What Players of Virtual Reality Exercise Games Want: Thematic Analysis of Web-Based Reviews

Moniz Game: Usability and User Experience Evaluation of a Musical Game for Motor Coordination

Purpose: The objective of this research was to develop a musical digital game for rehabilitation of upper limb and to verify its usability and user experience with professionals in the field (physical therapists). Materials and Methods: Thirty working professionals were recruited to evaluate the system. The usability was evaluated with the System Usability Scale (SUS) and the user experience was verified with the Game Flow scale. Results: The overall score of the SUS scale was 88.67 (±9.129); this score is interpreted as "Best Imaginable" (86-100). The user experience rating had most of its domains equal or higher than 4, which indicates that all the requirements for a good user experience were present in the game. Conclusions: The Moniz Game proved to be a game with good usability and can be a tool for application in clinical practice regarding motor coordination. However, further studies are needed to evaluate the effect of the Moniz Game on motor coordination in patients with neurological dysfunctions.

Virtual Reality-Based Exercise Rehabilitation in Cancer-Related Dysfunctions: Scoping Review

BACKGROUND

Virtual reality-based exercise rehabilitation (VRER) is a promising intervention for patients with cancer-related dysfunctions (CRDs). However, studies focusing on VRER for CRDs are lacking, and the results are inconsistent.

OBJECTIVE

We aimed to review the application of VRER in patients with CRDs.

METHODS

This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist framework. Publications were included from the time of database establishment to October 14, 2023. The databases were PubMed, Embase, Scopus, Cochrane, Web of Science, ProQuest, arXiv, IEEE Xplore, MedRxiv, CNKI, Wanfang Data, VIP, and SinoMed. The population included patients with cancer. A virtual reality (VR) system or device was required to be provided in exercise rehabilitation as an intervention. Eligible studies focused on VRER used for CRDs. Study selection and data extraction were performed by 2 reviewers independently. Extracted data included authors, year, country, study type, groups, sample size, participant age, cancer type, existing or potential CRDs, VR models and devices, intervention programs and durations, effectiveness, compliance, satisfaction, and safety.

RESULTS

We identified 25 articles, and among these, 12 (48%) were randomized clinical trials, 11 (44%) were other experimental studies, and 2 (8%) were observational studies. The total sample size was 1174 (range 6-136). Among the 25 studies, 22 (88%), 2 (8%), and 1 (4%) included nonimmersive VR, immersive VR, and augmented reality, respectively, which are models of VRER. Commercial game programs (17/25, 68%) were the most popular interventions of VRER, and their duration ranged from 3 to 12 weeks. Using these models and devices, VRER was mostly applied in patients with breast cancer (14/25, 56%), leukemia (8/25, 32%), and lung cancer (3/25, 12%). Furthermore, 6 CRDs were intervened by VRER, and among these, postmastectomy syndromes were the most common (10/25, 40%). Overall, 74% (17/23) of studies reported positive results, including significant improvements in limb function, joint range of motion, edema rates, cognition, respiratory disturbance index, apnea, activities of daily living, and quality of life. The compliance rate ranged from 56% to 100%. Overall, 32% (8/25) of studies reported on patient satisfaction, and of these, 88% (7/8) reported satisfaction with VRER. Moreover, 13% (1/8) reported mild sickness as an adverse event.

CONCLUSIONS

We found that around half of the studies reported using VRER in patients with breast cancer and postmastectomy dysfunctions through nonimmersive models and commercial game programs having durations of 3-12 weeks. In addition, most studies showed that VRER was effective owing to virtualization and interaction. Therefore, VRER may be an alternate intervention for patients with CRDs. However, as the conclusions were drawn from data with acknowledged inconsistencies and limited satisfaction reports, studies with larger sample sizes and more outcome indictors are required.

Self-Assessed Experience of Emotional Involvement in Sensory Analysis Performed in Virtual Reality

Virtual reality (VR) technology has gained significant attention in various fields, including education for health professionals, sensory science, psychology, and consumer research. The first aim of the paper is to explore the self-assessed experience of emotional involvement in sensory analysis performed in VR. The Positive and Negative Affect Schedule (PANAS) is a widely used self-report measure that assesses positive and negative affective states. VR sensory analysis involves the use of immersive, interactive, and multi-sensory environments to evaluate sensory perception and emotional responses. By synthesizing relevant literature, this paper provides insights into the impact of VR on affective states, the effectiveness of VR in eliciting emotions, and the potential applications of the PANAS in VR sensory analysis. Furthermore, the second aim of the paper is to uncover the effect of VR sensory evaluation on the participant's emotional states, as it has a significant effect on their evaluations. The results suggest an increase in the sum of positive effects and a decrease in the negative ones. Although these results are promising, the relationship between the PANAS and VR sensory analysis is still underexplored, with limited research investigating the specific effects of VR on affective states measured using the PANAS. Further research is needed to better understand the potential of the PANAS in assessing emotional responses in VR environments and its implications for sensory analysis.

Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities

Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.

Training effects of set- and repetition-interval rest time on recumbent-boxing exercise: Could virtual reality improve further?

This study examined the influence of set-interval and repetition-interval rest time of virtual reality (VR) boxing game in supine-lying posture. Fifty healthy middle-aged adults were randomly assigned into VR and non-VR groups to perform six different exercise protocols with varying set-interval and repetition-interval rest times (S0R0, S0R1/3, S0R2/3, S40R0, S40R1/3, and S40R2/3). Analysis on the non-VR group showed significant differences between exercise protocols for average heart rate (p < 0.001), maximum ventilation volume (p < 0.001), respiratory quotient (p < 0.001), oxygen pulse (p < 0.001), and excess post-exercise oxygen consumption (EPOC) (p = 0.003). VR appeared to have no further improvement on physical training effects in middle-aged adults, while the participants reported negative experience that might be associated with the over-exertion. Future study might need to explore game design elements that can accommodate high-exertion exercises.

Assessing bicycle-vehicle conflicts at urban intersections utilizing a VR integrated simulation approach

Animosity between drivers and cyclists has existed on urban road networks for many years. Conflicts between these two groups of road users are exceptionally high in the shared right-of-way environments. Benchmarking methods of conflict assessments are mostly based on statistical analysis with limited data sources. The actual crash data would be valuable to understand the features of bike-car collisions, however the available data are spatially and temporally sparse. To this end, this paper proposes a simulation-based bicycle-vehicle conflict data generation and assessment approach. The proposed approach uses a three-dimensional visualization and virtual reality platform, integrating traffic microsimulation to reproduce a naturalistic driving/cycling-enabled experimental environment. The simulation platform is validated to reflect the human-resembled driving/cycling behaviors under different infrastructure designs. Comparative experiments are carried out on bicycle-vehicle interactions under different conditions, with data collected from a total of 960 scenarios. Based on the results of the surrogate safety assessment model (SSAM), the obtained key insights include: (1) scenarios of a high conflict probability do not lead to actual crashes, which suggests that the classic SSM-based measurements such as TTC or PET values may not sufficiently reflect real cyclist-driver interactions; (2) the major cause of conflicts is variation in vehicle acceleration, which suggests that drivers are considered to be the main party responsible for bicycle-vehicle conflict/crash occurrence; (3) the proposed approach is able to generate near-miss events and reproduce interaction patterns between cyclists and drivers, facilitating experiments and data collections which would be typically unavailable for this type of study.

Designing to Leverage Presence in VR Rhythm Games

Rhythm games are known for their engaging gameplay and have gained renewed popularity with the adoption of virtual reality (VR) technology. While VR rhythm games have achieved commercial success, there is a lack of research on how and why they are engaging, and the connection between that engagement and immersion or presence. This study aims to understand how the design of two popular VR rhythm games, Beat Saber and Ragnarock, leverages presence to immerse players. Through a mixed-methods approach, utilising the Multimodal Presence Scale and a thematic analysis of open-ended questions, we discovered four mentalities which characterise user experiences: action, game, story and musical. We discuss how these mentalities can mediate presence and immersion, suggesting considerations for how designers can leverage this mapping for similar or related games.

Acceptance and use of virtual reality games: an extension of HMSAM

Virtual reality (VR) is considered as one of the technological megatrends of 2020s, and today, VR systems are used in various settings, digital gaming being among the most popular ones. However, there has been a dearth of understanding regarding the central factors behind VR gaming acceptance and use. The present study therefore aimed to explain the factors that drive the use and acceptance of VR games. We extended the hedonic-motivation system acceptance model with utilitarian and inconvenience factors to capture the pertinent features of VR systems more holistically. We proposed a theoretical model and analyzed it through covariance-based structural equation modeling using an online survey sample of 473 VR gamers. Our findings help explain the role of different antecedents behind VR gaming acceptance and demonstrate that VR gaming is driven more by the hedonic gaming aspects than by the utilitarian health and well-being aspects of VR games, enjoyment being the strongest driver behind VR gaming intention and immersion. Moreover, findings also suggested that use intentions and immersion levels are not significantly diminished by physical discomfort and VR sickness. The findings, which potentially extend to other VR systems as well, also pose important implications for the providers of VR games. As the main contribution, based on our empirical findings, we provide a greater theoretical understanding on VR gaming acceptance and use.

