stroop tasks was a more efficient network architecture in the topological organization of brain networks than during the pre-exercise Stroop tasks. As for resting states before versus after exercisethe, we detected an increased functional connectivity between the prefrontal cortex and the motor cortex after exercise.

CONCLUSIONS

These results suggest that an acute bout of VR competitive cycling exercise facilitates executive information processing by enhancing task-related cortical activations and brain functional network efficiency in MA-dependent individuals.

Feasibility, Acceptability, and Efficacy of Virtual Reality Training for Older Adults and People With Disabilities: Single-Arm Pre-Post Study

BACKGROUND

Unlike most virtual reality (VR) training programs that are targeted at homogenous populations, a set of VR games for rehabilitation purposes targeted at a heterogeneous group of users was developed. The VR games covered physical training, cognitive training (classification and reality orientation), community-living skills training, and relaxing scenery experiences. Special considerations for local older adults and people with disabilities were made in terms of hardware choice and software design.

OBJECTIVE

This study aimed to evaluate the feasibility, acceptance, and efficacy of VR training among users with varying abilities.

METHODS

A single-arm pretest-posttest evaluation study was conducted. The participants of the evaluation study were encouraged to undergo 30-minute VR training three times a week for 6 weeks. The 30-minute session consisted of 10 minutes of upper-limb motion games, 10 minutes of lower-limb motion games, and 10 minutes of cognitive games/community-living skills training/relaxing scenery experiences, as appropriate. On completion of each session, usage statistics were documented via the built-in VR software, whereas feedback on the experience of the VR games and adverse events was collected via self-reports and staff observations. Feasibility was reflected by usage statistics, and acceptance was reflected by positive feedback. In addition, health outcomes, including upper-limb dexterity, functional mobility, cognitive function, and happiness, were assessed at baseline, as well as 6 weeks and 3 months after baseline. The primary outcomes were upper-limb dexterity and acceptance of playing VR games.

RESULTS

A total of 135 participants with a mean age of 62.7 years (SD 21.5) were recruited from May 2019 to January 2020, and 124 (91.9%) completed at least one follow-up. Additionally, 76.3% (103/135) of the participants could attend at least 70% of the proposed 18 sessions, and 72.5% (1382/1906) of the sessions had a training time of at least 20 minutes. Linear mixed effect models showed statistically significant effects in terms of upper-limb dexterity (small effect) and cognitive function (moderate effect). Among the 135 participants, 88 provided positive comments. Additionally, 10.4% (14/135) reported mild discomfort, such as dizziness, and none reported severe discomfort.

CONCLUSIONS

A set of VR training games for rehabilitation could be applied to users with heterogeneous abilities. Our VR games were acceptable to local older adults and those with different disabilities. Benefits in upper-limb dexterity and cognitive function were observed despite partial compliance to the training protocol. Service providers could refer to our experiences when developing VR training systems for their clients.

Leveraging technology to move more and sit less

One of the major changes in the updated physical activity (PA) guidelines is the recommendation for adults to simply move more and sit less throughout the day. This recommendation comes during a time of proliferation and advancement of personal health technologies that allow adults greater access to interventions to increase PA. Wearable activity monitors provide direct feedback of activity levels allowing users to reach PA targets throughout the day. Gamification of these and other devices can engage users and sustain their motivation to increase PA, along with the formation of social networks through social media platforms. This review will discuss and present an overview of current technologies that can be leveraged to increase PA in adults. Specific attention will be paid to wearable activity monitors, gamification and social network platforms that can help adults increase and sustain their PA levels to improve their overall health.

