Physiological and Psychological Effects of Virtual Reality vs Traditional Exercise

Comparing Physiological and Psychological Effects of Virtual Reality Vs. Traditional HIIT In Healthy Individuals: Results From A Preliminary Pilot Randomised Controlled Trial

This study aimed to explore the feasibility and effectiveness of immersive Virtual Reality (VR) as an alternative to traditional High-Intensity Interval Training (HIIT) by comparing physiological and psychological outcomes in physically active university students. The pilot randomised controlled trial utilised a parallel design involving two groups: one group performed HIIT using the Facebook Oculus Quest 2 VR headset with the "FitXR" fitness game, while the other undertook traditional HIIT training that mirrored the movements and actions of the VR game.

The study's findings suggest that fully immersive VR provides a unique and potentially more enjoyable alternative to traditional HIIT, particularly because it may enhance motivation while still achieving health benefits. This pilot research study highlights VR's potential to reach high-flow states in exercise, where individuals become deeply absorbed and derive satisfaction from the activity. It also lays the groundwork for future studies involving larger sample sizes and clinical populations to further investigate the psychological and physiological impacts of VR-based exercise.

In summary, this pilot randomised controlled trial found that immersive VR could be a feasible and effective alternative to traditional HIIT training, offering similar physiological benefits while enhancing exercise motivation and enjoyment. Further research is necessary to validate these preliminary results and extend them to diverse populations.

Study Overview

• Status: Completed
• Conditions: Healthy; Physical Activity; Virtual Reality; Inactivity, Physical; Exergame
• Intervention / Treatment: Other: Virtual Reality; Other: Traditional HIIT

Detailed Description

Study Objectives and Design This study was designed as a pilot randomised controlled trial (RCT) to investigate the feasibility, efficacy, and effects of immersive VR compared to traditional HIIT on physiological and psychological outcomes in physically active university students. The parallel-design trial was conducted in accordance with the CONSORT guidelines and approved by the Teesside University Health Research Ethics Sub-Committee. The VR intervention used the Facebook Oculus Quest 2 VR headset with the fitness game "FitXR," while the non-VR group completed traditional HIIT that replicated the same movements as in the VR game.

Participants and Recruitment A purposive sampling method was used to recruit ten healthy physiotherapy students from Teesside University. Participants had to lead an active lifestyle, defined as performing either 150 minutes of moderate exercise weekly or 75 minutes of vigorous-intensity aerobic exercise, and have no prior experience with VR-based exercise. Those with medical conditions preventing them from exercising or those unable to give informed consent were excluded. Participants were recruited via email through a gatekeeper, indicating their willingness to participate by contacting the research physiotherapist directly. The allocation to either the VR or non-VR group was stratified by gender and block-randomised in blocks of five using a computer-generated software (Research Randomizer).

Interventions

Exergaming via VR:

Participants in the VR group used the Facebook Oculus Quest 2 and "FitXR," a fitness game in high-speed HIIT class mode. The 15-minute session included functional movements such as squats, lunges, and trunk rotations while trying to hit virtual targets by punching. The training session had a 10-second rest between each interval, and participants followed instructions from a virtual trainer.

Traditional HIIT:

The non-VR group followed a traditional HIIT session that mirrored the movements from the "FitXR" game. Participants replicated movements such as squats with punches, as pre-recorded and displayed on a laptop. The session matched the VR group's overall duration and intervals.

Safety and Blinding To ensure safety while using the VR headset, participants were restricted to a 3m by 3m safety boundary. Stepping out of the boundary automatically paused the game, activating external cameras to provide real-world visibility. Blinding was not feasible due to the nature of the intervention, but the researcher responsible for the data analysis was unaware of the group allocations to reduce bias.

Outcome Measures

Physiological Outcomes:

Heart Rate: Measured using a Polar RS400 monitor. Exercise intensity was calculated as a percentage of the maximum heart rate (%HRmax) and heart rate reserve (%HRR). The intensity was categorised according to American Heart Association standards.

Rating of Perceived Exertion (RPE): Measured using Borg's CR-10 scale every five minutes. Scores ranged from 0 (rest) to 10 (maximum effort).

Psychological Outcomes:

Flow State Scale (FSS): Assessed engagement and motivation using a 36-item questionnaire with nine subscales. Participants rated items on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The subscales measured challenge-skill balance, action-awareness merging, clear goals, unambiguous feedback, and other factors.

Statistical Analysis A frequentist approach was employed with SPSS software (version 26). Independent-samples t-tests were used with a significance level of 0.05, and effect sizes were expressed using Cohen's d (small = 0.2, moderate = 0.5, large = 0.8). Bayesian data analysis was conducted with JASP software to assess the robustness of findings. Bayes factors were calculated to compare evidence for alternative versus null hypotheses. Robustness checks were performed to ensure results remained consistent across different prior distributions.

