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. 2025 Mar 21;17(1):55.
doi: 10.1186/s13102-025-01102-9.

VR-guided exercise and mindfulness program for people with chronic pain: a randomised controlled cross-over pilot trial

Sella Aarrestad Provan  1   2 , Giovanna Calogiuri  3   4 , Linda Røset  3 , Maren Mariussen  3 , Ingeborg Rosøy  3 , Tonje Jossie Johnsen  5 , Thomas Johansen  5   6 , Ole Einar Flaten  7 , Sigbjørn Litleskare  3
Affiliations

VR-guided exercise and mindfulness program for people with chronic pain: a randomised controlled cross-over pilot trial

Sella Aarrestad Provan et al. BMC Sports Sci Med Rehabil. .

Abstract

Background: Physical exercises and mindfulness are important components in the management of chronic pain, but pain may reduce exercise adherence. Virtual reality (VR) can provide cognitive inhibition of the ascending pain signal and may thus be a tool for the delivery of pain management during exercise interventions. In this study we assessed a VR-guided intervention seeking to improve physical fitness in individuals with chronic pain.

Methods: Participants in rehabilitation for chronic pain were included in a randomised controlled pilot trial with a cross-over design. In counter-balanced order participants were asked to perform, five minutes of aerobic exercise following identical instructions given through either a VR headset or television (TV) screen. The procedures were then repeated with mindfulness exercises. Heart rate (HR) was monitored throughout all four sessions and participants self-reported perceived exercise intensity, benefit, relaxation, and reward. Paired Student's t-test, Wilcoxon signed rank test and McNemar's test were performed to compare the outcome variables across sessions for individuals, as appropriate. (Clinical trial registration NCT06611566 09.09.24, retrospectively registered).

Results: Twenty-seven participants were included in the study. The mean age (SD) was 40.4 (11.3) years, and 17 (63%) were men. Mean HR, the proportion of time spent at moderate-vigorous exercise intensity levels, and all self-reported measurements were comparable between the VR vs. TV sessions. No major adverse events were reported. The physiological and perceived exercise outputs of aerobic exercises were thus similar across modes of delivery (VR vs. TV) in individuals with chronic pain.

Conclusions: This study confirms the possibilities of VR-guided interventions in the pain management of individuals with chronic pain with comparable levels of exertion to TV-guided exercise and few adverse events. The promise of VR-guided mindfulness in the rehabilitation of patients with chronic pain conditions is also confirmed.

Keywords: Chronic pain; Exercise; Mindfulness; Rehabilitation; VR.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted according to the declaration of Helsinki and approved by the Local committee for medical and health research ethics at the Inland Norway University of Applied Sciences. Informed consent was obtained from all participants. CONSORT guidelines: The manuscript complies with the CONSORT guidelines and the checklist has been uploaded. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of time spent in each heart rate zone during VR-and TV-guided sessions. Heart-rate according to the American College of Sports Medicine recommendations based on the participants’ predicted maximal heart-rate (220 minus age). 1 = heart rate < 50% of maximal heart rate, 2 = heart rate ≥ 50% and < 65% of maximal heart, 3 = heart rate ≥ 65% and < 75% of maximal heart, 4 = heart rate ≥ 75% of maximal heart rate. VR; virtual reality TV; television
Fig. 2
Fig. 2
Self-reported outcomes following VR- and TV-guided sessions. VR; virtual reality, TV; television Numeric rating scale 1 = least, 5 = most
See this image and copyright information in PMC

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