Abstract
Objective purpose: This review synthesized the literature examining the effects of virtual reality (VR)-based exercise on physiological, psychological, and rehabilitative outcomes in various populations.
Design: A systematic review.
Data sources: 246 articles were retrieved using key words, such as “VR”, “exercise intervention”, “physiological”, “psychology”, and “rehabilitation” through nine databases including Academic Search Premier and PubMed.
Eligibility criteria for selecting studies: 15 articles which met the following criteria were included in the review: (1) peer-reviewed; (2) published in English; (3) randomized controlled trials (RCTs), controlled trials or causal-comparative design; (4) interventions using VR devices; and (5) examined effects on physiological, psychological, and/or rehabilitative outcomes. Descriptive and thematic analyses were used.
Results: Of the 12 articles examining physiological outcomes, eight showed a positive effect on physical fitness, muscle strength, balance, and extremity function. Only four articles examined the effects on psychological outcomes, three showed positive effects such that VR exercise could ease fatigue, tension, and depression and induce calmness and enhance quality of life. Nine articles investigated the effects of VR-based exercise on rehabilitative outcomes with physiological and/or psychological outcomes, and six observed significant positive changes. In detail, patients who suffered from chronic stroke, hemodialysis, spinal-cord injury, cerebral palsy in early ages, and cognitive decline usually saw better improvements using VR-based exercise.
Conclusion: The findings suggest that VR exercise has the potential to exert a positive impact on individual’s physiological, psychological, and rehabilitative outcomes compared with traditional exercise. However, the quality, quantity, and sample size of existing studies are far from ideal. Therefore, more rigorous studies are needed to confirm the observed positive effects.
1. Introduction
Over the past decades, the effects of physical activity (PA) on individual’s health have been well documented [1,2,3]. However, despite the well-known benefits of PA participation, according to the World Health Organization (WHO) approximately 25% of adults and 80% of adolescents around the world are physically inactive partly due to societal and lifestyle changes [4]. Exercise (i.e., planned, structured and repetitive PA) is often perceived as boring and hard, thereby causing adults and students shy away from PA-related behaviors after long days of work and/or school. Instead, individuals are more interested in leisure activities, such as video games, where entertainment can be obtained while relaxing (i.e., sedentary behavior). Thus, the combination of video games and engaging in PA (e.g., virtual reality (VR)-integrated exercise) may trigger their interest and improve their PA behavior.
In recent years, VR exercise has been recognized as a new approach to promote PA and health behaviors [5] and is becoming increasingly used in health promotion. Researchers have observed VR exercise to enhance the psychological benefits of exercise and increase the likelihood of long-term adherence to exercise [6,7]. VR is operationally defined as digital technology wherein sensory experiences, (e.g., visual, auditory, touch, and scent stimuli) are artificially created, prompting users to manipulate the objects within virtual environment [8]. In general, there are three types of VR: immersive, non-immersive, and interactive. Immersive VR utilizes head-mounted displays, body movement sensors, real-time graphics, and advanced interface devices (e.g., dedicated headsets) to simulate a completely virtual environment for users, whereas non-immersive VR utilizes an interface, such as a flat screen TV/computer screen, and requires the use of a corresponding keyboard, controller and/or joystick [9,10]. Interactive VR is centered on the user’s ability to interact with virtual objects through devices (e.g., gloves, digital glasses) which produce the sensation of manipulating real items, such as picking up an apple [11].
The development of VR technology and its utility during PA via its integration with traditional exercise equipment and rehabilitation practices has attracted attention in the fields of kinesiology and public health. As a therapeutic tool, VR offers the opportunity to intensify repetitive tasks and increase visual and auditory feedback, making VR therapy more interesting than traditional physical therapy and without posing any serious threat or physical limitations to participants [11]. Previous reviews have examined the effectiveness of VR exercise on physiological, psychological or rehabilitative outcomes. For example, researchers suggested that VR could promote the lower limb function of patients who suffered from stroke [12]. VR exercise has also shown to have a significant effect on the balance ability of patients who suffered from stroke, Parkinson’s disease (PD) or children with cerebral palsy (CP) [13]. Additionally, the effectiveness of the application of VR in psychological treatment in psychotherapy has been widely supported [14]. For instance, VR exercise has been observed to relieve anxiety and depression [15]. As for rehabilitative effectiveness, VR technology in disease rehabilitation has been widely applied, namely to help disabled patients acquire lost motor skills caused by injury or illness and ensure these individuals are able to carry out activities of daily living. As such, the effectiveness of VR exercise on physiological and rehabilitative outcomes have been mostly related and combined.
Thus far, a meta-analysis demonstrated the positive effects of VR exercise on balance function in stroke patients [16]. Similarly, another review suggested that VR was useful for enhancing motor control, functional, and cognitive abilities and balance in Parkinson’s patients [13]. Distinctly, the target populations of the studies within the preceding literature review were narrow and limited to specific diseases, such as strokes and Parkinson’s disease. However, there are other vulnerable populations who may benefit from VR exercise, such as the elderly who could benefit from improved balance and other physical abilities to facilitate better health-related quality of life (HRQoL). However, reviews examining the utilization of VR exercise to intervene in such populations are sparse. Moreover, many relevant reviews are outdated, and thus there is a need to synthesize more updated research. Furthermore, some reviews included single-case experimental designs (i.e., studies with no control group), and thus these reviews were not based on high-quality research and the findings need to be further explored. It has been suggested researchers should include more rigorous study designs like randomized controlled trials (RCTs).
Therefore, this review aimed to fill the existing research gaps. Specifically, most of the articles included in this review were RCTs. Even if some studies could not be randomly grouped on a large scale due to the sample limitations, studies were only included if there were control group(s) and employed a comparative analysis between experimental groups and control groups, as well as between baseline- and post-tests for the examined health outcomes. Further, the target population of this review was relatively extensive, including clinical and healthy populations, allowing the overall effectiveness of VR exercise to be established. Taken together, the purpose of this review is to systematically synthesize the literature examining the effects of VR exercise on the physiological, psychological, and rehabilitative outcomes in various populations.[…]
TBI Rehabilitation 