The Effects of Virtual Reality Greenspace on Stress Among Adults With Mobility Impairments

June 22, 2026 updated by: Laurie A Malone, PhD, University of Alabama at Birmingham

The Effects of Virtual Reality Greenspace Exposure on Physiological and Affective Acute Stress Responses Among Adults With Mobility Impairments: A Pilot Study

The purpose of this project is to examine the effects of virtual reality greenspace exposure on physiological and affective acute stress responses among adults with mobility impairments.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Active, not recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Exposure to greenspace is known to yield numerous mental and physical health benefits such as improved mood, decreased stress, and increased levels of physical activity. Regular access to greenspace however is difficult for various segments of the population including individuals with disabilities or chronic health conditions. Numerous factors contribute to this difficulty including architectural barriers, shortage of accessible trails, and limited transportation options. These challenges have led to a growing interest in exploring the use of virtual reality (VR) greenspace environments. Studies have demonstrated that VR greenspace exposure can reduce stress and improve mood and mental well-being in various populations but has not been tested among individuals with mobility impairments who experience high levels of stress. During a single lab visit, participants will be randomized to VR greenspace activity or control, undergo the Trier Social Stress Test. The VR group will then engage in a series of nature-based VR activities. The Control group will sit quietly. Assessments will be collected at 4 timepoints. Physiological stress responses will be measured via changes in BP, HR, and two saliva measures (salivary alpha-amylase, salivary cortisol). Affective response (stress, affect, anxiety) will be assessed using self-report surveys. This study will provide insight into the influence of VR greenspace exposure on stress recovery (physiological and affective responses), among individuals with mobility impairments.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
25

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Principal Investigator
  • Phone Number: 205-934-1876
  • Email: lamalone@uab.edu

Study Locations

  • United States
    • Alabama
      • Birmingham, Alabama, United States, 35294
        • University of Alabama at Birmingham

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age between 18 and 75 years
  • A self-reported lower extremity mobility impairment (e.g., cerebral palsy, spinal cord injury, multiple sclerosis, stroke) with partial or full use of the upper extremities.

Exclusion Criteria:

  • Impairment in visual acuity as measured by a Snellen eye chart <20/70 after correction
  • Regular engagement (>20 minutes/week) in virtual reality greenspace activity
  • Having an endocrine disorder (that can affect cortisol levels)
  • Taking oral corticosteroids
  • Score below 24 on the Mini Mental State Exam

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Virtual reality
Participants will be outfitted with a virtual reality headset. While seated in a recliner chair, participants will engage in a pre-specified VR nature experience called Nature Treks VR for 5 minutes.
Behavioral: Virtual Reality (VR)
Participants will engage in a virtual reality greenspace activity for a period of 5 minutes
Placebo Comparator: Control
Participants will be seated in a recliner chair and asked to sit quietly for 5 minutes.
Behavioral: Control
Participants will sit quietly for a period of 5 minutes

