Using Virtual Reality to Distract Overweight Children from Bodily Sensations During Exercise

Impact of virtual reality immersion on exercise performance and perceptions in young, middle-aged and older adults

This study compared the effect of high and low levels of virtual reality (VR) immersion during moderate and high intensity cycling-exercise in younger (18-35 years), middle-aged (36-50 years), and older (51-69 years) adults. Thirty participants (5 female and 5 males per age group) completed moderate (steady state: 15 minutes at 60-75% maximum heart rate (MHR)) and high (sprint: 10 x 30 second sprints at 75-85% MHR) intensity cycling in four conditions: VR using a head-mounted display (High HMD), room-projector (Low Room), screen-projector (Low Screen) and No VR. Exercise performance measures (cadence, distance, power output) were recorded. Following each VR condition, exercise enjoyment (PACES) and exercise engagement (Flow State Scale) were measured. Results showed that exercise intensity had a significant effect of age on; heart rate (steady state and sprint), cadence (sprint) and distance (sprint) (p's <0.05). A significant effect of condition was observed during the sprint exercise for heart rate (p < 0.05). No other significant condition effects were observed for exercise performance. Significant effects of condition were identified for exercise engagement relating to sense of control (p < 0.01) and loss of self-consciousness (p < 0.05) with the highest values occurring in the Low Screen condition for all age groups, while transformation of time was significantly different (p < 0.05) for the middle-aged adults (highest during High VR and Low Screen). These results indicate that irrespective of age, participants found themselves in control and immersed more during the Low Screen VR condition than the other VR and No VR conditions. The findings indicate that VR immersion impacts exercise performance and exercise engagement in different age-groups and therefore should be considered when using VR to promote exercise behaviour.

Effects of Perceptual-Cognitive Training on Anticipation and Decision-Making Skills in Team Sports: A Systematic Review and Meta-Analysis

Team sports require athletes' exceptional perceptual-cognitive skills, such as anticipation and decision-making. Perceptual-cognitive training in laboratories aims to enhance these abilities. However, its effectiveness in real-game performance remains controversial, necessitating a systematic review and meta-analysis to determine optimal training methods. Following the PRISMA guidelines, we searched databases (e.g., PubMed, WOS, Scopus, and EBSCO) for relevant studies published before November 2023, assessed study quality, extracted important characteristics, and conducted a meta-analysis using Stata 15.1. This study was registered in PROSPERO (CRD42023494324). A total of 22 quantitative studies involving 45 effect sizes were included. Perceptual-cognitive training positively influenced elite athletes' anticipation and decision-making. However, its transfer effect on real-game performance improvement (ES = 0.65) was inferior to laboratory performance improvement (ES = 1.51). Sub-group analyses indicated that the effects of training interventions varied based on stimulus presentation and intervention duration. Based on our findings, we concluded that while perceptual-cognitive training improved on-court performance, its transfer effects were limited. To maximize effectiveness, future interventions should use virtual reality to present training stimuli and incorporate participants' sport-specific responses to reflect real-game scenarios.

Assessment of the intensity and attractiveness of physical exercise while playing table tennis in an immersive virtual environment depending on the game mode

BACKGROUND

It appears that active video games (AVGs) and training apps that allow for physical activity (PA) in immersive virtual reality (VR) may be useful for sports, health-enhancing PA, and physical education (PE). Therefore, research is needed to identify their potential.

OBJECTIVE

The study aimed to evaluate the intensity and attractiveness of exercise during table tennis (TT) training in VR in arcade and simulation modes and to assess the potential for using such exercises in health-enhancing PA, sport, and PE.

METHODS

The research used the Racket Fury: Table Tennis VR. Exercise intensity during TT training in VR was evaluated by heart rate (HR) monitoring and rating of perceived exertion (RPE 6-20). The effectiveness of short-term TT training in VR was estimated based on the user's performance in playing against an opponent with artificial intelligence (AI), satisfaction with playing TT was measured using the Physical Activity Enjoyment Scale (PACES), and the potential usefulness of the tested app in PA, sport, and PE was assessed based on a questionnaire for participating PE teachers (30 participants).

RESULTS

PA intensity during TT training in VR expressed as a percentage of maximum heart rate (HRmax) was moderate but was significantly (p < 0.001; d=-0.830) higher in the easier arcade mode (69.50 ± 12.58%HRmax) than in the simulation mode (64.10 ± 9.67%HRmax). Despite the greater fatigue of respondents, user satisfaction was significantly higher in arcade mode. Users' performance when playing with AI was significantly better after 20 min of training in VR than before training. PE teachers recognize the great potential of the app.

CONCLUSIONS

The application tested is characterized by a beneficial PA intensity, with its level depending on the game mode. Facilitating strokes during a game of virtual TT promotes increased intensity of exercise and increased enjoyment of the PA. Short-term TT training in VR improves playing skills in a virtual environment. PE teachers spoke highly of the app and recognized the potential for using VR technology in PA, sports, and school PE.

Effect of Elastic Resistance on Exercise Intensity and User Satisfaction While Playing the Active Video Game BoxVR in Immersive Virtual Reality: Empirical Study

Background

One of the main contemporary forms of physical activity (PA) involves exercises and games in an immersive virtual reality (VR) environment, which allows the user to practice various forms of PA in a small space. Unfortunately, most of the currently available VR games and workout applications are mostly based on upper body movements, especially the arms, which do not guarantee sufficiently high exercise intensity and health benefits. Therefore, it is worth seeking solutions to help increase the exercise load during PA in VR.

Objective

The main aim of this study was to evaluate the effect of elastic arm resistance in the form of latex resistance bands of different elasticity levels on the intensity of students' PA while playing the BoxVR game. We further assessed the satisfaction of this form of exercise and its associations with PA intensity.

