Effects of a Modern Virtual Reality 3D Head-Mounted Display Exergame on Simulator Sickness and Immersion Under Specific Conditions in Young Women and Men: Experimental Study

Abstract

Background: Many young adults do not reach the World Health Organization's minimum recommendations for the amount of weekly physical activity. The virtual reality 3D head-mounted display (VR 3D HMD) exergame is a technology that is more immersive than a typical exercise session. Our study considers gender differences in the experience of using VR games for increasing physical activity.

Objective: The aim of this study was to examine the differences in the effects of VR 3D HMD gaming in terms of immersion, simulator sickness, heart rate, breathing rate, and energy expenditure during two 30-minute sessions of playing an exergame of increasing intensity on males and females.

Methods: To examine the effects of the VR 3D HMD exergame, we experimented with 45 participants (23 males and 22 females) exercising with VR 3D HMD Oculus Quest 1, hand controllers, and Zephyr BioHarness 3.0. Players exercised according to the Audio Trip exergame. We evaluated the immersion levels and monitored the average heart rate, maximum heart rate, average breathing rate, maximum breathing rate, and energy expenditure in addition to simulator sickness during two 30-minute exergame sessions of increasing intensity.

Results: Audio Trip was well-tolerated, as there were no dropouts due to simulator sickness. Significant differences between genders were observed in the simulator sickness questionnaire for nausea (F_2,86=0.80; P=.046), oculomotor disorders (F_2,86=2.37; P=.010), disorientation (F_2,86=0.92; P=.040), and total of all these symptoms (F_2,86=3.33; P=.04). The measurements after the first 30-minute VR 3D HMD exergame session for all the participants showed no significant change compared to the measurements before the first 30-minute exergame session according to the total score. There were no gender differences in the immersion (F_1,43=0.02; P=.90), but the measurements after the second 30-minute exergame session showed an increase in the average points for immersion in women and men. The increase in the level of immersion in the female group was higher than that in the male group. A significant difference between genders was observed in the average breathing rate (F_2,86=1.44; P=.04), maximum breathing rate (F_2,86=1.15; P=.047), and energy expenditure (F_2,86=10.51; P=.001) measurements. No gender differences were observed in the average heart rate and maximum heart rate measurements in the two 30-minute sessions.

Conclusions: Our 30-minute VR 3D HMD exergame session does not cause simulator sickness and is a very immersive type of exercise for men and women users. This exergame allows reaching the minimum recommendations for the amount of weekly physical activity for adults. The second exergame session resulted in simulator sickness in both groups, more noticeably in women, as reflected in the responses in the simulator sickness questionnaire. The gender differences observed in the breathing rates and energy expenditure measurements can be helpful when programming VR exergame intensity in future research.

Keywords: HMD; WHO recommendation; Zephyr; digital health; energy expenditure; exercise game; exergame; gender differences; immersion; physical activity; simulator sickness; virtual reality; young adult.

Figure 1

Exergame playlist in beginner and regular modes of the Audio Trip virtual reality game, including the title, duration of songs, and beats per minute. BPM: beats per minute.

Figure 2

Study protocol presented in the chronological order from left to right for the experimental group. Br-Ave: average breathing rate; Br-Max: maximum breathing rate; EE: energy expenditure; HR-ave: average heart rate; HR-Max: maximum heart rate; SSQ: Simulator Sickness Questionnaire; TIQ: The Immersion Questionnaire; VR: virtual reality; ZB3: Zephyr Bioharness 3.0.

Figure 3

The various elements of the 5-minute warm-up (5: running in place, 4: arm swings, 3: torso twists, 2: torso bends, 1: warming the joints, that is, wrist and ankle) on the television.

Figure 4

Virtual reality exergame intervention in a safe area of 2.5 meters × 2.5 meters.

Figure 5

View of the Audio Trip game. From left: A. Selecting a track from the list.; To the rhythm of the music, hitting two-colored triangles as intended: B. touching by R/L hand C. hitting at a certain angle by R/L hand, D. smashing the drums by R/L hand, E. following the path by R/L hand and dodging the barriers.; F. Following the trainer (back perspective).

Figure 6

Gender differences in the total simulator sickness score during the three measurements. PRE: before the first 30-minute exergame session; INTER: between the exergame sessions; POST: after the second 30-minute exergame session; SSQ: Simulator Sickness Questionnaire.

Figure 7

Gender differences in the immersion questionnaire score during the two measurements. INTER: between the exergame sessions; POST: after the second 30-minute exergame session; TIQ: The Immersion Questionnaire.