Active video games in fully immersive virtual reality elicit moderate-to-vigorous physical activity and improve cognitive performance in sedentary college students

Enhancing medical education for undergraduates: integrating virtual reality and case-based learning for shoulder joint

BACKGROUND

The integration of Virtual Reality (VR) with Case-Based Learning (CBL) has the potential to revolutionise undergraduate medical education, particularly in complex subjects such as the anatomy and rehabilitation of the shoulder joint. This study aimed to explore the effectiveness of this innovative approach in enhancing learning outcomes and knowledge retention.

METHODS

This study employed a parallel-group, assessor-blinded randomised controlled trial (RCT) design. A comprehensive five-week educational programme was developed, combining traditional lecture-based learning with VR-enhanced CBL. The study involved 82 undergraduate students from China Medical University, who were divided into groups receiving different combinations of VR and CBL. Student performance was evaluated through tests and questionnaires.

RESULTS

In the anatomy-related courses, the integration of VR technology with CBL yielded significantly higher results (87.71 ± 5.60) compared to traditional methods (82.59 ± 6.64), with a statistically significant difference (P < 0.05). This provides compelling evidence of VR's potential to enhance student engagement and knowledge retention. In the context of physiotherapy-related courses, however, while the test scores of the VR-combined CBL group (81.85 ± 5.99) were marginally higher than those of the traditional CBL group (79.02 ± 7.57), this difference was not statistically significant (P > 0.05).

CONCLUSION

The present study provides preliminary evidence for the benefits of incorporating VR into medical education, particularly in anatomy. While the results are promising, further research is needed to explore the optimal integration of VR and CBL in rehabilitation studies and to assess their long-term impact on student learning and clinical performance.

TRIAL REGISTRATION

The study was registered with Chinese Clinical Trials Registry (Registration Number: ChiCTR2400089295) on 05/09/2024.

Immersive virtual reality is more effective than non-immersive devices for developing real-world skills in people with intellectual disability

BACKGROUND

People with intellectual disability (ID) demonstrate persistent challenges around developing life skills. Immersive virtual reality (IVR) is gaining interest as a tool for training life skills as it enables individuals to engage in hands-on learning in a safe, controlled and repeatable environment. However, there are concerns about the potential drawbacks of IVR, such as cybersickness and practical challenges with using the equipment, which may hinder its widespread adoption in educational settings. The current study aimed to compare the effectiveness of training in IVR and a non-immersive virtual environment for improving real-world skills in people with ID.

METHODS

In the present study, 36 adults (16 female, 20 male) with ID were recruited from a disability organisation. Participants completed a real-world assessment of waste management skills before and after training in either the IVR or non-immersive group.

RESULTS

Consistent with our hypotheses, the IVR group scored significantly higher in the real-world assessment after virtual training (d = 1), and at the 1-week follow-up (d = 1.12), compared with the non-immersive group. Further analyses showed that the IVR group, but not the non-immersive group, significantly improved performance in the real-world assessment across timepoints.

CONCLUSIONS

The findings indicate that IVR was more effective for improving and retaining real-world waste management skills. This study supports IVR as a viable tool for professionals and caregivers to develop skills for independent living among people with ID.

Active Virtual Reality Games: Comparing Energy Expenditure, Game Experience, and Cybersickness to Traditional Gaming and Exercise in Youth Aged 8-12

Objective: The purpose of this study was to (1) quantify the oxygen consumption (VO2) and heart rate (HR) of virtual reality (VR) exergaming in youth, (2) compare the physical activity intensity of VR gaming to moderate-intensity thresholds, and (3) quantify the game experience and cybersickness of VR gaming, compared with traditional gaming. Material and Methods: Youth (N = 28; age, 9.4 ± 1.2 years) completed 10-minute conditions: seated rest, seated videogame Katamari Forever (SVG-KF), treadmill walking (TW) (5.6 km/h, 0% grade), and VR exergames Beat Saber (BS) and Thrill of the Fight (TOF) while VO2 and HR were collected. Game experience and Child Simulator Sickness Questionnaires were collected after gameplay. Results: VO2 and HR for BS (9.1 ± 3.0 mL/kg/min and 119 ± 15 bpm), TW (17.1 ± 2.4 mL/kg/min and 135 ± 15 bpm), and TOF (16.9 ± 5.4 mL/kg/min and 145 ± 19 bpm) were significantly higher than that at rest (4.2 ± 1.5 mL/kg/min and 94 ± 12 bpm) and for SVG-KF (4.3 ± 1.3 mL/kg/min and 94 ± 12 bpm). BS was light-to-moderate, whereas TW and TOF were of moderate intensity based on HR and metabolic equivalents (METs). For game experience, SVG-KF (1.6 ± 1.6) was less challenging than BS (3.3 ± 1.0) and TOF (3.1 ± 1.1). BS was more visually satisfying (3.5 ± 0.7 vs 2.7 ± 0.9) and required more concentration than SVG-KF (3.6 ± 0.7 vs 3.1 ± 1.1). TOF (3.4 ± 0.8) was more fun than SVG-KF (2.8 ± 0.7). Two youths (7%) experienced cybersickness symptoms, but neither requested to stop play. Oculomotor symptoms (0.6 ± 0.9), although minimal, were significantly greater than nausea (0.2 ± 0.5) and disorientation (0.3 ± 0.6) in both games. Conclusions: VR exergames provided light- to moderate-intensity exercise, challenge, visual stimulation, attention, and fun with minimal cybersickness symptoms, compared with conventional gameplay in youth.

