Immersive Virtual Reality Exergaming vs Video-Guided Screen-Based Exercise for Cognitive and Neurophysiological Adaptations in Young Adults: Protocol for Acute and Chronic Experimental Studies

Background Physical exercise involving simultaneous cognitive demands, including dance-based exergames, has shown moderate effects on executive function. Immersive virtual reality (VR) may enhance these effects by increasing presence and frontal cortical activation; however, evidence in youth integrating objective neurophysiological measures remains limited and methodologically heterogeneous. Objective This study aims to examine the acute and chronic effects of an immersive VR dance exergame, considered as an integrated package of immersion, interactivity, and real-time performance feedback, compared with a matched video-guided screen-based exercise condition (comparator condition [CS]), on inhibitory control as the primary outcome, and on frontal cortical activity, perceived self-efficacy, affective state, and physiological response as mechanistic or secondary outcomes. Methods This protocol reports 2 methodologically independent studies, covered by a single prospective trial registration that describes both, in young adults aged 18 to 30 years: an acute randomized crossover study with up to 40 participants, and a 10-week 2-arm randomized controlled trial with a target sample of 64 participants and 3 sessions per week. In the VR condition, participants will play Beat Saber using Meta Quest 2 headsets. In the CS, they will follow a prerecorded video of the same playlist, matched for songs, tempo, movement sequence, difficulty, transition periods, and session duration. The primary outcome is the Stroop interference index. The confirmatory neurophysiological end point is absolute frontal theta power (4-7 Hz) averaged across F3, F4, AF3, and AF4 during the color-word interference condition. Secondary and exploratory outcomes include additional spectral measures, perceived self-efficacy, affective state, heart rate and percentage of heart rate reserve, rating of perceived exertion, wrist accelerometry, presence, cybersickness, enjoyment, and expectations. Assessments are conducted before and after each session in the acute study and at baseline, midpoint, postintervention, and 4-week follow-up in the chronic study. Linear mixed models accounting for period, sequence, participant, and the within-session pre/post structure will be used, with a prespecified hierarchy of confirmatory and exploratory analyses and false discovery rate correction applied within defined families. Results Recruitment is expected to begin in October 2026, with data collection completed by December 2027 and first results available by June 2028. No participants had been enrolled at submission. Conclusions This protocol presents a controlled experimental design to examine the effects of immersive VR exergaming, compared with matched video-guided screen-based exercise, on neurocognitive, psychological, and physiological outcomes. Incorporating immersion-related variables may help clarify the mechanisms underlying VR-based exercise and inform future technology-supported interventions in exercise and cognitive health. Trial Registration ISRCTN Registry ISRCTN15563829; https://www.isrctn.com/ISRCTN15563829 International Registered Report Identifier (IRRID) PRR1-10.2196/105801