Effect of Virtual Reality–assisted Mindfulness-Based Cardiopulmonary Rehabilitation on Exercise Capacity and Psychological Outcomes in Cardiac Patients: A Randomized Controlled Trial

Background: Cardiac rehabilitation (CR) improves functional capacity and reduces morbidity; however, adherence and psychological distress limit its effectiveness. Virtual reality (VR) and mindfulness-based interventions may enhance engagement and rehabilitation outcomes. Objective: To evaluate the effectiveness of VR-assisted mindfulness-based cardiopulmonary rehabilitation on exercise capacity and psychological outcomes in cardiac patients. Methods: A single-blinded randomized controlled trial was conducted on 50 cardiac patients in Pakistan Institute of Cardiology Peshawar. Participants were randomly allocated into an intervention group (VR-assisted mindfulness-based CR) and a control group (conventional CR). The intervention lasted 8 weeks. Primary outcomes included the 6-minute walk test (6MWT) and VO₂ max. Secondary outcomes included anxiety, depression, and stress. Data were analyzed using paired and independent t-tests, with effect sizes (Cohen’s d) and 95% confidence intervals reported. Results: Forty-six participants completed the study. The intervention group demonstrated significantly greater improvements in exercise capacity, with a mean between-group difference of 60 meters in the 6-minute walk test (95% CI: 35–85; p < 0.001), and higher VO₂ max (mean difference: 3.7 ml/kg/min; 95% CI: 2.1–5.3; p < 0.001). Significant reductions were observed in psychological outcomes, with lower post-intervention scores in anxiety (6.5 ± 1.8 vs 9.8 ± 2.2; p = 0.002; Cohen’s d ≈ 1.4), depression (6.2 ± 1.7 vs 9.6 ± 2.3; p = 0.001; Cohen’s d ≈ 1.5), and perceived stress (14.3 ± 2.8 vs 18.9 ± 3.1; p = 0.003; Cohen’s d ≈ 1.3). Effect sizes ranged from moderate to large. Conclusion VR-assisted mindfulness-based cardiopulmonary rehabilitation is associated with improvements in both functional and psychological outcomes in patients with cardiovascular disease. The observed effect sizes indicate substantial treatment effects; however, given methodological constraints, these findings require confirmation in larger multicenter trials with longer follow-up.