Virtual reality exercise before bariatric surgery: a feasibility randomised controlled trial

Introduction Preoperative physical activity remains a challenge in bariatric patients. This pilot randomised controlled trial assessed the feasibility, adherence and clinical impact of virtual reality (VR)-based exercise in preparation for bariatric surgery. Methods A single bariatric centre randomised patients from January 2020 to May 2023 to a 6-week home-based exercise programme: either VR-based exercise or standard walking exercise. Physical activity levels were assessed using the New Zealand Physical Activity Questionnaire Short Form pre- and post-intervention. Secondary outcomes included adherence, patient satisfaction, weight loss and 30-day postoperative outcomes. Results A total of 43 patients were enrolled (mean age 46.3 ± 11.2 years, mean body mass index [BMI] 46.4 ± 6.37kg/m 2 , 83.7% female). Of these, 25 (58.1%) completed the intervention (VR: 13, control: 12). Enjoyment scores were significantly higher in the VR group (4.3 ± 0.85 vs 3 ± 0.95; p = 0.001). Post-intervention increases in physical activity were observed in both groups, with modest improvements in brisk and vigorous activity levels. Total weight loss percentage (TWL%) at 6 weeks and BMI at 12 months were comparable between groups. Dropout rates were similar (VR: 43.5%, control: 40%; p = 1). No statistically significant differences were observed in postoperative complications or readmissions. Conclusions VR-based exercise was deliverable and acceptable as a preoperative exercise intervention in bariatric surgery, with significantly higher enjoyment compared with standard walking exercise. However, adherence remained challenging, with similar dropout rates between groups and no significant between-group differences in clinical outcomes. These findings may support further development of tailored VR-based prehabilitation programmes, with future adequately powered trials. Trial registration: ClinicalTrials.gov Identifier: NCT04297306