Feasibility and Effects of an Immersive Virtual Reality Exergame Program on Physical Functions in Institutionalized Older Adults: A Randomized Clinical Trial

Abstract

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre–post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population.

Immersive Virtual Reality and its Influence on Physiological Parameters in Healthy People

“…In addition, this intervention scarcely had any adverse effects, these being slight and residual, confirming good usability of the commercial HMD device and a very positive evaluation of the experience by the participants. This positive and motivating evaluation of IVR use is in line with previous studies [32][33][34][35]37,41,51,63], although there are also studies which state the opposite [52]. In any case, our results did not allow us to verify whether the presence of severe cybersickness symptoms would produce variations in the physiological parameters studied, nor whether a certain stability in these guarantees the absence of cybersickness, aspects to be evaluated in future studies.…”

“…One benefit of this study -though it was not a study objective -was that it seems IVR training may attract people to exercise, especially those with physical difficulties or a previous lack of interest, and that it may also promote adherence to such physical training programs [34,35,64], and also to programs promoting healthy living, and disease prevention and treatment -as other research has previously illustrated [33][34][35]37,[65][66][67][68][69]. Initially, at least, this is suggested by what our sample reported when answering the SUS, SSQ, post-game GEQ and ad hoc satisfaction questionnaire.…”

“…So far these studies have focused on whether these programs are feasible for different populations and whether the improvements in physical, cognitive and functional abilities generally attributed to traditional exercise, can be replicated or even improved by the use of fully immersive virtual environments [34][35][36][37][38][39][40][41]. To the best of our knowledge, however, physiological responses, such as raised levels of cortisol in the saliva after exposure to IVR exergames have not yet been studied.…”

In too deep? A systematic literature review of fully‐immersive virtual reality and cybersickness among older adults

“…Across all studies, the most common study purpose was to assess the feasibility of fully-immersive virtual reality interventions for older adults. The majority of studies (23 studies) utilized a one-time session intervention, 22,24,28,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] whereas 16 studies 21,23,[25][26][27]29,[50][51][52][53][54][55][56][57][58][59] consisted of more than one session. The duration of the virtual reality intervention varied considerably from a one-time seven to 9 min session 38 to 20 min sessions per day for 4 weeks.…”

“…The duration of the virtual reality intervention varied considerably from a one-time seven to 9 min session 38 to 20 min sessions per day for 4 weeks. 27 Most studies' interventions included a virtual task that related to cognitive training or assessment, 22,24,[31][32][33][34]39,41,43,47,[53][54][55][56]58,59 activity or physical rehabilitation, 27,37,38,40,42,[49][50][51][52]57 exploration for purposes such as well-being or reminiscence, 21,23,25,[28][29][30]35,36,46,48 or a combination. 44,45 The most common virtual reality headsets used among the studies were the HTC Vive 32,35,37,[40][41][42]44,47,…”