JMIR Publications

ABSTRACT

Background:

Exercise is a well-recognized non-pharmacological intervention in pediatric oncology, offering numerous physiological and psychological benefits. However, its feasibility is often constrained by cancer treatments and hospitalization.

Objective:

This study aims to evaluate the feasibility of a hospital-based Virtual Reality (VR) exergame for children with cancer by assessing compliance and acceptance, as well as estimating exercise intensity to ensure it meets medical recommendations (>3 METs).

Methods:

Thirteen pediatric cancer patients diagnosed with leukemia or sarcoma, aged 12.4±4.2 years participated in VR-based exergame sessions conducted four times per week over a two-months period in the pediatric oncology unit of the hospital. The exergame, similar to Beat Saber (i.e., players slice incoming blocks with lightsabers and dodge obstacles), included adaptability options to accommodate different physical constraints. Games lasted five minutes with participants choosing the number of games they played per session, up to a maximum of 30 minutes. A total of 131 games were analyzed to assess compliance rates (number of sessions attended divided by the total number of sessions offered for each child), patient acceptance (estimated with Technology Acceptance Model which contains Perceived ease of Use, Perceived usefulness, Intention to use, User Experience, Nausea/Oculomotors symptoms corresponding to adverse-effect score and Self assessed performance) and exercise intensity.

Results:

The participants demonstrated a good compliance rate of 68±29 % towards the VR-based exergame sessions, with individual variability influenced by factors such as age, prior VR experience, and usage intent. The average exercise intensity by child reached 4.44±1.91 METs (Metabolic Equivalent of Task), surpassing the moderate-intensity threshold. Acceptance was high with a high user experience (5.36 ±0.51) and no serious adverse effects were reported, with a low average adverse-effect score of 0.37/6.

Conclusions:

The main findings suggest that the proposed VR-based exergame practice is feasible and well-accepted with no significant adverse effects in a pediatric oncology setting. It can provide effective moderate-to-vigorous exercise levels while demonstrating a strong patient engagement, even in the face of individual differences. Although the results are promising, with a compliance rate of 68%, there is still room for improvement. Expanding the variety of VR content could better accommodate diverse age groups, particularly adolescents (13–17 years). Additionally, larger-scale studies are needed to confirm and validate these findings while further exploring the potential of VR as a tool to promote exercise in pediatric oncology. Moreover, integrating autonomous adaptation based on physiological and kinematic data could enhance both the effectiveness and engagement of the program.