Methods

A total of 21 healthy and physically fit men (mean age 22.5, SD 2.0 years) were included in the study. The tests consisted of 3 10-minute games. One game was run with no load and the other two were run with 1.5-meter latex resistance bands (low and high resistance). The order of the tests was randomized and the participants rested for 20 minutes after each exercise. Exercise intensity was estimated using objective (heart rate monitoring) and subjective (Borg scale) methods. The Physical Activity Enjoyment Scale was used to assess satisfaction with the PA. The effect of elastic resistance on exercise intensity and user enjoyment was estimated using ANOVA for repeated measures.

Results

The ANOVA results indicated that incorporation of elastic resistance caused a significant change (F2,40=20.235, P<.001; η²p=0.503) in the intensity of PA in VR, which was low while playing without resistance and then increased to a moderate level with additional resistance. The use of elastic bands also changed participants' perceptions of the enjoyment of exercise in VR (F2,40=9.259, P<.001; η²p=0.316). The students rated their satisfaction with PA in VR on a 7-point scale highly and similarly when exercising without an upper limb load (mean 6.19, SD 0.61) and with slight elastic resistance (mean 6.17, SD 0.66), whereas their satisfaction declined significantly (mean 5.66, SD 0.94) when incorporating a higher load.

Conclusions

The intensity of PA among students playing the BoxVR game is at a relatively low level. With the added resistance of elastic bands attached to the upper limbs, the intensity of the exercise increased to a moderate level, as recommended for obtaining health benefits. Participants rated the enjoyment of PA in VR highly. The use of slight elastic resistance did not negatively affect satisfaction with the BoxVR game, although user satisfaction declined with a higher load. Further research should be undertaken to increase the effectiveness of exercise in VR so that regular users can enjoy the health benefits.

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.

Want to be fit? Start with your mind! The role of the placebo effect in physical fitness in children: a preliminary systematic review and meta-analysis

Physical activity is crucial to prevent and reduce excess body mass. The placebo effect can influence the outcomes of fitness-related interventions; however, this topic has not yet been extensively investigated in children. Summarising the data on placebo effects in fitness-related interventions is essential to understand this problem better. A systematic review of PubMed, Cochrane, PsycINFO, PsycARTICLES, TripDatabase and Embase was carried out. A meta-analysis of the results of studies with comparable research plans was performed. There were significant differences, favouring the placebo intervention. At the final follow-up, the children in placebo groups had higher maximal heart rates, shorter recovery times, longer ergometry phases, running time and lower peak and average perceived exertion than the control. The placebo effect is present in fitness-related parameters in children, regardless of the Body Mass Index status. It is crucial, as for youth with excess body mass, it is difficult to be active, especially to show appropriate levels of motivation and involvement. Importantly, the benefits of the placebo were the strongest in the motivation/ engagement-related parameters and self-assessed exertion. Notably, the nocebo effect was not observed, which is advantageous when considering placebo interventions in practice.

Recreational cycling provides greater satisfaction and flow in an immersive virtual environment than in real life

BACKGROUND

As the state of satisfaction and flow involved in the physical activity (PA) determines future training commitment, it is undoubtedly very important to study the factors influencing the attractiveness of PA. One of such factors is the usage of virtual reality (VR) technology which creates opportunities for its users to practice various forms of PA in a altered way. It is interesting whether PA practiced in a virtual environment can offer higher levels of satisfaction and flow comparing with PA practiced in the real world. Positive answer to this question support the statement that the use of such technology could contribute to the future commitment in PA. Therefore, in order to find out whether PA in VR can be an attractive alternative towards the PA in a real world, the research should be undertaken to verify if the state of satisfaction and flow involved in the practising certain PA in the VR environment could be higher comparing to the levels of pleasure and flow connected with the same PA carried out in the real world.

OBJECTIVE

The main objective of the study was to assess the level of satisfaction and flow experienced by healthy adults during various cycling conditions: real life (RL), non-immersive and immersive virtual reality (nIVR and IVR). Additionally, questionnaires for assessing satisfaction with PA and flow in RL and VR were also validated in terms of their measurement reliability. The correlation of the results obtained during tests using both measurement tools was also assessed.

METHODS

Forty students were studied, including 20 women (age 22.35 ± 2.32 years) and 20 men (age 22.95 ± 2.19 years). The Physical Activity Enjoyment Scale (PACES) was used to evaluate the enjoyment of cycling. Flow state was assessed using The Flow State Scale (FSS).

RESULTS

Based on Friedman's analysis of variance regarding the results obtained for all the respondents, it can be concluded that the conditions of cycling significantly affect their level of satisfaction (χ2 = 85.61(40;3); p < 0.001) and flow (χ2 = 40.52(40;3); p < 0.001). The research participants rated cycling the highest in IVR. Based on the calculated Cronbach's alpha coefficients, high measurement reliability of the questionnaires used in nIVR (PACES, α = 0.94; FFS-2, α = 0.86) and IVR (PACES, α = 0.89; FFS-2, α = 0.91). There was also a significant positive moderate correlation between PA satisfaction and user flow.

CONCLUSIONS

The research is the first attempt to directly compare the sense of satisfaction and flow when practicing cycling in RL and in nIVR and IVR. The greater attractiveness and higher level of flow during PA in IVR compared to a similar traditional form of PA in RL, found on the basis of the conducted research, should prompt reflection by both those involved in planning and promoting PA, as well as the creators of active video games (AVGs). Due to the great attractiveness of PA in IVR and the constant, dynamic development of immersive information technologies, virtual training may, in the near future, become not only an important supplement to conventional forms of exercise, but perhaps even an alternative solution.