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Perceived Stress Scale (PSS)
Time Frame: The survey will be completed at 4 timepoints: 1) Baseline (Stage 1) 2) Immediately after the Trier Social Stress Test (Stage 2); 3) Immediately following the VR or control activity; 4) 20 minutes after completion of the activity (VR or control).
The survey consists of 10 questions that assess the frequency of feelings and thoughts related to stress on a 5-point Likert scale (Never = 0, Almost never = 1, Sometimes = 2, Fairly often = 3; Very often = 4). To calculate a total PSS score, responses to the four positively stated items (items 4, 5, 7 and 8) first need to be reversed (i.e. 0 => 4; 1 => 3; 2 => 2; 3 => 1; 4 => 0). The PSS score is then obtained by summing across all items. Higher scores indicate higher levels of perceived stress.
The survey will be completed at 4 timepoints: 1) Baseline (Stage 1) 2) Immediately after the Trier Social Stress Test (Stage 2); 3) Immediately following the VR or control activity; 4) 20 minutes after completion of the activity (VR or control).
State-Trait Anxiety Inventory (STAI) short form
Time Frame: The survey will be completed at 4 timepoints: 1) Baseline (Stage 1); 2) Immediately after the Trier Social Stress Test (Stage 2); 3) Immediately following the VR or control activity; 4) 20 minutes after completion of the activity (VR or control).
The 5-item short form of the State-Trait Anxiety Inventory (STAI) is designed to quickly assess anxiety levels. The questions measure state (temporary feelings of anxiety) and trait anxiety (general tendency to experience anxiety).The STAI short form is scored by summing the responses to each of the five items, which are rated on a 4-point Likert scale ranging from 1 (not at all) to 4 (very much so). The total score can range from 5 to 20, with higher scores indicating higher levels of anxiety.
The survey will be completed at 4 timepoints: 1) Baseline (Stage 1); 2) Immediately after the Trier Social Stress Test (Stage 2); 3) Immediately following the VR or control activity; 4) 20 minutes after completion of the activity (VR or control).
Positive and Negative Affect Schedule
Time Frame: The survey will be completed at 4 timepoints: 1) Baseline (Stage 1); 2) Immediately after the Trier Social Stress Test (Stage 2); 3) Immediately following the VR or control activity; 4) 20 minutes after completion of the activity (VR or control).
The Positive and Negative Affect Schedule (PANAS) is designed to measure positive and negative affect. It consists of 20 items, with 10 items each for positive affect (PA) and negative affect (NA). Respondents rate each item on a 5-point Likert scale ranging from 1 (very slightly or not at all) to 5 (extremely). Positive Affect Score: Sum the scores of items 1, 3, 5, 9, 10, 12, 14, 16, 17, and 19. Scores can range from 10 to 50, with higher scores indicating higher levels of positive affect. Negative Affect Score: Sum the scores of items 2, 4, 6, 7, 8, 11, 13, 15, 18, and 20. Scores can range from 10 to 50, with higher scores indicating higher levels of negative affect.
The survey will be completed at 4 timepoints: 1) Baseline (Stage 1); 2) Immediately after the Trier Social Stress Test (Stage 2); 3) Immediately following the VR or control activity; 4) 20 minutes after completion of the activity (VR or control).
Saliva stress biomarkers
Time Frame: The saliva will be collected at 4 timepoints: 1) Baseline (Stage 1); 2) Immediately after the Trier Social Stress Test (Stage 2); 3) Immediately following the VR or control activity; 4) 20 minutes after completion of the activity (VR or control).

Saliva samples will be collected to measure stress biomarkers. The process is simple and non-invasive:

Preparation: Participants should avoid eating, drinking (except water), brushing teeth, or using mouthwash for at least 30 minutes before sample collection.

Collection: Participants will be provided with a sterile saliva collection device. They will be asked to spit into the device until it reaches the indicated fill line.

Storage: The collected saliva samples will be stored in a cooler bag and then later transported to the UAB lab for storage and analyses.
The saliva will be collected at 4 timepoints: 1) Baseline (Stage 1); 2) Immediately after the Trier Social Stress Test (Stage 2); 3) Immediately following the VR or control activity; 4) 20 minutes after completion of the activity (VR or control).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Alabama at Birmingham

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
April 7, 2025

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 30, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
June 30, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
October 22, 2024

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 7, 2024

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 12, 2024

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 25, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 22, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • IRB-300012947
  • Faculty Development Grant (Other Grant/Funding Number: University of Alabama at Birmingham)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

This is a pilot study so IPD will not be shared.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Cookie Settings

We use cookies to ensure that we give you the best experience on our website. For more details carefully read our Privacy and Cookies Policy. ...>>>You can change your preferences or withdraw your consent at any time by deleting the cookies from your website or computer as described in the policy. Please accept it and choose your preferences by ticking the corresponding boxes in the "Manage Settings" section below. Please carefully read our Terms of Service before you proceed with using any part of this website.
«Manage Settings