Background The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely. Objective This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs. Methods This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale. Results In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures. Conclusions Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale.

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Mixed reality technology is being increasingly used in cultural heritage attractions to enhance visitors’ experiences. However, how the characteristics of mixed reality affect satisfaction and brand loyalty has not been explored in previous research. The purpose of this study is to identify factors affecting satisfaction with mixed reality experiences at cultural and artistic visitor attractions and their influence on brand loyalty, which is connected with management performance. We propose a theoretical model based on brand equity theory in the context of mixed reality experience. Survey data were gathered from 251 respondents visiting a cultural and artistic visitor attraction in Seoul, Korea, using a stratified sampling method. Partial least squares structural equation modeling (PLS-SEM) was employed for the data analysis. The results suggest that the characteristics of mixed reality (interactivity, vividness) not only influence the affective aspects (perceived immersion, perceived enjoyment) of visitors’ experiences, but also positively affect brand awareness, brand association, and brand loyalty.