Virtual training leads to real acute physical, cognitive, and neural benefits on healthy adults: study protocol for a randomized controlled trial

Abstract

Background Keeping a certain level of physical activity has beneficial effects on the body itself but also, surprisingly, on cognition: specifically, physical high-intensity intermittent aerobic exercise (HIE) can show improvement on cognitive executive functions. Although, in some cases performing strength or aerobic training is problematic or not feasible. Immersive virtual reality (IVR) can induce the illusory feeling of ownership and agency over a moving virtual body, therefore showing comparable physiological reactions: for example, if an individual is sitting on a chair but his virtual body climbs a hill, the individual’s heart rate increases coherently, as if he is actually walking. In this study, we investigate whether this same illusion can show beneficial consequences on the body as well as on executive functions (using the color-word matching Stroop task) and on its neural substrates (using functional near-infrared spectroscopy [fNIRS]). Methods In a cross-over randomized controlled trial, 30 healthy young adults will experience HIE training in IVR (i.e. the virtual body will perform eight sets of 30 s of running followed by 30 s of slow walking, while the participant is completely still) according to two random-ordered conditions: during the experimental condition, the virtual body is displayed in first-person perspective (1PP), while in the control condition, the virtual body is displayed in third-person perspective (3PP). To confirm that individuals have the illusion of ownership and agency over the virtual body in 1PP (and not in 3PP), we will record the heart rate, in addition to subjective questionnaires. Before and after every IVR sessions (one week apart), we will measure cortical hemodynamic changes in the participants’ prefrontal cortex using the fNIRS device during the Stroop task’s execution. Discussion From a theoretical perspective, we could prove that the sense of body ownership and agency can modulate physical and cognitive parameters, even in the absence of actual movements; from a clinical perspective, these results could be useful to train cognition and body simultaneously, in a completely safe environment. Trial registration University Hospital Medical Information Network Clinical Trial Registry, UMIN000034255. Registered on 1 October 2018.

Repeated Exposure to Illusory Sense of Body Ownership and Agency Over a Moving Virtual Body Improves Executive Functioning and Increases Prefrontal Cortex Activity in the Elderly

“…Recent studies have shown that the illusory feeling of ownership and agency over the virtual body creates the necessary conditions to induce effects on the physiological (Martini et al, 2013;Kokkinara et al, 2016;Fossataro et al, 2020) or even components higher than the mere perceptual level, such as social (Peck et al, 2013;Banakou et al, 2018), neural (Seinfeld et al, 2021), or cognitive functions: concerning the latter, in our previous study, we demonstrated on young healthy participants acute improvement of cognitive (executive) functions after a high-intensity intermittent exercise performed exclusively by the considered-as-own virtual body (Burin et al, 2019c(Burin et al, , 2020. We argued that, despite the participants being completely still, the feeling of ownership and agency over the virtual body (only if displayed in a first-person perspective) (Kokkinara et al, 2016) induced a cascade of events (from the physiological activation of the heart rate to the increased neural activity over task-related areas), culminating in the improved cognitive performance immediately after the virtual exercise, comparable to what happens after a similar training performed by one's own physical body (Hyodo et al, 2016;Kujach et al, 2017).…”

“…In the present study, in order to answer these questions, we adapted the same virtual training (Burin et al, 2019c(Burin et al, , 2020 to test its efficacy on a sample of 42 physically and neurologically healthy elderly (over 60 years old) and to compare the acute and long-term impacts on cognitive, physiological, and neural functions. We conducted a parallel-group randomized controlled trial (RCT) composed of a 6-week (twice a week) IVR intervention, each session including 20 min of virtual highintensity intermittent exercise (vHIE), alternating the avatar between fast walking and slowly walking every 2 min: while the participants were sitting still, they observed the virtual body, either in a first-person perspective (1PP, the experimental group) or a third-person perspective (3PP, the control group), performing the virtual exercise.…”

Aerobic Exercise with Superimposed Virtual Reality Improves Cognitive Flexibility and Selective Attention in Young Males

“…Maintaining a certain level of physical activity has beneficial effects on the body itself but also, surprisingly, on cognition [65]. Despite new developments, a large portion of VR s potential is still unexplored; therefore, real experiences in a flexible context that combine relevant cultural, physical, and cognitive aspects are necessary [66].…”

Effect of virtual reality-simulated exercise on sympathovagal balance

“…VR has found multiple effective therapeutic uses in recent years, to increase exercise motivation [31], and to stimulate HR in stationary users [24,25]. Its use to encourage patients to complete therapeutic recovery regimens, sometimes called exergaming, is particularly welldeveloped [32,33].…”

“…The findings in Drosophila, coupled with the fact that epinephrine and norepinephrine increase during exercise in humans, and the fact that VR has been shown to be capable of increasing HR in stationary users [24,25], led us to propose that intermittent stimulation of adrenergic signaling might have therapeutic benefit in humans with a sedentary lifestyle [26].…”