The Efficacy of an Immersive Virtual Reality Exergame Incorporating an Adaptive Cable Resistance System on Fitness and Cardiometabolic Measures: A 12-Week Randomized Controlled Trial

Exergaming, combining elements of video game into the realm of exercise, has recently incorporated immersive virtual reality (IVR) with resistance training. Thirty-two participants (14 females, mean age = 24.3) were randomized to IVR or self-directed control group (SELF) and worked out thrice weekly for 12 weeks (for 36 sessions). The IVR group spent 14 fewer minutes per session (p < 0.001) while reporting the sessions “enjoyable’. Compared to SELF, the IVR group had significantly greater improvement in changes from baseline to post-training in upper-and-lower muscular strength (1-RM) and muscular endurance (85% 1-RM) (14.3 kg vs. 10.0 kg for 1-RM upper, 28.6 kg vs. 22.5 kg for 1-RM lower, 2.6 reps vs. 1.9 reps for 85% 1-RM of upper, 2.7 vs. 2.0 reps for 85% 1-RM of lower, all p < 0.001), peak leg power (1424 vs. 865 W, p < 0.001), body fat% (−3.7% vs. −1.9%, p < 0.001), heart rate variability (4.3 vs. 1.8 ms, p < 0.001), rVO2max (3.28 vs. 0.89 mL/min/kg, p < 0.001) with decreased systolic BP (−0.4 vs. −2.3 mmHg, p < 0.001), and level of perceived exertion during workouts (RPE 14 vs. 16, p < 0.001). With its high-paced and action-filled gaming coupled with superior fitness and cardiometabolic outcomes, this IVR exergaming platform should be considered as another exercise modality for performance and health-related training.

The Effects of Acute Virtual Reality Exergaming on Mood and Executive Function: Exploratory Crossover Trial

Background

Virtual reality (VR) exergaming is a new intervention strategy to help humans engage in physical activity to enhance mood. VR exergaming may improve both mood and executive function by acting on the prefrontal cortex, expanding the potential benefits. However, the impact of VR exergaming on executive function has not been fully investigated, and associated intervention strategies have not yet been established.

Objective

This study aims to investigate the effects of 10 minutes of VR exergaming on mood and executive function.

Methods

A total of 12 participants played the exergame “FitXR” under 3 conditions: (1) a VR exergame condition (ie, exercise with a head-mounted display condition [VR-EX]) in which they played using a head-mounted display, (2) playing the exergame in front of a flat display (2D-EX), and (3) a resting condition in which they sat in a chair. The color-word Stroop task (CWST), which assesses executive function; the short form of the Profile of Mood States second edition (POMS2); and the short form of the Two-Dimensional Mood Scale (TDMS), which assess mood, were administered before and after the exercise or rest conditions.

Results

The VR-EX condition increased the POMS2 vigor activity score (rest and VR-EX: t₁₁=3.69, P=.003) as well as the TDMS arousal (rest vs 2D-EX: t₁₁=5.34, P<.001; rest vs VR-EX: t₁₁=5.99, P<.001; 2D-EX vs VR-EX: t₁₁=3.02, P=.01) and vitality scores (rest vs 2D-EX: t₁₁=3.74, P=.007; rest vs VR-EX: t₁₁=4.84, P=.002; 2D-EX vs VR-EX: t₁₁=3.53, P=.006), suggesting that VR exergaming enhanced mood. Conversely, there was no effect on CWST performance in either the 2D-EX or VR-EX conditions. Interestingly, the VR-EX condition showed a significant positive correlation between changes in CWST arousal and reaction time (r=0.58, P=.046). This suggests that the effect of exergaming on improving executive function may disappear under an excessively increased arousal level in VR exergaming.

Conclusions

Our findings showed that 10 minutes of VR exergaming enhanced mood but did not affect executive function. This suggests that some VR content may increase cognitive demands, leading to psychological fatigue and cognitive decline as an individual approaches the limits of available attentional capacity. Future research must examine the combination of exercise and VR that enhances both brain function and mood.

Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360° virtual reality application for medical education: a post hoc analysis of a randomized controlled trial

Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.

Improving the Health of Emerging Adult Gamers-A Scoping Review of Influences

Emerging adults (EAs), defined as adults aged 18 to 25, remain a difficult group to engage in healthy behaviours (including positive dieting and eating patterns). The environmental elements that influence the health behaviours of EAs have been studied. However, the literature is mixed on how online game environments, including eSports and game streaming, can be used to positively engage EAs. In this scoping review, we identified and analysed research on online games, EAs, and dietary patterns to create a behavioural ecological map of influences that intersect with EAs through online games. In total, 75 studies were found, identifying 23 influences that intersect with EAs through their online game use. ESports organisations, eSports athletes, and content creators may be areas of future research (and intervention) as these factors could positively influence the dietary behaviours of EAs (through online games).

Active video games in fully immersive virtual reality elicit moderate-to-vigorous physical activity and improve cognitive performance in sedentary college students

BACKGROUND

Active video games are a new method for increasing physical activity (PA). Fully immersive virtual reality (VR) is a hardware device on which an active video game can run. Active (video games in) VR (AVR), might increase immersion, game engagement, and moderate-to-vigorous PA (MVPA), thereby yielding greater exercise-related benefits, e.g., cognitive performance.

METHODS

We examined the induction of MVPA via an AVR and a sedentary VR (SVR) as well as the effects of VR play on cognitive performance, which was monitored using 2 different methods. Each of 29 sedentary college students attended three 20-min laboratory sessions (AVR, SVR, or control) in a randomized order; during the control session, they sat quietly doing nothing. A fully immersive headset was used for the 2 video game sessions. We monitored and computed participants' PA using hip-worn accelerometers (wGT3x-bt; ActiGraph, Pensacola, FL, USA) and a heart rate band (Polar H7; Polar, Kempele, Finland). After each session, the participants completed a mnemonic similarity test (MST) to measure recognition memory. They also filled out a motion sickness questionnaire and an abbreviated game experience questionnaire.

RESULTS

The AVR session induced a significantly greater heart rate and more time spent in MVPA than did either of the other 2 sessions regardless of the PA monitoring method. AVR elicited greater game experience questionnaire-assessed sensory and imaginative immersion, challenge, and positive affect than did SVR. The mnemonic similarity test recognition score was marginally higher post-AVR session than it was post-SVR session.

CONCLUSION

AVR elicited MVPA without a significant increase in motion sickness and induced a better game experience and better borderline cognitive performance than did SVR.

Analysis of Unsatisfying User Experiences and Unmet Psychological Needs for Virtual Reality Exergames Using Deep Learning Approach

The number of consumers playing virtual reality games is booming. To speed up product iteration, the user experience team needs to collect and analyze unsatisfying experiences in time. In this paper, we aim to detect the unsatisfying experiences hidden in online reviews of virtual reality exergames using a deep learning method and find out the unmet psychological needs of users based on self-determination theory. Convolutional neural networks for sentence classification (textCNN) are used in this study to classify online reviews with unsatisfying experiences. For comparison, we set eXtreme gradient boosting (XGBoost) with lexical features as the baseline of machine learning. Term frequency-inverse document frequency (TF-IDF) is used to extract keywords from every set of classified reviews. The micro-F1 score of textCNN classifier is 90.00, which is better than 82.69 of XGBoost. The top 10 keywords of every set of reviews reflect relevant topics of unmet psychological needs. This paper explores the potential problems causing unsatisfying experiences and unmet psychological needs in virtual reality exergames through text mining and makes a supplement for experimental studies about virtual reality exergames.

Rehabilitation of upper extremity by telerehabilitation combined with exergames in chronic stroke survivors: Preliminary findings from a feasibility clinical trial (Preprint)

Background

Exergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician.

Objective

This study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy.

Methods

This study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention).

Results

A total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60%), hand function (5/5, 100%), and mobility (2/5, 40%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9% (1/11) of participants.

Conclusions

The VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae.

International Registered Report Identifier (IRRID)

RR2-10.2196/14629

A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study

Background

In Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program.

Objective

This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment.

Methods

A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment–upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week.

Results

The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels.

Conclusions

VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising.