The impact of an immersive digital therapeutic tool on experimental pain: a pilot randomized within-subject experiment with an active control condition

Background

Pain is a complex and multifaced sensory and emotional experience. Virtual reality (VR) has shown promise in reducing experimental pain and chronic pain. This study examines an immersive VR environment initially designed for endometriosis patients, which demonstrated short-term analgesic effects. The research aims to determine the impact of the VR environment on experimental pain intensity and unpleasantness both during and after VR exposure (3D with binaural beats), while using an active control condition (2D with no binaural beats). Additionally, a secondary objective of the study was to identify the psychological and psychophysical factors that predict the analgesic effects of the immersive digital therapeutic tool.

Methods

The study involved twenty-one healthy individuals and used a within-subject design, comparing a VR treatment with an active control condition. Continuous heat stimulation was applied to the left forearm with a Peltier thermode. Pain ratings were collected for immediate and short-term effects.

Results

In both the VR and Control conditions, there were no significant differences in pain intensity before, during, and after exposure. However, during VR exposure, there was a significant decrease in pain unpleasantness as compared to before exposure (p < 0.001), with a 27.2% pain reduction. In the Control condition, there were no significant differences in pain unpleasantness during and after exposure. Furthermore, no psychological and psychophysical factors predicted the analgesic effects.

Discussion

The study investigated how a VR environment affected experimentally induced pain in healthy volunteers. It showed that VR reduced pain unpleasantness during exposure but had no lasting impact. The VR environment mainly influenced the emotional aspect of pain, possibly due to its inclusion of binaural beats and natural stimuli. The study suggests that the VR environment should be tested in chronic pain population with high distress levels.

Registration number clinicaltrialsgov

NCT06130267.

Examining and Comparing the Energy Expenditure of Two Modes of a Virtual Reality Fitness Game (Supernatural): Indirect Calorimetry Study

BACKGROUND

The effectiveness of virtual reality (VR) fitness games as a form of moderate to vigorous physical activity has yet to be thoroughly quantified through gold standard energy expenditure measures.

OBJECTIVE

The purpose of this study was to examine the energy expenditure of 2 medium-intensity modes ("Flow and "Boxing") of a VR fitness game, Supernatural, using indirect calorimetry.

METHODS

Indirect calorimetry was used to examine relative and objective maximal oxygen consumption (VO2 max), metabolic equivalents of task (METs), and calories burned during medium-intensity bouts of both Flow and Boxing gameplay modes in young (mean age 25.42, SD 3.25 years), active individuals (n=12 female and n=11 male). METs and calories were also compared using a triaxial waist-worn accelerometer, an Apple smartwatch, and a VR headset. Mood states were assessed pre- and postbout using the shortened Profile of Mood States Questionnaire. Paired 2-tailed t tests were used to examine differences in game modes, between sexes, and pre-post exercise sessions.

RESULTS

Objective and relative VO2 max averaged 1.93 (SD 0.44) L/min and 27.61 (SD 5.60) mL/kg/min, respectively, between modes. Flow (mean 8.2, SD 1.54 METs) and Boxing (mean 7.6, SD 1.66 METs) are both classified as high energy expenditure, vigorous activities. Calorie expenditure data of the accelerometer and VR headset differed significantly from the metabolic cart. Mood changes pre- to post exercise were consistent with expected values for moderate- to vigorous-intensity physical activity, with participants reporting that they felt more "active," "full of pep," "vigorous," and "lively" (P<.05) following bouts. Male individuals reported higher objective oxygen consumption (VO2) for both Flow and Boxing modes; no other sex-specific differences were observed.