Using Augmented Reality with Older Adults in the Community to Select Design Features for an Age-Friendly Park: A Pilot Study

Sedentary behavior is prevalent in older adults. Older adults often underutilize public parks for exercising because the parks do not support their needs and preferences. Engaging older adults on the redesign of parks may help promote active lifestyles. The objectives of this pilot study were to evaluate (1) the effects of wearing augmented reality (AR) and virtual reality (VR) glasses on balance; (2) the effects of different virtual walls separating the walking trail from the roadway on older adults' gait, and (3) the preferences of the participants regarding wall design and other features. The participants were ten older adults (68 ± 5 years) who lived within two miles from the park. Balance and gait were assessed using a force plate and an instrumented mat. It was feasible to use AR with older adults in the park to evaluate features for redesign. Motion sickness was not an issue when using AR glasses, but balance was affected when wearing VR goggles. The area of postural sway increased approximately 25% when wearing AR glasses, and it increased by close to 70% when wearing VR goggles compared to no glasses. This difference is clinically relevant; however, we did not have enough power to identify the differences as statistically significant because of the small sample size and large variability. Different walls did not significantly affect the participants' gait either because they did not alter the way they walked or because the holograms were insufficiently realistic to cause changes. The participants preferred a transparent wall rather than tall or short solid walls to separate the park from the roadway.

Effect of Pokémon Go on Self-Harm Using Population-Based Interrupted Time-Series Analysis: Quasi-Experimental Study

Background

Pokémon Go is a very popular location-based augmented reality game with widespread influences over the world. An emerging body of research demonstrates that playing Pokémon Go can lead to improvements in physical activity and psychosocial well-being; however, whether Pokémon Go reduces self-harm incidence at the population-level is still questionable.

Objective

This study aimed to quantify how the launch of Pokémon Go in Hong Kong affected the incidence of self-harm using a quasi-experimental design.

Methods

An interrupted time-series design with Poisson segmented regression adjusted for time and seasonality trends was used on data from 2012 to 2018 to detect any changes in the number of accident and emergency attendances due to self-harm, after Pokémon Go was launched. The findings were validated using a baseline control period and using other intentional injuries and minor noninjuries as control outcomes. We also assessed intervention effects by age group.

Results

From January 1, 2012 to July 31, 2018, there were 13,463 accident and emergency attendances due to self-harm in Hong Kong. During the period after launching Pokémon Go, self-harm attendances dropped by 34% (adjusted incidence rate ratio: 0.66, 95% CI 0.61-0.73). When analyzed by age group, a reduction in self-harm incidence was only apparent in adults (18 to 24 years of age: adjusted incidence rate ratio: 0.78, P=.02; 25 to 39 years of age: adjusted incidence rate ratio: 0.75, P<.001; 40 years of age and older: adjusted incidence rate ratio: 0.57, P<.001).

Conclusions

Self-harm incidence in the population, particularly in adults, showed a significant decline in the period after Pokémon Go was launched. Augmented reality games such as Pokémon Go show great promise as a tool to enhance psychosocial well-being and improve mental health.

Manipulating Self-Avatar Body Dimensions in Virtual Worlds to Complement an Internet-Delivered Intervention to Increase Physical Activity in Overweight Women

Virtual reality has been found to be a useful tool for positively influencing relevant psychological variables in order to increase physical activity (PA), especially in the overweight population. This study investigates the use of avatars and their physical variations to extend the effectiveness of existing interventions to promote PA. The main objective is to analyze the influence of the avatars' body dimensions on the efficacy of an Internet intervention to increase PA levels and improve other relevant variables (motivation toward PA, enjoyment, anxiety, self-efficacy, and PA goals). A total of 42 overweight women received a brief online intervention, and they were randomly assigned to one of three conditions: the "Ideal avatar" (IAC: participants are represented by avatars with ideal body dimensions); the "Real avatar" (RAC: participants are represented by avatars with participants' current body dimensions); and the "Non avatar" (NAC: participants are not represented by avatars). Results showed that the online intervention was effective in increasing PA practice and self-efficacy expectations. However, manipulating the body dimensions of avatars did not improve this intervention, although ideal avatars helped to reduce the anxiety experienced during PA in this population.