Effects of Immersive Virtual Reality-Based Rehabilitation on Quality of Life, Sleep Quality, and Cognitive Function in Women With Fibromyalgia (VIR-FM)

Effects of Immersive Virtual Reality-Based Rehabilitation on Quality of Life, Sleep Quality, and Cognitive Function in Women With Fibromyalgia: A Randomized Controlled Trial

Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive complaints, and psychoemotional symptoms, leading to functional impairment and reduced quality of life. Although exercise is recommended as a first-line non-pharmacological treatment, maintaining long-term adherence remains a major challenge.

Immersive virtual reality (IVR) has emerged as a promising approach to increase motivation and engagement during rehabilitation by integrating therapeutic exercise with interactive virtual environments. This randomized controlled trial evaluated the effects of a six-week exercise program delivered through immersive virtual reality compared with conventional exercise in women with fibromyalgia.

Participants were randomly assigned to either an IVR exercise group or a conventional exercise group. Clinical outcomes were assessed at baseline and after the intervention, including fibromyalgia-related impact, global cognitive screening performance, sleep quality, and psychoemotional symptoms. Treatment adherence and user experience were also evaluated to explore their association with clinical outcomes.

Study Overview

• Status: Completed
• Conditions: Fybromyalgia
• Intervention / Treatment: Behavioral: Immersive Virtual Reality Exercise; Behavioral: convencional exercise

Detailed Description

Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive dysfunction, and psychoemotional symptoms, resulting in substantial reductions in physical function and health-related quality of life. Although therapeutic exercise is considered a core component of fibromyalgia management, maintaining long-term adherence to exercise programs remains challenging due to pain exacerbation, fatigue, and reduced motivation.

Immersive virtual reality (IVR) has emerged as an innovative rehabilitation strategy that integrates therapeutic exercise with interactive virtual environments. By providing real-time visual feedback, immersive environments, and gamified exercise tasks, IVR may improve motivation, enjoyment, and engagement during rehabilitation while promoting adherence to structured exercise programs.

The present study was designed as a two-arm parallel-group randomized controlled trial comparing an immersive virtual reality exercise program with a conventional exercise program in women diagnosed with fibromyalgia according to the 2016 American College of Rheumatology diagnostic criteria. Participants were randomly allocated in a 1:1 ratio to either intervention and completed a supervised six-week rehabilitation program consisting of two sessions per week.

Participants allocated to the IVR group performed a combined intervention consisting of aerobic exercise followed by immersive virtual reality exercise using Meta Quest 2 head-mounted displays (Meta Platforms, Menlo Park, CA, USA) and the FitXR® platform (AeroBox modality). Participants allocated to the control group performed a conventional exercise program matched for treatment frequency and session duration. All intervention sessions were supervised by a physiotherapist trained in the study protocol.

Clinical assessments were performed at baseline and immediately after completion of the intervention. The predefined primary outcomes included fibromyalgia-related impact (FIQR), global cognitive screening performance (MoCA), psychoemotional symptoms (DASS-21), and sleep quality (Jenkins Sleep Questionnaire). Secondary outcomes included treatment adherence and user experience, assessed using the Player Experience of Need Satisfaction (PENS) questionnaire in participants allocated to the IVR group.

The primary objective of the randomized controlled trial was to compare the effects of immersive virtual reality exercise and conventional exercise on clinical outcomes in women with fibromyalgia. In addition, the study was designed to explore whether user experience during immersive virtual reality was associated with treatment adherence and changes in clinical outcomes.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Chile
  • Biobio
    • Concepción, Biobio, Chile, 41000
      • Universidad San Sebastián

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria

• Female participants aged 18 years or older
• Clinical diagnosis of fibromyalgia according to the 2016 American College of Rheumatology (ACR) diagnostic criteria
• Ability to understand and follow study procedures
• Provision of written informed consent

Exclusion Criteria

• Pregnancy or breastfeeding
• Cancer-related pain
• Uncontrolled metabolic disorders
• History of vertigo, vestibular disorders, or any condition that could be aggravated by immersive virtual reality exposure
• Neurological or musculoskeletal conditions that contraindicated participation in therapeutic exercise