Effect of virtual reality-based exercise and physical exercise on adolescents with overweight and obesity: study protocol for a randomised controlled trial

INTRODUCTION

Obesity is a complex and multifactorial disease that has affected many adolescents in recent decades. Clinical practice guidelines recommend exercise as the key treatment option for adolescents with overweight and obesity. However, the effects of virtual reality (VR) exercise on the physical and brain health of adolescents with overweight and obese remain unclear. This study aims to evaluate the effects of physical and VR exercises on physical and brain outcomes and explore the differences in benefits between them. Moreover, we will apply a multiomics analysis to investigate the mechanism underlying the effects of physical and VR exercises on adolescents with overweight and obesity.

METHODS AND ANALYSIS

This randomised controlled clinical trial will include 220 adolescents with overweight and obesity aged between 11 and 17 years. The participants will be randomised into five groups after screening. Participants in the exercise groups will perform an exercise programme by adding physical or VR table tennis or soccer classes to routine physical education classes in schools three times a week for 8 weeks. Participants in the control group will maintain their usual physical activity. The primary outcome will be the change in body fat mass measured using bioelectrical impedance analysis. The secondary outcomes will include changes in other physical health-related parameters, brain health-related parameters and multiomics variables.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Shanghai Sixth People's Hospital and registered in the Chinese Clinical Trial Registry. Dissemination of the findings will include peer-reviewed publications, conference presentations and media releases.

TRIAL REGISTRATION NUMBER

ChiCTR2300068786.

A systematic narrative review of extrinsic strategies to improve affective responses to exercise

Background

Extrinsic strategies affect the exercise experience but fall outside the frequency, intensity, time, and type (i.e., dose-determining) principles. To our knowledge, no systematic review has focused on extrinsic strategies to influence the affective responses to exercise. The objective was to identify extrinsic strategies that seek to influence affective responses during exercise and other motivationally relevant variables including post-exercise momentary affective valence, remembered and forecasted pleasure, and enjoyment.

Methods

For inclusion, eligible articles reported peer-reviewed original research, used acute bouts of exercise, and used a dimensional approach for measuring affective responses or measured enjoyment post-exercise. Web of Science, PubMed, and PsychINFO databases were last searched on 10th September 2021. Quality assessment was completed following the Effective Public Health Practice Project approach. Results were presented using a narrative synthesis.

Results

125 studies were included with sample descriptions, study design (extrinsic strategies, mode, type, intensity, and duration), measurement details, and results summarised for each study.

Conclusions

71% of studies were categorised as Weak according to the quality assessment tool with sampling practices (self-referred participants) and poor reporting of participant withdrawals/drop-outs the predominant reasons for Weak ratings. A wide variety of extrinsic strategies were reported with music, music videos, immersive virtual reality, outdoor exercise, caffeine, high-to-low pattern of exercise intensity, self-selected exercise intensity, and manipulation of self-efficacy offering promise as suitable strategies to positively change how people feel during exercise.

Systematic Review Registration

https://osf.io/jbh8v/.

Physical Activity in Immersive Virtual Reality: A Scoping Review

Physical activity has benefits for health, but many adolescents are inactive. However, video games such as Immersive Virtual Reality (IVR) have grown in popularity as a leisure activity among young people, allowing them to manipulate objects in virtual environments increasing the practice of physical activity. The evidence indicates that the interest in physical activity through IVR is greater than in traditional methods, and different experiences have been reported. However, few studies indicate the sample evaluated, the effects found, or the IVR instruments used. Due to this, is the aim of this study is to identify the publications referring to IVR and physical activity, characterize them, and present the obtained main findings. For this, the guidelines described in the PRISMA-ScR for scoping reviews were applied. After the use of the inclusion and exclusion criteria, eight articles were included. Results show evidence regarding physiological outcomes, perceptual variables, interest and enjoyment, and psychological effects regarding physical activity through IVR. Additionally, the use of different devices and their prescriptions are explored. It is concluded that there is interest from the scientific community for the practice of physical activity through IVR, as well as for its application for the maintenance of active habits. This is important as it positions IVR as a method that can be a more experiential and effective way to develop and maintain a healthy lifestyle.

Large Estimate Variations in Assessed Energy Expenditure and Physical Activity Levels during Active Virtual Reality Gaming: A Short Report

The purpose of the study was to compare methods for estimating energy expenditure (EE) and physical activity (PA) intensity during a 30 min session of active virtual reality (VR) gaming. Eight individuals (age = 25.4 ± 2.0 yrs) participated, with a maximal oxygen consumption (VO2max) of 41.3 ± 5.7 mL∙kg−1∙min−1. All tests were conducted over two days. An incremental test to determine the VO2max when running was performed on day 1, while 30 min of active VR gaming was performed on day 2. The instruments used for EE estimations and PA measurements were indirect calorimetry, a heart rate (HR) monitor, and waist- and wrist-worn accelerometer. Compared to indirect calorimetry, waist-worn accelerometers underestimated EE (mean difference: −157.3 ± 55.9 kcal, p < 0.01) and PA levels. HR-based equations overestimated EE (mean difference: 114.8 ± 39.0 kcal, p < 0.01 and mean difference: 141.0 ± 81.6 kcal, p < 0.01). The wrist-worn accelerometer was the most accurate in estimating EE (mean difference: 23.9 ± 45.4 kcal, p = 0.95). The large variations in EE have implications for population-based surveillance of PA levels and for clinical studies using active VR gaming.

Virtual self-conversation using motivational interviewing techniques to promote healthy eating and physical activity: A usability study

Introduction

We aim to examine the usability of a Virtual Reality (VR) platform, called ConVRSelf, which has been designed to address the needs of People Living With Obesity (PLWO).

