Effectiveness of 3D virtual reality motionless imagery exercise through an avatar for mental health in older people: A randomized controlled trial

Objective This study developed a 3D virtual reality (VR)–based Mental Imagery Exercise with Avatars (MIEA) and evaluated its effectiveness in improving cognitive, emotional, and physical outcomes in older adults. Methods The experiment involved 38 older adults aged between 65 and 84 years. The study subjects were divided into experimental and control groups, with 19 individuals in each group. Both groups engaged in the VR intervention for 20 minutes, three times a week, for six weeks. The experimental group selected an avatar matching their gender and engaged in virtual exercise using a jogging track, while the control group performed virtual exercise on the same jogging track without an avatar. Results Most cognitive assessments showed significant improvements over time, except for the Stop Signal Task. Significant time-by-group interactions were observed in the Stroop Test, immediate and delayed recall in the K-AVLT, working memory in the Digit Span Task, and semantic fluency in the COWAT. Emotional well-being analysis showed a significant improvement in physical self-efficacy over time, along with a time-by-group interaction. Group differences were significant for stress, positive affect, and negative affect. Electromyography (EMG) data from the left gastrocnemius indicated significant time effects and time-by-group interaction, suggesting physiological changes associated with the intervention. Conclusions The results indicated that 3D MIEA provides certain psychological benefits associated with exercise and 3D MIEA may offer potential utility for individuals who are unable to engage in physical exercise.