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Immersive Virtual Reality Exercise; Participants performed immersive virtual reality exercise using Meta Quest 2 head-mounted displays (Meta Platforms, USA) and the FitXR® platform (AeroBox modality). The intervention consisted of gamified boxing-based exercises requiring upper-limb movements, straight punches, hooks, uppercuts, lateral displacements, weight shifting, squatting, and obstacle avoidance within an immersive virtual environment. Participants received continuous real-time visual feedback and automated performance reinforcement while exercise difficulty progressed according to individual performance. All sessions were supervised by a physical therapist.	Behavioral: Immersive Virtual Reality Exercise; Participants performed immersive virtual reality exercise using Meta Quest 2 head-mounted displays (Meta Platforms, USA) and the FitXR® platform (AeroBox modality). The intervention consisted of gamified boxing-based exercises requiring upper-limb movements, straight punches, hooks, uppercuts, lateral displacements, weight shifting, squatting, and obstacle avoidance within an immersive virtual environment. Participants received continuous real-time visual feedback while exercise difficulty progressed automatically according to individual performance. All sessions were supervised by a physical therapist.; Other Names: Virtual Reality Training
Active Comparator: Conventional Exercise; Participants performed a supervised conventional exercise program matched to the experimental intervention for treatment frequency, session duration, therapist supervision, and overall exercise intensity. Sessions consisted of moderate-intensity aerobic exercise followed by a structured exercise circuit including boxing movements toward therapist-guided targets or a punching bag, squatting exercises, lateral trunk displacement tasks, and progressive coordination exercises, followed by cool-down stretching and breathing exercises.	Behavioral: convencional exercise; Participants performed a supervised conventional exercise program matched to the experimental intervention for treatment frequency, session duration, therapist supervision, and prescribed exercise intensity. The intervention included aerobic exercise followed by therapist-guided mobility, coordination, strengthening, balance, and functional movement exercises, concluding with stretching and breathing exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fibromyalgia Impact (FIQR Total Score)	Quality of life in patients with fibromyalgia will be assessed using the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), which evaluates the impact of fibromyalgia across three dimensions: difficulty in activities of daily living during the past week, overall impact of the disease during the past week, and symptom intensity during the past week. The total score ranges from 0 to 100, with higher values indicating greater symptom severity and a higher level of functional disability	Baseline and immediately after completion of the 6-week intervention
Global Cognitive Function (MoCA Total Score)	Global cognitive function in both groups will be assessed using the MoCA questionnaire, a brief cognitive assessment tool that measures performance in domains such as memory, orientation, language, attention, executive function, and visuospatial abilities. The MoCA total score ranges from 0 to 30 points, with higher scores indicating better cognitive performance. A score of 26 or higher is generally considered within the normal cognitive range, although cutoff values may vary depending on age, education level, and clinical context.	Baseline and immediately after completion of the 6-week intervention
Depression, Anxiety, and Stress Symptoms (DASS-21)	Psychoemotional variables will be assessed using the DASS-21 questionnaire, which consists of 21 items designed to evaluate the presence of stress, anxiety, and/or depression. The instrument is divided into three subscales assessing depression, anxiety, and stress, with seven items assigned to each domain. Each item is rated on a 4-point Likert scale ranging from 0 ("did not apply to me at all") to 3 ("applied to me very much or most of the time"). Higher scores indicate greater severity of psychoemotional symptoms.	Baseline and immediately after completion of the 6-week intervention
Sleep Quality (Jenkins Sleep Questionnaire Score)	Sleep quality was assessed using the Jenkins Sleep Questionnaire, a validated instrument designed to measure the frequency of sleep-related difficulties during the previous week, including problems falling asleep, nighttime awakenings, non-restorative sleep, and fatigue upon waking. The questionnaire consists of four items rated according to the frequency of symptoms experienced, with higher scores indicating poorer sleep quality and greater sleep disturbance.	Baseline and immediately after completion of the 6-week intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
User Experience (Player Experience of Need Satisfaction [PENS])	User experience will be assessed using the Player Experience of Need Satisfaction (PENS) questionnaire, which measures dimensions related to interactive virtual environments, including competence, autonomy, intuitive control, enjoyment, and presence/immersion. The questionnaire provides information on psychological need satisfaction during immersive virtual reality exercise. PENS will be administered only to participants allocated to the immersive virtual reality group immediately after completion of the intervention. Higher scores indicate a more positive user experience and greater satisfaction across the evaluated dimensions.	Immediately after completion of the 6-week intervention
Treatment Adherence (Percentage of Completed Sessions)	Adherence to the intervention program will be assessed as the percentage of completed sessions relative to the total number of scheduled sessions. Individual attendance at each session will be recorded to calculate treatment compliance. Adherence will be expressed as a percentage, with higher values indicating greater participation in the intervention program. This indicator will quantify participant engagement and will be used to explore its association with user experience and clinical outcomes.	Baseline and immediately after completion of the 6-week intervention

Collaborators and Investigators

• Sponsor: gonzalo arias alvarez

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2025
• Primary Completion (Actual): February 16, 2026
• Study Completion (Actual): February 26, 2026

Study Registration Dates

• First Submitted: May 13, 2026
• First Submitted That Met QC Criteria: May 19, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): July 17, 2026
• Last Update Submitted That Met QC Criteria: July 16, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: adherence; virtual reality; fibromialgia
• Other Study ID Numbers: 202605RVI; 171-25 (Registry Identifier: Scientific Ethics Committee, Universidad San Sebastián)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared because the informed consent approved by the institutional ethics committee did not include provisions for public data sharing. The dataset contains sensitive clinical information from participants with fibromyalgia, and confidentiality will be maintained in accordance with institutional ethical requirements and applicable data protection regulations.

Drug and device information, study documents

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