Methods

Fourteen participants with a desire to eat healthier and exercise more (6 normal weight and 8 PLWO; Mean age = 41.86, SD = 13.89) were assigned to the experimental group (EG) or the control group (CG). EG participants, after being trained on motivational interviewing skills, engaged in a virtual self-conversation using embodiment and body swapping techniques, which aimed to normalize and resolve their ambivalence to change lifestyle habits. CG participants, embodied in their virtual bodies, participated in a pre-established discourse with a virtual counselor giving them psychoeducational advice about how to change lifestyle habits. A mixed-methods design was used, involving a semi-structured interview and self-report questionnaires, including readiness to change habits (Readiness Rulers), body ownership (Body Ownership Questionnaire, BOQ), and system usability (System Evaluation Questionnaire, SEQ). Thematic content analysis was carried out for qualitative data while statistical data analysis was carried out using SPSS 20.0.

Results

Participants from both groups showed high readiness to change lifestyle (Readiness Rulers) before engaging with the virtual experiences, which was maintained at the same level after the interventions and their scores on the SEQ and BOQ were satisfactory. Regarding qualitative information obtained from the interviews, almost all participants found the VR experience to be novel, interesting, and enjoyable. A higher acceptability was observed among PLWO from the EG than normal weight participants from the same group, a promising finding for the ConVRSelf platform, which had been specifically designed to address the needs of PLWO.

Conclusion

The ConVRSelf system is well-accepted by participants and is ready to be tested with PLWO in a clinical setting.

Decision-Making in Virtual Reality Sports Games Explained via the Lens of Extended Planned Behavior Theory

This study aims to determine whether the effect of interactivity on participation in virtual sports has risen because of the COVID-19 pandemic and if there is a difference in decision-making. The significance of social factors may be highlighted even more as a rationale for using virtual reality (VR) sports apps throughout the prolonged COVID-19 epidemic. A model was built based on the literature to describe the intention to participate in VR sports, and eight associated hypotheses were established. A sample of 301 submissions from a user poll on Korea's cycling information sharing website was used for our analysis. SPSS 23.0 (IBM, Armonk, NY, USA) and AMOS 18.0 (IBM, Armonk, NY, USA) were used to validate Hypotheses 1-8 using a multigroup structural equation model (SEM) analysis and multigroup analysis. Although some hypotheses were not validated, the impact of perceived interaction presented as an extra variable altered based on the group participating before and after the COVID-19 epidemic, and the study's goal was achieved. Given that information technology has evolved by overcoming physical space and socio-cultural constraints to create a society that connects people, the importance of online interaction, such as networking and competition between users, will be emphasized in the VR sports field in the future.

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.

Biomechanical fidelity of athletic training using virtual reality head-mounted display: the case of preplanned and unplanned sidestepping

Virtual reality has recently been recognised as an effective tool for investigating visual-perceptual tasks. To develop a sport-specific virtual environment with realistic locomotion, it is crucial to examine the effect of using virtual reality devices on athletes performing intense and complex movements. Twelve collegiate football players were instructed to perform pre-planned and unplanned sidestepping in both environments with the same dimension and experimental setup in the virtual environment as in the real one. Analysis of the performance and knee biomechanical parameters showed that movements performed in the two environments were generally comparable. Consistent changes in approach velocity and knee angle/moment under unplanned conditions (compared with preplanned conditions) were also found in the virtual environment as in the real one, except for the significantly larger peak flexion angle (p < .05) observed in the virtual environment. Interestingly, half of the participants changed from producing abduction to adduction moment at the weight acceptance phase in the preplanned condition (p < .05). These findings suggested that while it is generally feasible to use virtual reality head-mounted displays for designated experiments and training, the effect of wearing virtual reality devices could be somewhat subject-specific.

A Pilot Study on Attentional Focus in Prescribing Physical Exercise in Outpatients with Obesity

This pilot study compared the effects of two attentional focus strategies on fitness parameters and body composition in outpatients with obesity. This was a randomized, controlled study that enrolled 94 obese individuals and allocated them into an internal focus group (IF) or an external focus group (EF) while performing six weeks of a home-based training program. The home-based exercise program was the same for both groups except for the instructions that shifted the attention to an external or an internal condition. At the beginning and after the intervention period, participants were assessed for functional performance using the Functional Movement Screen (FMS), body balance using the Modified Balance Error Scoring System (M-BESS) and muscular strength with the Handgrip Strength Test (HST) and the Five-Repetition Sit-To-Stand (FRSTS) test. Concerning body composition and anthropometric parameters, the body mass index (BMI) and fat mass percentage (FM%) were calculated. Significant improvements, main interactions and effects of time and groups were highlighted in the EF group as compared to the IF group in FMS (35% vs. 21%), M-BESS (42% vs. 18%), HST (13% vs. 7%) and FRSTS (23% vs. 12%) measures, while FM% (5%) and BMI (6% vs. 5%) showed a similar improvement overtime (p < 0.001). In conclusion, our findings provide initial evidence that a 6-week training program performed following external focus instruction is able to promote significant enhancements in movement efficiency, balance and muscular strength as compared to an internal focus cue. Fitness coaches and therapists might consider integrating a specific attentional focus strategy when designing rehabilitation programs in subjects with obesity.