International Registered Report Identifier (IRRID)

RR2-10.2196/14629

Physiological and Metabolic Requirements, and User-Perceived Exertion of Immersive Virtual Reality Exergaming Incorporating an Adaptive Cable Resistance System: An Exploratory Study

Objective: To measure metabolic and physiological demand, subjective fatigue, and enjoyment during a signature 30-minute immersive virtual reality (IVR) adaptive cable resistance exergaming session. Methods: Fourteen healthy college-aged individuals (seven females) were initially acquainted with the IVR equipment and gameplay dynamics. Participants then underwent a 30-minute IVR exergaming session performing six different cable resistance exercises. A portable metabolic gas exchange analyzer concurrently assessed energy expenditure (EE) through indirect calorimetry while a chest-worn monitor captured heart rate (HR). Participants subsequently completed questionnaires, including the Borg scale for rating of perceived exertion (RPE), Physical Activity Enjoyment Scale (PACES), and Simulator Sickness Questionnaire (SSQ). Results: The mean EE, mean metabolic equivalent, and average total calories expended during the 30-minute session were 14.7 (standard deviation [SD] 2.8) kcal/minute, 12.9 (SD 0.5), and 440 (SD 84) kcals respectively. The mean HR was 176 (SD 3.1) beats per minute (bpm) with a mean max HR of 188 SD (SD 2.9) bpm. The combined training volume among all participants was 16,102 kg (SD 4137). Participants classified the IVR training session to be "somewhat hard-to-hard" with a RPE score of 14 (SD 1) while indicating the session to be "enjoyable" with a PACES score of 4.31 (SD 0.36). The participants did not report any cybersickness symptoms, demonstrating an average total SSQ score of 24.04 (SD 24.13). Conclusions: IVR exergaming incorporating cable resistance training elicits high EE and physiological demand with high enjoyment scores while attenuating perceived fatigue. The potential for IVR to elicit these acute training effects over long-term training periods warrants further investigation into its contribution to fitness and health.

Immersive virtual reality exergames to promote well-being of community-dwelling older adults: a mixed-methods pilot study protocol (Preprint)

Background

Despite the proven benefits of exercise in older adults, challenges such as access and motivation can deter their engagement. Interactive virtual reality (VR) games combined with exercise (exergames) are a plausible strategy to encourage physical activity among this population. However, there has been little research on the feasibility, acceptability, and potential benefits of deploying at-home VR exergames among community-dwelling older adults.

Objective

The objectives of this study are to estimate the feasibility, usability, and acceptability of a co-designed VR exergame in community-dwelling older adults; examine intervention feasibility and assessment protocols for a future large-scale trial; and provide pilot data on outcomes of interest (physical activity, exercise self-efficacy, mood, cognition, perception, and gameplay metrics).

Methods

The study will be a remote, 6-week intervention comprising an experimental and a control group. A sample of at least 12 community-dwelling older adults (with no or mild cognitive impairment) will be recruited for each group. Both groups will follow the same study procedures and assessment methods. However, the experimental group will engage with a co-designed VR exergame (Seas The Day) thrice weekly for approximately 20 minutes using the Oculus Quest 2 (Facebook Reality Labs) VR headset. The control group will read (instead of playing Seas The Day) thrice weekly for approximately 20 minutes over the 6-week period. A mixed methods evaluation will be used. Changes in physical activity, exercise self-efficacy, mood, cognition, and perception will be compared before and after acute data as well as before and after the 6 weeks between the experimental (exergaming) and control (reading) groups. Qualitative data from postintervention focus groups or interviews and informal notes and reports from all participants will be analyzed to assess the feasibility of the study protocol. Qualitative data from the experimental group will also be analyzed to assess the feasibility, usability, and acceptability of at-home VR exergames and explore perceived facilitators of and barriers to uptaking VR systems among community-dwelling older adults.

Results

The screening and recruitment process for the experimental group started in May 2021, and the data collection process will be completed by September 2021. The timeline of the recruitment process for the control group is September 2021 to December 2021. We anticipate an estimated adherence rate of ≥80%. Challenges associated with VR technology and the complexity of remote assessments are expected.

Conclusions

This pilot study will provide important information on the feasibility, acceptability, and usability of a custom-made VR exergaming intervention to promote older adults’ well-being. Findings from this study will be useful to inform the methodology, design, study procedures, and assessment protocol for future large-scale trials of VR exergames with older adults as well as deepen the understanding of remote deployment and at-home use of VR for exercise in older adults.

International Registered Report Identifier (IRRID)

DERR1-10.2196/32955

"Will It Affect Our Chances of Having Children?" and Feeling "Like a Ticking Bomb" -The Fertility Concerns and Fears of Cancer Progression and Recurrence in Cancer Treatment Decision-Making Among Young Women Diagnosed With Gynaecological or Breast Cancer

Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence.

Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18–45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses.

Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important.

Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an “add-on” was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.

A Spherical Video-Based Immersive Virtual Reality Learning System to Support Landscape Architecture Students’ Learning Performance during the COVID-19 Era

During the COVID-19 pandemic, campuses are closed, and many schools are forced to transition to online instruction. There are many problems in landscape architecture education during the pandemic such as students’ decreased attention, poor self-regulation, low proactivity, and difficulty in grading. In addition, situational effects are required for landscape architecture education, but online education lacks the necessary case scenarios for courses during the pandemic. In order to solve these problems, the present study adopted a more accessible, and interactive spherical video-based immersive virtual reality (SV-IVR) approach, developed a landscape architecture SV-IVR learning system, and conducted a quasi-experimental study to examine its effectiveness. The results indicated that the experimental group students showed more positive results in their learning achievements, learning attitudes, and self-regulation than the control group. Besides, it was found that students required more time to develop their self-efficacy and that this system would not have an effect on students’ cognitive load.

Virtual Training of Endurance Cycling - A Summary of Strengths, Weaknesses, Opportunities and Threats

Virtual online training has emerged as one of the top 20 worldwide fitness trends for 2021 and continues to develop rapidly. Although this allows the cycling community to engage in virtual training and competition, critical evaluation of virtual training platforms is limited. Here, we discuss the strengths, weaknesses, opportunities and threats associated with virtual training technology and cycling in an attempt to enhance awareness of such aspects. Strengths include immersive worlds, innovative drafting mechanics, and versatility. Weaknesses include questionable data accuracy, inadequate strength and reliability of power-speed algorithms. Opportunities exist for expanding strategic partnerships with major cycling races, brands, and sponsors and improving user experience with the addition of video capture and "e-coaching." Threats are present in the form of cheating during competition, and a lack of uptake and acceptance by a broader community.

A Virtual Reality Exergame to Engage Adolescents in Physical Activity: Mixed Methods Study Describing the Formative Intervention Development Process

Background

Early adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity.

Objective

The vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration.

Methods

The formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group.

Results

VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback.

Conclusions

This is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial.

What do users think about Virtual Reality relaxation applications? A mixed methods study of online user reviews using natural language processing

The advent of affordable Virtual Reality (VR) technology has spurred consumer and commercial interest in VR relaxation applications, which has quickly grown into a popular non-gaming genre on digital marketplaces. While laboratory studies have demonstrated efficacy of VR relaxation for mental health purposes, little is known about how users experience this type of intervention and no study has examined the reception of consumer versions among regular users in everyday life. Studying published user reviews offers a unique window into naturalistic user experiences that complements traditional qualitative methods by circumventing the sampling bias of interview studies, and allowing analyses on full samples, unconstrained by coding resources. Using an innovative, semi-automated Natural Language Processing technique, the current study analyzed 1379 published reviews (including star ratings) of 30 different VR relaxation applications available for the Oculus Go and Gear VR. The uncovered topic structure and sentiment analysis thereof suggests that users have an overall positive view of VR relaxation applications, describing them as successful in inducing immersion and relaxation, and having appreciated gamification elements. However, perceived quality varied substantially between applications that explained more variance in star ratings than specific features. Critical issues raised were both technical (e.g. "overheating") in nature and related to specific design elements and use. Implications for the design of consumer VR applications and future research are discussed.

Motivation in Team Exergames: Testing the Köhler Discrepancy Effect with a Software-Generated Partner During Plank Exercise

Objective: The Köhler effect is a social-psychological group motivation gain phenomenon that has been successfully adapted to video-based exercise games (exergames) using human partners. This research then shifted to using software-generated partners (SGPs), providing greater flexibility and adaptability to manipulate the game environment to be most motivating for the user. However, recent SGP-based experiments have demonstrated a diminished motivation gain effect. Extending previous work with human-human partners, this experiment varied the perceived exercise ability of the SGP as a potential motivation gain effect moderator on the participant's exercise persistence. Materials and Methods: Male and female college students (n = 176; mean age, 21.5 years) completed two series of abdominal plank exercises using an exergame developed specifically for a previous Köhler study. Participants completed the exercises individually and, after a rest, were randomly assigned to complete the same exercises again alone or with one of three SGPs: low ability discrepancy partner (LP), moderate ability discrepancy partner (MP), and high ability discrepancy partner (HP). Results: A 2 (sex) × 4 (condition) analysis of covariance main effect for Condition was not significant after controlling for Block 1 times (P = 0.093). However, contrast estimates of plank persistence times between the MP condition and individual no-partner control were significant, P = 0.014, 95% confidence interval [4.34-37.68]. There were no other significant condition persistence differences. Conclusions: A moderate discrepancy between the participant and the superior nonhuman partner is more motivating in a conjunctive task paradigm than exercising alone or with an SGP that is low or high in ability discrepancy.

