Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 11, 2025
Date Accepted: Feb 19, 2026
Clinical effectiveness of immersive virtual reality exercise interventions: a systematic review and meta-analysis
ABSTRACT
Background:
Physical inactivity remains a global health concern, with only one in five adults meeting combined aerobic and muscle strengthening guidelines. Exercise interventions delivered through Immersive Virtual Reality (IVR) offer a novel mode of delivery. Little is known about the clinical effectiveness of exercise via IVR across population groups.
Objective:
The objective of this systematic review was to assess the clinical effectiveness of immersive virtual reality (IVR) interventions employing aerobic and/or anaerobic exercise.
Methods:
A systematic review incorporating meta-analyses was conducted. Searches were conducted across PubMed, Embase, Web of Science and CINAHL from inception until 14th January 2025. Randomised controlled trials including participants with an acute health condition, chronic disease, history of reconstructive or restorative surgery and older adults implementing IVR exercise and reporting clinical effectiveness outcomes were included. Meta-analyses were conducted for between-group comparisons for clinical effectiveness outcomes. Risk of Bias was assessed using the Cochrane Risk of Bias 2 tool and the certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Results:
Twenty-five trials were included in this review, with 21 progressing to meta-analyses. A large effect favouring IVR compared to exercising comparators was identified for pain intensity. Pooled analyses revealed no statistical differences between IVR and comparator intervention (exercising and/or non-exercising) for functional balance, condition severity, quality of life, functional leg strength, composite static and dynamic balance, static balance or aerobic physical activity outcomes. Eighty percent of outcomes assessed were rated as ‘some concerns’ (n=16) or at ‘high’ (n=21) risk of overall bias. GRADE certainty grading was deemed to be ‘low’ or ‘very low’ for all outcomes.
Conclusions:
IVR exercise appears to be as effective as comparators for clinical effectiveness outcomes. While these results indicate that IVR may be a viable option for the delivery of exercise, more robust methodology in future trials is needed to properly verify findings and improve certainty. Clinical Trial: PROSPERO registration number: CRD420250650110
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.