Effects of video-based training on anticipation and decision-making in football players: A systematic review

The training of athletes' anticipation and decision-making skills has received increasing attention from researchers, who developed and implemented training programs to achieve this. Video-based training (VBT) has become a popular method in anticipation and decision-making skills training. However, little is known about the benefits of implementing VBT in soccer. This systematic review considered the results of studies on VBT aiming to develop decision-making and anticipation skills in football players, and analyzed its effects. Literature published up to March 2022 was systematically searched on the scientific electronic databases Web of Science, PubMed, Scopus, SportDiscus, and Google Scholar. In total, 5,749 articles were identified. After screening the records according to the set exclusion and inclusion criteria, ten articles were considered eligible, including six longitudinal studies and four acute studies. Eight of the ten included studies (80%) showed that VBT group performance in anticipation or decision-making skills was significantly better at post-test than at pre-test, as evidenced by improvements in response accuracy (RA), response times (RT), mean distance scores (MDS) and passing decision-making performance. In six studies that included the no video-based training (NVBT) group, results showed that athletes in the VBT group performed better in anticipation or decision-making skills than in the NVBT group, as evidenced by improvements in RA and RT performance. The studies used different methods for VBT, both explicit and implicit training effectively improved participants' anticipation and decision-making skills. In addition, the implementation of the "first-person" perspective (i.e., the player's perspective) and virtual reality (VR) improved the presentation of video stimuli, effectively improving anticipation and decision-making. The findings of this review suggest that VBT is beneficial in developing anticipation and decision-making judgments in football players. However, some findings were inconsistent with previous studies due to differences in intervention duration and experimental protocols, and further studies are needed. Furthermore, future research should actively seek to design appropriate retention tests and transfer tests to truly understand the benefits of VBT for athletes.

Effect of Longitudinal Practice in Real and Virtual Environments on Motor Performance, Physical Activity and Enjoyment in People with Autism Spectrum Disorder: A Prospective Randomized Crossover Controlled Trial

(1) Background: People with ASD commonly present difficulty performing motor skills and a decline in physical activity (PA) level and low enjoyment of PA. We aimed to evaluate whether longitudinal practice of an activity in virtual and real environments improves motor performance and whether this improvement is transferred to a subsequent practice when changing the environment, promoting PA and providing enjoyment; (2) Methods: People with ASD, aged between 10 and 16 years, were included and distributed randomly into two opposite sequences. The participants performed a 10 session protocol, with five sessions practicing in each environment (virtual or real). Heart rate measurement was carried out and an enjoyment scale was applied; (3) Results: 22 participants concluded the protocol. Sequence A (virtual first) presented an improvement in accuracy and precision and transferred this when changing environment; they also had a greater change in heart rate reserve. The majority of participants reported "fun" and "great fun" levels for enjoyment; (4) Conclusions: The virtual reality activity presented a higher level of difficulty, with greater gains in terms of transference to the real environment. Considering PA, our task provided very light to light activity and the majority of participants enjoyed the task.

Global trends and hotspots in research on extended reality in sports: A bibliometric analysis from 2000 to 2021

Objective

Extended reality technologies (e.g. virtual reality (VR), augmented reality (AR) and mixed reality (MR)) are gaining popularity in sports owing to their unique advantages. This study aims to analyse the progress of the application of extended reality technology in sports and reveal its cooperative features, research hotspots and development trends.

Methods

We searched the literature in the Web of Science Core Collection (WoSCC) database within the period 2000 to 2021 and conducted a bibliometric analysis. The analysis methods included statistical, co-occurrence, hierarchical clustering and social network analyses.

Results

A total of 340 articles were gathered. The literature related to its research showed an increasing trend over time. The paper collaboration rate was 90.88% (309/340 papers), and the degree of author collaboration was 3.96 (1345/340). VR was found to be the most productive journal, and Queen's University Belfast was the most productive institution. The United States, China and the United Kingdom were the three main contributors to the field. The foundational themes in sports extended reality research were (i) sports games and extended reality systems, (ii) virtual simulation devices and artificial intelligence, (iii) sports training and performance and (iv) age-appropriate physical activity, sports rehabilitation and physical education.

Conclusion

The level of author collaboration was low, but the degree of author collaboration is largely on the rise. The closeness of the collaboration between institutions and countries was also low. In addition, the subject of sport extended reality is relatively fragmented. Therefore, more research is needed to strengthen it in the future.

Virtual Reality as a Surgical Care Package for Patients Undergoing Weight Loss Surgery: A Narrative Review of the Impact of an Emerging Technology

While bariatric surgery is regarded as the most effective treatment for people with severe and morbid obesity, its pathway is regarded as a complex one due to the multidisciplinary approaches required from pre-surgery education until long-term management. This is essential to maintain weight loss and improve the quality of life after bariatric surgery. Although these approaches are broadened, patient education, pre-operative preparation, behavioural therapy, rehabilitation, and dietary changes are regarded as the main domains in such complex care. With the increase in technological adaptation in medical services, virtual reality (VR) has shown many benefits that can be utilized in the care of bariatric patients undergoing surgery. However, VR has not been innovated to be a multidomain care package in which bariatric patients could benefit throughout their journey from the pre-operative optimization, recovery, and long-term follow-up. This review aims to give a brief description of some of the applications of VR technology and question whether it has the potential to be considered as a virtual ecosystem to improve the bariatric patients’ experience and pathway throughout surgery and follow-up.

Actual vs. perceived exertion during active virtual reality game exercise

Background

Virtual exercise has become more common as emerging and converging technologies make active virtual reality games (AVRGs) a viable mode of exercise for health and fitness. Our lab has previously shown that AVRGs can elicit moderate to vigorous exercise intensities that meet recommended health benefit guidelines. Dissociative attentional focuses during AVRG gameplay have the potential to widen the gap between participants' perception of exertion and actual exertion.

Objective

The aim of this study was to determine actual exertion (AEx) vs. perceived exertion (PEx) levels during AVRGs by measuring heart rate (HR) and ratings of perceived exertion (RPE) in two different settings.

Materials and methods

HR and RPE were collected on participants (N = 32; age 22.6 ± 2.6) during 10 min of gameplay in LabS and GymS using the HTC VIVE with the following games played: Fruit Ninja VR (FNVR), Beat Saber (BS), and Holopoint (HP).

