BackgroundPersistent postural-perceptual dizziness (PPPD) is a newly defined disorder of functional dizziness. Due to its recent discovery, definitive treatment for PPPD has not been established; therefore, this study aimed to measure the effectiveness of virtual reality (VR)-guided, dual-task, body trunk balance training using the mediVR KAGURA system for the treatment of PPPD.MethodsData from patients with PPPD collected from January 1, 2021 to February 28, 2021 were reviewed. Additionally, healthy people were included as controls. VR-guided training was performed using 100 tasks for 10 min. Equilibrium tests were performed at baseline and immediately after VR-guided training to examine the effectiveness of static and dynamic balance ability. Additionally, assessments of clinical questionnaire-based surveys of balance disorders were performed at baseline and 1 week after VR-guided training to examine the effects on the symptoms related to balance disorders. The primary outcome was the usefulness of static and dynamic body balance and NPQ scores.ResultsVR-guided training using mediVR KAGURA improved objective symptoms, including static and dynamic postural stability (relating to somatosensory and visual weighting, respectively) even when the training was conducted once for 10 min. Additionally, VR-guided training improved the Hospital Anxiety and Depression Scale score and the Niigata PPPD Questionnaire score, 1 week after a 10-min training session. ConclusionVR-guided training was found to be a viable method in managing the balancing ability, anxiety, and symptoms of patients with PPPD. VR-guided training offers safety and reduction of human resources; however, its clinical efficiency warrants further evaluation in prospective studies.Trial registrationInstitutional Ethics Committee of Kitano Hospital, approval number: 1911003. Registered 18 December 2019, https://kitano.bvits.com/rinri/publish_document.aspx?ID=426