Non-Immersive Virtual Reality Exercise Can Increase Exercise in Older Adults Living in the Community and in Long-Term Care: A Randomized Controlled Trial.

Purpose: To assess the impact of an 8-week non-immersive virtual reality exercise program for older adults on 1) balance, physical function, community integration and quality of life; 2) falls, emergency room visits, hospital and long-term care admissions; 3) quantity of exercise performed; and 4) acceptance of non-immersive virtual reality.

Patients and methods: This prospective, assessor-blinded, randomized controlled trial was carried out on two separate samples of older adults: those living in their own homes ("home-based") and those living in long-term care ("facility-based"). Participants were randomized to non-immersive virtual reality or usual activity. Non-immersive virtual reality consisted of 20-30 minutes of customized, gamified exercises for balance, stepping, strengthening, and aerobic conditioning, performed 3-5x/week for 8 weeks. Outcomes were measured before the intervention, immediately after, and 1 month later. Physical testing and questionnaires addressed objective 1). Counts for objectives 2) and 3) were reported by the participants and retrieved from the non-immersive virtual reality platform. Logbooks and a short interview addressed objective 4).

Results: Recruitment was substantially impacted by the COVID-19 pandemic. The facility-based sample had 31 participants; the home-based sample had 16. There were no statistically-significant benefits to non-immersive virtual reality in either sample for objective 1), although the facility-based non-immersive virtual reality group showed a clinically-significant improvement in functional walking. Effect sizes were small (≤ 0.16). No falls occurred during non-immersive virtual reality exercise. The facility-based non-immersive virtual reality group did an average of 14.1 sessions (average 20.1 minutes/session) and the home-based non-immersive virtual reality group did an average of 17.2 sessions (22.6 minutes/session). Participants enjoyed the non-immersive virtual reality, found it challenging and motivating and felt that it improved balance and walking. Most were interested to continue beyond the study.

Conclusion: Non-immersive virtual reality for home-based and facility-based older adults is safe, enjoyable and feasible and may increase users' weekly levels of physical activity leading to clinical benefits for functional walking in facility-based users.

Trial registration: ClinicalTrials.gov (NCT04083885; registered 2019-09-06).