Impact of 4week(s) or more immersive virtual reality on quality of life and physical activity in older adults: a systematic review and meta-analysis (Preprint)

BACKGROUND Population aging poses significant public health challenges. Older adults often face multimorbidity, functional decline, and diminished quality of life. While physical activity can mitigate these effects, adherence remains low. Immersive virtual reality (IVR) has emerged as a promising, engaging tool to promote physical and cognitive health in this population. OBJECTIVE To evaluate the effectiveness of IVR interventions lasting four weeks or more on quality of life, physical activity, pain, perceived effort, and adverse events in older adults. METHODS A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines. Literature was searched across PubMed, Web of Science, PEDro, and Scopus, as well as sources of grey literature. Eligible studies included randomized controlled trials (RCTs) involving participants aged 60+, using IVR via head-mounted displays (HMDs). Outcomes assessed included quality of life, physical activity, pain, perceived effort, and adverse events. Risk of bias and evidence certainty were assessed using Risk of Bias 2.0 and Grades of Recommendation Assessment Development and Evaluation (GRADE), respectively. RESULTS A total of 14 studies (n= 839 participants) were included in the qualitative synthesis, of which 8 were eligible for quantitative meta-analysis. The pooled analysis showed a statistically significant moderate effect of IVR on quality of life (Standardized Mean Difference (SMD) = 0.48, 95% CI: 0.1 to 0.8, p = 0.007), particularly in interventions lasting 10–12 weeks or involving more than 600 minutes of exposure. For physical activity, no significant differences were found between IVR and control groups (SMD = –0.2, 95% CI: –0.7 to 0.4, p = 0.5). Pain outcomes, assessed in two studies, indicated reductions in the IVR group, especially when multimodal approaches were used. Perceived effort was not systematically measured. Adverse events were generally mild, with cybersickness being the most reported issue CONCLUSIONS IVR interventions of four weeks or more appear to moderately improve quality of life in older adults, especially those with clinical vulnerabilities or in institutional settings. Although effects on physical activity were not significant, trends suggest potential with appropriate program design. Preliminary findings support IVR's utility in pain reduction, particularly when incorporating emotional and multisensory elements. The low incidence of adverse events suggests good tolerability. Overall, IVR is a promising and safe tool to support healthy aging, though further high-quality studies are needed to confirm these findings and assess long-term outcomes.