Acute Heart-Rate Responses and User Experience During Immersive Virtual Reality and Camera-Based Versions of a Digital Painting Task: An Exploratory Randomized Crossover Study

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Abstract
Background: Despite the growing use of immersive virtual reality (IVR) and camera-based exergaming (CBE), direct comparisons between these approaches using equivalent motor tasks remain limited. Comparing two technologically distinct implementations helps distinguish physiological and psychophysical responses associated with the technological interface from those linked to the exercise content. This study aimed to compare user satisfaction (USEQ), acute heart-rate (HR) response, rating of perceived exertion (RPE), and adverse experiences between IVR and CBE during a five-minute digital painting task with dual-hand tracking capabilities. Methods: Eighteen asymptomatic adults completed both 5 min conditions in a randomized sequence, separated by a 30 min washout period. HR was monitored continuously, RPE was assessed before and after, and satisfaction and open-ended feedback were collected immediately post-task. Results: Both modalities achieved high total USEQ scores, although no significant between-group differences were found (25.61 ± 3.74 for IVR vs. 24.44 ± 4.23 for CBE; p = 0.376). Changes in RPE were similarly low across conditions (p = 0.772). However, mean HR was significantly lower during IVR than during CBE (82.56 ± 16.42 vs. 86.67 ± 17.45 bpm; p = 0.007). Open-ended feedback favoured IVR for its perceived realism and immersion, although two participants reported mild transient dizziness during IVR, with no adverse events during CBE. Conclusions: Both IVR and CBE are highly satisfactory and present similar perceived exertion for short-duration digital motor tasks. IVR may provide a more immersive experience and was accompanied by a modestly lower acute heart-rate response, whereas CBE avoids headset-related transient symptoms. These preliminary findings highlight the need to balance user preference for immersion with tolerability and safety monitoring when designing interactive rehabilitation tools.

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