CONCLUSIONS

Both Flow and Boxing gameplay modes of Supernatural classify as vigorous physical activity and demonstrate the potential to promote mental and physical health benefits. Supernatural may be an effective exercise modality in a VO2 training program.

Application of immersive virtual reality in the training of wheelchair boxers: evaluation of exercise intensity and users experience additional load- a pilot exploratory study

BACKGROUND

Over the last few years, there has been a growing interest in workout apps and active virtual reality video games (AVRGs), which provide entertainment and enable users to undertake various forms of physical activity (PA) at home. Presumably, these types of exercises can be particularly useful for people with physical disabilities, who experience problems with access to sports and leisure facilities due to architectural and communication barriers. However, it is interesting whether the intensity of PA in VR is high enough to provide users with health benefits, as it is mainly based on arm movements.

OBJECTIVE

The main aim of the study was to evaluate the intensity of physical exercise of wheelchair boxers during a boxing training session using the FitXR app in immersive VR in light of health-related PA recommendations. The effect of Velcro-fastened hand-held weights (HHWs) on the intensity of PA undertaken by people in VR was also examined, and the attractiveness of virtual exercise were assessed in the opinion of users.

METHODS

PA intensity was evaluated using a heart rate monitor based on the percentage of maximal heart rate (% HRmax) and the Borg's rating of perceived exertion (RPE 6-20). The attractiveness perceived during exercise by users were evaluated using the Physical Activity Enjoyment Scale (PACES 1-7 scale).

RESULTS

The study shows that the exercise intensity of the athletes during wheelchair boxing training in VR is at a beneficial moderate level for health (HRave=68.98% HRmax). The use of HHWs (0.5 kg) does not significantly increase the PA intensity of the individuals during virtual exercise. Users with disabilities highly rated the attractiveness (6.32 ± 0.79 points) of PA during virtual boxing training.

CONCLUSIONS

Boxing exercises in VR can be an attractive and health-related form of PA for wheelchair boxers and a supplement to their conventional training.

Training using a commercial immersive virtual reality system on hand–eye coordination and reaction time in students: a randomized controlled trial

Abstract

The implementation of VR games opens up a wide range of opportunities for the development of dexterity, speed and precision of movements among various professional groups. The aim of this study was to investigate the effects of a commercial immersive VR music game on hand–eye coordination and reaction time speed in students. This study enrolled 32 individuals, randomly assigned to the experimental or control group. The intervention consisted of a 15-min training session of the immersive music game “Beat Saber”, once a day for 5 consecutive days. The primary outcomes included reaction time measurements: the plate tapping test and the ruler-drop test (Ditrich's test), trial making test (TMT) A and TMT B to assess coordination and visual attention, likewise VR sickness assessment by Virtual Reality Sickness Questionnaire (VRSQ). The secondary outcome included an energy expenditure assessment (SenseWear Armband). The data analysis revealed a statistically significant improvement in hand–eye coordination in the experimental group, with no improvement in the control group. The results were similar in measurements of reaction time. Analysis of the VRSQ questionnaire results showed a statistically significant reduction in oculomotor domain symptoms and total score during successive training days. The immersive VR music game has the potential to improve reaction time and hand–eye coordination in students.

Graphical abstract

Effects of exergaming on executive functions of children: a systematic review and meta-analysis from 2010 to 2023

BACKGROUND

Executive function plays a crucial role in children's cognitive development, academic performance, as well as their physical and mental health. This study aims to assess the impact of exergaming on executive functions in pediatric populations.

METHODS

The criteria of inclusion were randomized controlled trials of exergaming intervention and evaluation of executive function in children aged 4-12 years. A meta-analysis was performed in databases of China National Knowledge Infrastructure (in Chinese), Wan Fang (in Chinese), Web of Science, Embase, and PubMed, from January 2010 to February 2023, following the PRISMA guidelines. Risk of bias was assessed by the Jadad scale, the Cochrane risk of bias assessment tool, funnel plot, and regression-based Egger test. The Review Manager 5.3 was used to analyze the included articles using a random-effects model, and the effects were calculated as standardized mean difference (SMD).