Sample Size and Feasibility Given that this was a pilot study, the emphasis was placed on assessing feasibility rather than ensuring the study was fully powered. As such, recruitment spanned a period of time with the objective of enrolling as many patients as possible, without specifying a target participant number to achieve optimal study power. An aim of this study was, therefore, to explore feasibility and preliminary outcomes, which will inform future, larger-scale research

Conclusion This pilot study provides preliminary evidence that immersive VR training can offer a feasible alternative to traditional HIIT, achieving comparable physiological benefits with potentially greater intrinsic motivation and engagement. Future studies with larger sample sizes are needed to validate these findings and assess VR's impacts on diverse clinical populations.

• Study Type: Interventional
• Enrollment (Actual): 10
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Middlesbrough, United Kingdom
    • Teesside University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Teesside University physiotherapy student.
2. Participants willing and able to give informed consent.
3. Have an active lifestyle (performing either 150 minutes of moderate exercise weekly or 75 minutes of vigorous intensity aerobic exercise).
4. No prior experience with exercise using the VR headset.

Exclusion Criteria:

1. Have a known medical condition that would prevent them from exercising.
2. Are not able to provide informed consent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual Reality (VR) HIIT; Participants in this arm underwent a single session of High-Intensity Interval Training (HIIT) via the Facebook Oculus Quest 2 virtual reality headset and "FitXR" fitness game. This immersive VR environment engaged participants in a 15-minute HIIT session, involving squats, lunges, and punches to virtual targets. The intensity was comparable to traditional HIIT, with a 10-second rest between intervals.	Other: Virtual Reality; Participants engaged in a 15-minute HIIT session using the Facebook Oculus Quest 2 VR headset with the "FitXR" fitness game. The advanced level workout (High Speed) was chosen, where participants performed functional movements like squats, lunges, and trunk rotations while punching virtual targets. The VR environment provided a 10-second rest period between intervals and featured a virtual trainer's guidance.; Other Names: Facebook Oculus Quest 2
Active Comparator: Traditional HIIT; Participants in this arm underwent a single session of traditional High-Intensity Interval Training (HIIT), mirroring the movements and duration of the "FitXR" VR game. Exercises like squats, lunges, and punching targets were replicated, ensuring the same 15-minute workout duration and 10-second rest intervals, as in the VR arm.	Other: Traditional HIIT; Participants followed a non-VR 15-minute HIIT programme designed to replicate the exercises and patterns seen in the "FitXR" game. The traditional exercises included squats, lunges, and punches, matching the VR programme's intensity and interval structure. Participants watched a pre-recorded video on a laptop, which guided them through the workout. The 10-second rest periods were also maintained for consistency.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart Rate (HR)	Average percentage of maximum heart rate (%HRmax) and heart rate reserve (%HRR), measured using the Polar HR monitor RS400. The intensity levels were classified according to American Heart Association guidelines: ≥50% HRmax or ≥45% HRR as moderate intensity and ≥70% HRmax or ≥60% HRR as vigorous intensity.	During each 15-minute HIIT session for both VR and traditional groups.
Perceived Exertion (RPE)	Average score on the CR-10 BORG's scale, where 0 represents "rest" and 10 represents "maximal" effort. Perceived exertion scores were obtained every 5 minutes, and an average score was calculated. Higher scores are an indication of greater exertion.	Every 5 minutes throughout the 15-minute HIIT session for both groups.
Flow Experience	The Flow State Scale (FSS) questionnaire measured the extent to which participants experienced flow states during their respective HIIT sessions. There is a total of 36 items with 9 subscales measuring challenge-skill balance, action awareness merging, clear goals, unambiguous feedback, concentration on the task at hand, paradox (or sense) of control, loss of self-consciousness, time transformation, and autotelic experience. Each question is measured using a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate a better outcome, reflecting a higher degree of flow experience.	Immediately after each 15-minute HIIT session.

Collaborators and Investigators

• Sponsor: Teesside University
• Investigators: Principal Investigator: Jonathan Robinson, PhD, Teesside University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2023
• Primary Completion (Actual): January 31, 2023
• Study Completion (Actual): January 31, 2023

Study Registration Dates

• First Submitted: May 14, 2024
• First Submitted That Met QC Criteria: May 17, 2024
• First Posted (Actual): May 20, 2024

Study Record Updates

• Last Update Posted (Actual): May 20, 2024
• Last Update Submitted That Met QC Criteria: May 17, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: Healthy; RCT; Virtual Reality; Heart rate; Technology acceptance; Exergaming; Pilot; Meta Oculus Quest; Rate of perceived exertion; Bayesian Inferences
• Other Study ID Numbers: 10853

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No