Results

Participants exhibited significantly higher levels of AEx compared to reported PEx for all three AVRGs (Intensity): FNVR [AEx = 11.6 ± 1.8 (Light), PEx = 9.0 ± 2.0 (Very Light)], BS [AEx = 11.3 ± 1.7 (Light), PEx = 10.3 ± 2.1 (Very Light)], HP [AEx = 13.1 ± 2.3 (Somewhat Hard), PEx = 12.3 ± 2.4 (Light–Somewhat Hard)]. Additionally, participants playing in the GymS experienced significantly higher levels of AEx [12.4 ± 2.3 (Light–Somewhat Hard)] and PEx [10.8 ± 2.5 (Very Light–Light)] compared to the LabS [AEx = 11.6 ± 1.8 (Light), PEx = 10.3 ± 2.6 (Very Light–Light)].

Conclusion

Perceptions of exertion may be lower than actual exertion during AVRG gameplay, and exertion levels can be influenced by the setting in which AVRGs are played. This may inform VR developers and health clinicians who aim to incorporate exercise/fitness regimens into upcoming ‘virtual worlds' currently being developed at large scales (i.e., the “metaverse”).

Cadence Feedback and Video-Based Engagement Improves Motivation and Performance during Pedalling in Stroke Patients

Video and music as a dissociative attention stimulus during exercise is known to distract from the discomfort of physical exertion and improve exercise adherence; however, the influence of video-based feedback and engagement during pedalling on the performance and motivation of pedalling in stroke patients is poorly understood. The aim of this study was to employ a novel video-based engagement paradigm for pedalling in stroke patients and evaluate its capacity to influence the cadence control, physiological output, and perceived motivation and enjoyment. Thirteen stroke patients were recruited with low-to-moderate lower-limb disability (mean age: 64.0 yrs.). A reference group of 18 healthy young adult subjects (mean age: 27.7 yrs.) was also recruited to assess the broad applicability of the techniques to a contrasting non-pathological cohort. The participants pedalled at a slow (60 RPM) and fast (100 RPM) target speed with constant resistance in 15 min pedalling bouts that included (i) baseline pedalling with real-time visual feedback of cadence deviation from the target provided only in the first 20 s (ii) real-time visual feedback of cadence data over the entire pedalling session, and (iii) real-time engagement to maintain the playback rate of a prerecorded video by pedalling at the target speed. During low speed pedalling, stroke patients demonstrated significantly smaller absolute cadence deviation during pedalling with feedback (mean difference: 1.8 RPM, p = 0.014) and video-based engagement (mean difference: 2.4 RPM, p = 0.006) compared to the baseline pedalling. For the healthy adults, feedback and video-based engagement reduced cadence deviation significantly at all speeds (p < 0.05). All but one stroke patient either enjoyed or really enjoyed the video engagement during pedalling and felt motivated to undertake this form of exercise in therapy in the future. This proof-of-concept study showed that feedback and video-based engagement may improve the targeted pedalling performance in stroke patients, and by helping dissociate subjects from physical cues associated with fatigue, may ultimately improve exercise motivation and compliance.

Effects of technology-based physical activity interventions for women after bariatric surgery: study protocol for a three-arm randomised controlled trial

INTRODUCTION

A recent meta-analysis provided proof of efficacy for mobile technology to increase physical activity or weight loss in the short term. Videoconferencing may also be effective, especially as it reduces the barriers related to face-to-face physical activity interventions. Both technologies seem particularly interesting for bariatric surgery management, but their long-term effects on physical activity maintenance are unknown. Moreover, the mechanisms underlying their effectiveness, such as technology acceptability and motivational processes, have not been examined.The objectives of this study are to determine the effects of two technology-based (mobile technology and videoconferencing) physical activity programmes after bariatric surgery compared with standard care and to assess the contribution of acceptability and motivational mechanisms in explaining these effects on physical activity, physiological measures and health indicators.

METHODS AND ANALYSIS

One hundred and twenty young women who have undergone bariatric surgery in the last 3-6 months will be included. The volunteers will be randomly assigned to one of three arms: CONTROL (standard care), ACTI-MOBIL (mobile technology) or ACTI-VISIO (videoconferencing). The primary outcome is the distance travelled during a 6 min walk test relativised according to Capadaglio's theoretical distance. Secondary outcomes are behavioural measures of physical activity, physiological measures, health indicators, technology acceptability and motivational concepts. Data will be collected at baseline (T0), 3 months (T3) and 6 months (T6). The technology groups will receive a physical activity programme for 12 weeks (between T0 and T3). A mixed model approach will be used to analyse the change in outcomes over time for each group.

ETHICS AND DISSEMINATION

This study protocol was reviewed and approved by the French East 1 Protection of Persons Ethics Committee (number: 2020.A00172-37) and the French National Commission for Information Technology and Civil Liberties (number: UCA-R20-034). The results will be disseminated through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT04478331.

A Mindfulness-Based Physical Activity Intervention: A Randomized Pilot Study

OBJECTIVE

Most US adults are insufficiently active. One strategy individuals could use to increase physical activity is to exercise mindfully (i.e., while paying attention to present-moment experiences with acceptance. A mindfulness-based intervention for exercise can be delivered via an audio recording, which is advantageous in regard to time demands, cost, and dissemination potential. The aims of this parallel two-arm pilot randomized controlled trial were to assess the feasibility and acceptability of an audio-recorded mindfulness-based intervention and to assess whether the intervention resulted in a clinically meaningful difference in physical activity compared with the control condition.