RESULTS

Eleven experimental studies with children (n = 508) were included. Exergaming was found to have a positive impact on children's cognitive flexibility (SMD = 0.34, 95%CI [0.17,0.52], P < 0.01), inhibitory control (SMD = 0.57, 95%CI [0.31,0.83], P < 0.01), and working memory (SMD = 0.26, 95%CI [0.02,0.51], P < 0.05). The publication bias were observed.

CONCLUSIONS

Exergaming has the potential to improve executive functions in children. More studies with rigorous designs are warranted to explore the specific effects of exergaming intervention. This study was registered on the PROSPERO (CRD42023401526).

Intensity of a Physical Exercise Programme Executed through Immersive Virtual Reality

Evidence suggests that moderate to vigorous physical activity (MVPA) is necessary for health benefits. Immersive virtual reality is a technology that uses images, sounds, and tactile sensations from a simulated world to encourage healthy behaviours and physical activity. The aims of this research are (1) to determine the duration and intensity of physical activity performed through immersive virtual reality; (2) to determine differences in physical activity intensity according to gender.

METHODS

A nonprobabilistic convenience sample composed of 39 university students of physical education pedagogy, who performed, through immersive virtual reality, a physical activity programme composed of three levels that progressively increased in complexity. Physical activity intensity was measured using accelerometers.

RESULTS

Of the three levels, the most complex was not the one that produced the most minutes of MVPA. The three levels added up to 08:53 min of MVPA. No significant differences were found when comparing them by sex.

CONCLUSIONS

The results of this study suggest that an exercise programme delivered through immersive virtual reality generates MVPA levels, with no major differences between sexes. Further research is needed to confirm the contribution of immersive virtual reality to physical activity.

Acute effects of exergaming on young adults' energy expenditure, enjoyment, and self-efficacy

This study investigated the effects of a dance-based exergaming on Chinese college students' energy expenditure, self-efficacy, and enjoyment in comparison with the traditional aerobic dance exercise. Forty young adults (33 females; Mage = 21.55 years, SD = 2.06) completed two separate 20 min exercise sessions with 10 min intervals on the same day: (1) Xbox 360 Kinect Just Dance exergaming session; and (2) a traditional instructor-led aerobic dance exercise session. Participants' energy expenditure (Kcal/session) was measured by the ActiGraph GT9X Link accelerometers, and their perceived self-efficacy and enjoyment were assessed via validated surveys following each session. Dependent t-test indicated significant differences in participants' enjoyment (t = -1.83, p = 0.04). Specifically, participants in the dance-based exergaming session reported a higher level of enjoyment (M = 3.96, SD = 0.65) as compared to the aerobic dance session (M = 3.61, SD = 0.54). However, there was no significant difference in energy expenditure and self-efficacy between the two sessions. Findings suggest that college students had comparable energy expenditure as the traditional aerobic dance session while experiencing more fun and enjoyment. This suggests that exergaming can be a fun exercise alternative for promoting physical activity among young adults.

The effect of different combinations of physical activity and natural environment videos on children's attention levels between class breaks

BACKGROUND

Physical activity intervention and watching natural environment videos have been proven to improve young children's attention levels. However, evidence comparing the improvement effects of different combinations of the two activities has rarely been reported. By comparing the differences in the improvement effects of four combinations of physical activities and watching natural environment videos on young children's attention levels, this study can enrich the evidence in this research field and also provide a reference for arranging effective intervention methods for children's attention recovery between classes.

METHOD

A total of 152 children aged 4 to 6 years were recruited and randomly divided into four intervention groups: (1) physical activity intervention first and thereafter watching a natural environment video group (activity + video group), (2) watching a natural environment video first and thereafter the physical activity intervention group (video + activity group), (3) physical activity-based group, and (4) natural environment video-based group. Physical activity involved 4 min of moderate-intensity basic physical fitness combination training. The subjects wore the Pico Neo pioneer version of the VR glasses all-in-one machine to watch a natural environment video. Thereafter, population sociological variables and daily physical activity levels were investigated. Auditory and visual sustained attention tests were performed before and after intervention in each group.

RESULT

The auditory attention post-test scores of the four groups showed an improvement trend compared with the pretest scores. In particular, the activity + video group (F = 10.828; ɳp2 = 0.226; p = 0.002) and natural environment video-based group (F = 9.452; ɳp2 = 0.203; p = 0.004) have the best improvement effect. For visual attention, only the activity + video group showed a significant improvement trend (F = 4.287; ɳp2 = 0.104; p = 0.045), while the other three groups showed a downward trend in scores.