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.

Exergaming With Beat Saber: An Investigation of Virtual Reality Aftereffects

BACKGROUND

Virtual reality (VR) exergaming has the potential to target sedentary behavior. Immersive environments can distract users from the physical exertion of exercise and can motivate them to continue exergaming. Despite the recent surge in VR popularity, numerous users still experience VR sickness from using head-mounted displays (HMDs). Apart from the commonly assessed self-reported symptoms, depth perception and cognition may also be affected. Considering the potential benefits of VR exergaming, it is crucial to identify the adverse effects limiting its potential and continued uptake.

OBJECTIVE

This study aims to investigate the consequences of playing one of the most popular VR exergames for 10 and 50 min on aspects of vision, cognition, and self-reported VR sickness.

METHODS

A total of 36 participants played an exergame, called Beat Saber, using an HMD. A repeated measures within-subject design was conducted to assess changes in vision, cognition, and well-being after short (10 min) and long (50 min) durations of VR exposure. We measured accommodation, convergence, decision speed, movement speed, and self-reported sickness at 3 test periods-before VR, immediately after VR, and 40 min after VR (late).

RESULTS

Beat Saber was well tolerated, as there were no dropouts due to sickness. For most participants, any immediate aftereffects were short-lived and returned to baseline levels after 40 min of exiting VR. For both short and long exposures, there were changes in accommodation (F1,35=8.424; P=.006) and convergence (F1,35=7.826; P=.008); however, in the late test period, participants returned to baseline levels. Measures on cognition revealed no concern. The total simulator sickness questionnaire (SSQ) scores increased immediately after VR (F1,35=26.515; P<.001) and were significantly higher for long compared with short exposures (t35=2.807; P=.03), but there were no differences in exposure duration in the late test period, with scores returning to baseline levels. Although at a group level, participants' sickness levels returned to baseline 40 min after VR exposure, approximately 14% of the participants still reported high levels of sickness in the late test period after playing 50 min of Beat Saber. We also showed that the participants who experienced a high level of sickness after a short exposure were almost certain to experience a high level of symptoms after a longer exposure.

CONCLUSIONS

Irrespective of the duration of exposure, this study found no strong evidence for adverse symptoms 40 min after exiting VR; however, some individuals still reported high levels of VR sickness at this stage. We recommend that users commit to a waiting period after exiting VR to ensure that any aftereffects have deteriorated. Exergames in HMDs have the potential to encourage people to exercise but are understudied, and the aftereffects of exergaming need to be closely monitored to ensure that VR exergames can reach their full potential.

Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy

Virtual reality (VR) is an immersive technology capable of creating a powerful, perceptual illusion of being present in a virtual environment. VR technology has been used in cognitive behavior therapy since the 1990s and accumulated an impressive evidence base, yet with the recent release of consumer VR platforms came a true paradigm shift in the capabilities and scalability of VR for mental health. This narrative review summarizes the past, present, and future of the field, including milestone studies and discussions on the clinical potential of alternative embodiment, gamification, avatar therapists, virtual gatherings, immersive storytelling, and more. Although the future is hard to predict, clinical VR has and will continue to be inherently intertwined with what are now rapid developments in technology, presenting both challenges and exciting opportunities to do what is not possible in the real world.

Virtual Reality Games and the Role of Body Involvement in Enhancing Positive Emotions and Decreasing Anxiety: Within-Subjects Pilot Study

Background

In the last few years, the introduction of immersive technologies, especially virtual reality, into the gaming market has dramatically altered the traditional concept of video games. Given the unique features of virtual reality in terms of interaction and its ability to completely immerse the individual into the game, this technology should increase the propensity for video games to effectively elicit positive emotions and decrease negative emotions and anxiety in the players. However, to date, few studies have investigated the ability of virtual reality games to induce positive emotions, and the possible effect of this new type of video game in diminishing negative emotions and anxiety has not yet been tested. Furthermore, given the critical role of body movement in individuals’ well-being and in emotional responses to video games, it seems critical to investigate how body involvement can be exploited to modulate the psychological benefits of virtual reality games in terms of enhancing players’ positive emotions and decreasing negative emotions and anxiety.

