Currently submitted to: JMIR Serious Games
Date Submitted: Apr 28, 2026
Open Peer Review Period: Apr 29, 2026 - Jun 24, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Impact of Extended Reality Physical Activity Intensity on the Physical and Mental Health of Adolescents and Young Adults: A Systematic Review
ABSTRACT
Background:
Extended reality physical activity engages adolescents and young adults through immersive exercise, yet the differential health effects of its highly variable intensity remain unclear. This review aimed to systematically evaluate the intensity-specific impacts of XR physical activity on physical and mental health outcomes in individuals aged 10--24 years.
Objective:
The aim is to systematically assess the specific intensity impact of immersive reality-based sports activities on the physical and mental health of individuals aged 10 to 24.
Methods:
A systematic search of six electronic databases was conducted for randomized controlled trials published between January 2005 and January 2025. Eligible studies reported XR physical activity intensity and assessed physiological, psychological, cognitive, or behavioral outcomes in healthy adolescents and young adults. A narrative synthesis was performed stratified by a prespecified intensity classification standard. The risk of bias was assessed via the Cochrane RoB-2 tool, and evidence certainty was evaluated via the GRADE approach. The protocol was prospectively registered.
Results:
Eighteen randomized controlled trials involving 1,081 participants were included. The intensity ranged from low to high. Moderate-to-high-intensity extended reality activities yielded significant improvements in body composition, cardiorespiratory fitness, muscular strength, and specific cognitive functions, including working memory and inhibitory control. In contrast, mental health and mood improvements were more pronounced with low-to-moderate intensity, highly immersive activities, with no additional emotional benefits observed at high intensity. While XR activities generally enhance exercise enjoyment, evidence for long-term adherence is inconclusive. Most outcomes demonstrated low or very low certainty of evidence due to risk of bias and imprecision.
Conclusions:
The health benefits of extended reality physical activity demonstrate a domain-specific intensity‒effect relationship. Effective interventions require tailoring exercise intensity to targeted outcomes and integrating behavioral theory. Current evidence is predominantly limited to young adults and of low certainty, underscoring the need for rigorous, long-term trials to establish precise dose‒response guidelines. Clinical Trial: PROSPERO CRD420261285966.
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