JMIR Publications

ABSTRACT

Background:

Immersive virtual reality (VR) is increasingly used for embodied training, but its practical value for older adults depends on whether experiential benefits can be achieved without unacceptable discomfort or overstated claims about motor learning.

Objective:

This randomized study compared head-mounted immersive VR with standardized, content-matched 2D video instruction for Tai Chi movement-encoding in community-dwelling older adults.

Methods:

A total of 106 older adults were randomized to immersive VR (n=56) or video instruction (n=50). The primary analysis included 92 participants with complete age, pre-test, and post-test data (VR: n=45; Video: n=47). The primary outcome was a five-item movement-encoding knowledge score (0-20), analyzed using ANCOVA with post-test score as the dependent variable and group, pre-test score, and age as predictors. Secondary outcomes were intrinsic motivation, game experience, and learning engagement; safety, tolerability, and feasibility were assessed using the Intrinsic Motivation Inventory, Game Experience Questionnaire, Utrecht Work Engagement Scale-Short Form, participant flow, and Virtual Reality Sickness Questionnaire. VR system telemetry was analyzed descriptively as an exploratory process outcome.

Results:

Adjusted post-test movement-encoding performance did not differ between VR and video instruction (adjusted difference -0.27, 95% CI -2.25 to 1.72; P=.788; partial eta squared=0.001). GEQ results favored VR for competence (Video: 3.36 [1.21]; VR: 4.15 [0.92]; q=.009), flow (Video: 3.77 [1.26]; VR: 4.46 [0.76]; q=.014), and lower tension (Video: 1.76 [1.04]; VR: 1.27 [0.63]; q=.037), whereas challenge did not remain significant after FDR correction (q=.073). In the VR group, recognition accuracy was associated with post-test movement-encoding score (n=44; r=.317, P=.036), but pose accuracy was not (n=44; r=.129, P=.405). VRSQ scores were low among valid VR participants (total score 3.77 [11.12]), and 36/46 (78%) reported zero symptoms.

Conclusions:

Under a strong active control, immersive VR did not produce higher short-term Tai Chi movement-encoding performance than video instruction. Among participants who completed the VR session, the immediate game-experience profile was more favorable. These findings indicate that VR may offer experiential benefits, while also highlighting the need to manage cybersickness and technical exclusions and to distinguish movement knowledge from actual motor execution. Clinical Trial: International Traditional Medicine Clinical Trial Registry (ITMCTR), ITMCTR2026001760; retrospectively registered.