Objective

This within-subjects study aimed to explore the ability of commercial virtual reality games to induce positive emotions and diminish negative emotions and state anxiety of the players, investigating the effects of the level of body involvement requested by the game (ie, high vs low).

Methods

A total of 36 young adults played a low body-involvement (ie, Fruit Ninja VR) and a high body-involvement (ie, Audioshield) video game in virtual reality. The Visual Analogue Scale (VAS) and the State-Trait Anxiety Inventory, Form-Y1 (STAI-Y1) were used to assess positive and negative emotions and state anxiety.

Results

Results of the generalized linear model (GLM) for repeated-measures multivariate analysis of variance (MANOVA) revealed a statistically significant increase in the intensity of happiness (P<.001) and surprise (P=.003) and, in parallel, a significant decrease in fear (P=.01) and sadness (P<.001) reported by the users. Regarding the ability to improve anxiety in the players, the results showed a significant decrease in perceived state anxiety after game play, assessed with both the STAI-Y1 (P=.003) and the VAS-anxiety (P=.002). Finally, the results of the GLM MANOVA showed a greater efficacy of the high body-involvement game (ie, Audioshield) compared to the low body-involvement game (ie, Fruit Ninja VR), both for eliciting positive emotions (happiness, P<.001; and surprise, P=.01) and in reducing negative emotions (fear, P=.05; and sadness, P=.05) and state anxiety, as measured by the STAI-Y1 (P=.05).

Conclusions

The two main principal findings of this study are as follows: (1) virtual reality video games appear to be effective tools to elicit positive emotions and to decrease negative emotions and state anxiety in individuals and (2) the level of body involvement of the virtual video game has an important effect in determining the ability of the game to improve positive emotions and decrease negative emotions and state anxiety of the players.

Ready Exerciser One: Effects of music and virtual reality on cycle ergometer exercise

OBJECTIVES

Physical inactivity remains a major global health concern, and researchers have been encouraged to explore the role of technology in the promotion of physical activity. Technologies that deliver audio-visual stimuli are frequently applied in the exercise domain. However, there is a paucity of research that examines the efficacy of modern virtual reality (VR) technology in this context. We investigated the effects of VR and music on affective, perceptual, enjoyment, and cardiac responses to aerobic-type exercise.

DESIGN

A fully counterbalanced, within-subjects design was employed.

METHODS

A convenience sample of recreationally active adult volunteers (N = 24) completed a 12-min protocol during which they exercised under music, VR, VR-with-music, and control conditions.

RESULTS

Analyses indicated a Condition × Time interaction for affective valence and perceived activation. Moreover, a main effect of condition emerged for state attention and perceived enjoyment. The VR and VR-with-music conditions elicited the most positive affective valence, highest levels of perceived activation, greatest number of dissociative thoughts, and most exercise enjoyment. Differences between these two conditions were negligible across the breadth of dependent variables.

CONCLUSIONS

The present findings illustrate the efficacy of modern VR technology in the exercise context, applied both with and without musical accompaniment. Additional research is required to assess the degree to which the findings are replicable among sedentary or ageing segments of the population. Given the emerging support pertaining to a positive relationship between affective responses and exercise adherence, VR technology should be considered as a means by which to promote an enjoyable exercise experience.

[New perspectives of motor rehabilitation of patients after focal brain lesions]

Rehabilitation of patients after focal brain lesions is one of the topical issues of modern medicine. Motor disorders are known to develop in more than 80% of survivors of stroke and traumatic brain injury and be one of the main causes of disability, which necessitates an active search for new effective techniques for correction of motor disorders. Modern rehabilitation includes both traditional techniques for recovery of patients with motor deficit (exercise therapy and physiotherapy) and botulinum therapy, kinesiotherapy, mechanotherapy, etc., which have been developed in recent years. Robotic technologies have been developed, improved, and implemented. Currently, due to progress in computerization, virtual reality-based rehabilitation of patients is of particular interest. The article reviews the key studies in this field. We describe various visualization methods and means of immersion in a virtual environment for recovery of upper and lower extremity function in patients with focal brain lesions. The study provides an assessment of the effectiveness and safety of various virtual reality-based rehabilitation programs in patients with motor disorders after stroke and traumatic brain injury.