METHODS

Physically underactive adults (N = 50) were randomized to a mindfulness intervention condition in which they were instructed to exercise while listening to an audio-recorded mindfulness-intervention or an active control group in which they were instructed to exercise while using a heart rate monitor. Participants completed a 30-minute moderate intensity treadmill exercise bout during a baseline in-laboratory session in the manner in which they were randomized (i.e., mindfulness recording versus using a heart rate monitor) and instructed to exercise in this manner for the next week. At follow-up, acceptability was measured by self-report, feasibility by frequency of intervention use, and physical activity using both self-reported physical activity recall and an accelerometer.

RESULTS

The audio-recorded mindfulness-based physical activity intervention was rated as acceptable and feasible to use. Compared with the control group, the intervention also resulted in clinically meaningful differences in self-reported moderate-to-vigorous physical activity minutes (mean difference = 67.16 minutes) and accelerometer-measured minutes (mean difference = 35.48 minutes) during a 1-week follow-up.

CONCLUSIONS

The audio-recorded mindfulness-based physical activity intervention is a promising approach to increasing physical activity with good dissemination potential.

Virtual reality for the enhancement of emotion regulation

In recent decades, a growing body of literature has focused on emotion regulation (ER), which refers to the ability to implement strategies in order to modulate emotional responses and reach desirable goals. To date, impaired ER (i.e., emotion dysregulation) has been identified as a transdiagnostic factor across a wide range of psychopathological conditions, which shows the importance of improving patients' ability to regulate negative and positive emotions in clinical practice. In addition to the increasing evidence showing its efficacy in the treatment of several clinical conditions, virtual reality (VR) has recently emerged as a potentially powerful tool for enhancing ER, thus breaking new ground in the development of cutting-edge transdiagnostic interventions. In the present narrative review, we will provide an overview of the existing evidence about VR-based interventions in the field of ER, emphasizing the promising findings and the barriers that still have to be addressed. To this aim, the available VR-based literature will be analysed in relation to four categories of ER strategies: situational strategies, attentional strategies, cognitive strategies, and response modulation strategies. Furthermore, new emerging fields of research targeting innovative aspects of ER will be highlighted, including the use of VR to promote positive emotions and interpersonal ER skills. Besides, its cost-effectiveness will be discussed, taking into account the costs for both developers (e.g., clinicians and researchers) and end-users. Finally, future directions in this promising field of research will be outlined.

Can Physical Activity in Immersive Virtual Reality Be Attractive and Have Sufficient Intensity to Meet Health Recommendations for Obese Children? A Pilot Study

Immersive virtual reality (IVR) is a technology that blurs the line between the physical world and a digital environment. Using appropriate pointing devices, it is possible to engage in physical activity (PA). The main aim of the study was to assess the attractiveness and intensity of physical exercise while playing active video games (AVGs) in IVR on an omnidirectional treadmill by obese children and to present the results compared to health recommendations (PA). It was also assessed whether the AVGs storyline can effectively motivate the participants to undertake locomotor activity by increasing the intensity of their effort (moving in a limited space vs. having to follow a set route). Eleven children aged 8 to 12 years with diagnosed obesity participated in the experiment. The attractiveness of PA was assessed with a questionnaire, while the intensity of exercise was estimated on the basis of heart rate. The answers show that AVGs are attractive and more enjoyable for the respondents than conventional video games. All participants declared their willingness to practice this form of PA. The intensity of PA of obese children during two games was high but during the game where the player was supposed to follow a set route, it was significantly higher (83.3 ± 9.2% HRmax) than during the game whose storyline assumed moving in a limited space (77.4 ± 9.8% HRmax). Due to the high intensity of PA while playing the AVGs studied, it can be assumed that obese children can benefit for their health if the games are used on a regular basis. However, further research is needed to verify this thesis.

Results and Guidelines From a Repeated-Measures Design Experiment Comparing Standing and Seated Full-Body Gesture-Based Immersive Virtual Reality Exergames: Within-Subjects Evaluation

BACKGROUND

Although full-body seated exercises have been studied in a wide range of settings (ie, homes, hospitals, and daycare centers), they have rarely been converted to seated exergames. In addition, there is an increasing number of studies on immersive virtual reality (iVR) full-body gesture-based standing exergames, but the suitability and usefulness of seated exergames remain largely unexplored.

OBJECTIVE

This study aimed to evaluate the difference between playing a full-body gesture-based iVR standing exergame and seated exergame in terms of gameplay performance, intrinsic motivation, and motion sickness.

METHODS

A total of 52 participants completed the experiment. The order of the game mode (standing and sitting) was counterbalanced. Gameplay performance was evaluated by action or gesture completion time and the number of missed gestures. Exertion was measured by the average heart rate (HR) percentage (AvgHR%), increased HR%, calories burned, and the Borg 6-20 questionnaire. Intrinsic motivation was assessed with the Intrinsic Motivation Inventory (IMI), whereas motion sickness was assessed via the Motion Sickness Assessment Questionnaire (MSAQ). In addition, we measured the fear of falling using a 10-point Likert scale questionnaire.

RESULTS

Players missed more gestures in the seated exergame than in the standing exergame, but the overall miss rate was low (2.3/120, 1.9%). The analysis yielded significantly higher AvgHR%, increased HR%, calories burned, and Borg 6-20 rating of perceived exertion values for the seated exergame (all P<.001). The seated exergame was rated significantly higher on peripheral sickness (P=.02) and sopite-related sickness (MSAQ) (P=.004) than the standing exergame. The score of the subscale "value/usefulness" from IMI was reported to be higher for the seated exergame than the standing exergame. There was no significant difference between the seated exergame and standing exergame in terms of intrinsic motivation (interest/enjoyment, P=.96; perceived competence, P=.26; pressure/tension, P=.42) and the fear of falling (P=.25).