CONCLUSIONS

Among the different intervention combinations, the physical activity intervention first and watching natural environment videos thereafter group has the best effect on improving children's attention during recess. Physical activity interventions at the end of recess adversely affect young children's visual attention levels at the beginning of the class. Therefore, this study recommends that children should not engage in physical activity interventions in the second half of the class break. Lastly, the current research recommends presenting the content of physical activity interventions first and further improving their attention thereafter by watching natural environment videos.

The effect of narrative element incorporation on physical activity and game experience in active and sedentary virtual reality games

Narratives are pervasive in video games and have been found to increase physical activity in active video games. However, the effect of incorporating narrative elements has seldom been examined in fully immersive virtual reality games. We investigated the effect of narrative element incorporation (between-subject: narrative vs. no narrative) in active virtual reality and sedentary virtual reality games (within-subject) and examined between- and within-subject effects on physical activity behavior, game experience, and physical activity engagement. We randomized 36 sedentary college students to either the narrative or the non-narrative group. All participants played an active virtual reality and a sedentary virtual reality game in counter-balanced order. Before each game session, they either watched a 5-min narrative video (narrative) or directly played the original virtual reality games without narratives (non-narrative). We collected participants' physical activity data using wrist-worn accelerometers; we obtained their game experience and physical activity engagement via questionnaires. The narrative group spent a greater proportion of time in moderate-to-vigorous physical activity (%) and had less non-movement time during the active virtual reality gameplay than the non-narrative group (all p values < .05). The active virtual reality sessions induced a greater positive affect and greater physical activity engagement ratings than the sedentary virtual reality sessions. The incorporation of narrative elements in active virtual reality increased the relative time spent in moderate-to-vigorous physical activity and reduced non-movement time, compared to the non-narrative group. Active virtual reality encouraged more activity by participants and offered them a more enjoyable gaming experience in which they engaged more. Active virtual reality is a feasible physical activity promotion option among sedentary adults; the incorporation of narrative elements in active virtual reality helps increase relative moderate-to-vigorous physical activity and should be further explored for its efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00754-7.

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.

Effects of Exergaming on College Students' Situational Interest, Self-Efficacy, and Motion Sickness

Objective: Given the low levels of physical activity (PA) among U.S. college students, the use of exergaming as a supplement to traditional exercise may promote higher levels of motivation and PA. Therefore, this study’s purpose was to examine the effect of two different exergames on college students’ situational interest (SI), self-efficacy (SE), and equilibrium change (EQC) compared to traditional treadmill walking. Methods: Sixty college students (30 female; Mage = 23.6 ± 4.1 years; MBMI = 23.9 ± 4.0 kg/m2) participated in three separate 20 min exercise sessions: (1) Xbox 360 Kinect Just Dance; (2) Xbox 360 Kinect Reflex Ridge; and (3) traditional treadmill walking at 4.0 mph. Participants’ SI, SE, and EQC were measured after each session using a series of validated surveys. Results: A mixed model analysis of covariance (ANCOVA) with repeated measures evaluated mean differences between exercise sessions for all outcomes. Significant main effects were observed between the three exercise sessions (all p < 0.01). Specifically, Just Dance and Reflex Ridge sessions yielded significantly higher SI scores than treadmill exercise, F (10, 49) = 54.61, p < 0.01, η2 = 0.92. In addition, participants experienced significantly lower EQC in Reflex Ridge than in treadmill exercise, F (2, 58) = 4.26, p = 0.02, η2 = 0.13. No differences were identified for SE. Conclusion: The integration of exergaming into traditional exercise routines may help to promote higher levels of SI but not SE amongst college students. RR exergaming also demonstrated low EQC as compared to traditional exercise. Experimental study designs are warranted to provide additional evidence on the efficacy of exergaming.

Psychological safety of students in interaction with virtual reality

In the current situation, the relevance of studying the problems of the psychological security of the individual, the conditions and technologies that ensure its safe formation and development is increasing. The article presents an overview of foreign studies of the peculiarities of the influence of virtual reality technologies on the psychological safety of students, specialists, pensioners in situations of specially organized training. The results of studies of the psychological safety of a person in the context of the development of cognitive abilities, psychological well-being, mental and psychological health are analyzed. It is shown that interventions in virtual reality and game models based on virtual reality technologies used in education allow students to overcome the risks and threats to psychological security. The necessity of developing virtual reality technologies is substantiated, taking into account the goals of training and the conditions for their use by students of different ages, in different professional fields and cultures to ensure the psychological safety of the individual.