CONCLUSIONS

Seated iVR full-body gesture-based exergames can be valuable complements to standing exergames. Seated exergames have the potential to lead to higher exertion, provide higher value to players, and be more applicable in small spaces compared with standing exergames. However, gestures for seated exergames need to be designed carefully to minimize motion sickness, and more time should be given to users to perform gestures in seated exergames compared with standing exergames.

Common themes and emerging trends for the use of technology to support mental health and psychosocial well-being in limited resource settings: A review of the literature

There are significant disparities in access to mental health care. With the burgeoning of technologies for health, digital tools have been leveraged within mental health and psychosocial support programming (eMental health). A review of the literature was conducted to understand and identify how eMental health has been used in resource-limited settings in general. PubMed, Ovid Medline and Web of Science were searched. Six-hundred and thirty full-text articles were identified and assessed for eligibility; of those, 67 articles met the inclusion criteria and were analyzed. The most common mental health use cases were for depression (n = 25) and general mental health and well-being (n = 21). Roughly one-third used a website or Internet-enabled intervention (n = 23) and nearly one-third used an SMS intervention (n = 22). Technology was applied to enhance service delivery (n = 32), behavior change communication (n = 26) and data collection (n = 8), and specifically dealt with adherence (n = 7), ecological momentary assessments (n = 7), well-being promotion (n = 5), education (n = 8), telemedicine (n = 28), machine learning (n = 5) and games (n = 2). Emerging trends identified wearables, predictive analytics, robots and virtual reality as promising areas. eMental health interventions that leverage low-tech tools can introduce, strengthen and expand mental health and psychosocial support services and can be a starting point for future, advanced tools.

Enjoyment and Intensity of Physical Activity in Immersive Virtual Reality Performed on Innovative Training Devices in Compliance with Recommendations for Health

The aim of the study is to assess the enjoyment and intensity of physical exercise while practicing physical activity (PA) in immersive virtual reality (IVR) using innovative training devices (omni-directional Omni treadmill and Icaros Pro flight simulator). The study also contains the results of subjective research on the usefulness of such a form of PA in the opinion of users. In total, 61 adults (10 women and 51 men) took part in the study. To assess the enjoyment level (EL) Interest/Enjoyment subscale of Intrinsic Motivation Inventory (IMI) was used. Exercise intensity was assessed during 10-min sessions of active video games (AVGs) in IVR based on heart rate (HR). The average enjoyment level during physical exercise in IVR on the tested training devices was high (Omni 5.74 points, Icaros 5.60 points on a 1-7 Likert scale) and differed significantly in favor of PA on Omni. In the opinion of the majority of participants, AVGs in IVR on the tested devices constitute a sufficiently useful form of PA to meet the needs of leisure time activities, and they can even replace some forms of physical effort performed in a classic way. The intensity of PA during games on training devices was at the level recommended for health benefits for 80.55% (Omni) and 50.77% (Icaros Pro) of its duration. Based on the conducted research, it can be assumed that AVGs in IVR using a multi-directional treadmill and a flight simulator can be an effective tool for increasing participation in health-oriented PA.

Affective and Attentional States When Running in a Virtual Reality Environment

Engaging in physical exercise in a virtual reality (VR) environment has been reported to improve physical effort and affective states. However, these conclusions might be influenced by experimental design factors, such as comparing VR environments against a non-VR environment without actively controlling for the presence of visual input in non-VR conditions. The present study addressed this issue to examine affective and attentional states in a virtual running task. Participants (n = 40), completed a 21 min run on a treadmill at 70% of Vmax. One group of participants ran in a computer-generated VR environment that included other virtual runners while another group ran while viewing neutral images. Participants in both conditions showed a pattern of reduced positive affect and increased tension during the run with a return to high positive affect after the run. In the VR condition, higher levels of immersive tendencies and attention/absorption in the virtual environment were associated with more positive affect after the run. In addition, participants in the VR condition focused attention more on external task-relevant stimuli and less to internal states than participants in the neutral images condition. However, the neutral images condition produced less negative affect and more enjoyment after the run than the VR condition. The finding suggest that the effects of exercising in a VR environment will depend on individual difference factors (e.g., attention/absorption in the virtual world) but it may not always be better than distracting attention away from exercise-related cues.

Perceived Exertion during Exercise Is Associated with Children's Energy Intake

PURPOSE

To examine the individual-level factors that predict energy intake (EI) after imposed exercise (EX) and sedentary time (SED) in children.

METHODS

Healthy-weight children ages 9-12 yr (n = 20) reported to the laboratory for one baseline and two experimental visits (EX and SED) each separated by 1 wk in a randomized crossover design. Percent body fat, weight (kg), and height (m) were used to calculate fat-mass index (FM index) and fat-free mass index (FFM index; kg·m). On the EX day, children exercised at 70% estimated V˙O2peak for 30 min on a cycle ergometer, whereas cardiovascular responses and RPE were measured. Objective EI (kcal) was measured at identical meals (breakfast, lunch, snack, and dinner) on the EX and SED days.

RESULTS

Total EI was not statistically different between the EX and SED days (t = 1.8, P = 0.09). FFM index was positively associated with EI on the EX day (r = 0.54, P < 0.05). RPE was also positively associated with EI on the EX day (r = 0.82, P < 0.001). Together, FFM index and RPE explained 77% of the variability in EX day EI (F(2,17) = 26.4, P < 0.001). For each unit increase in RPE, children consumed approximately 270 more calories on the EX day. A similar pattern of associations was observed on the SED day.

CONCLUSIONS

FFM index was positively associated with EI on the EX day. Despite experiencing the same 70% relative exercise intensity, increased perceived difficulty predicted greater EI on both the EX and SED day. These findings demonstrate a role for both FFM and RPE in explaining EI variability in children.