Javier Bravo-Aparicio

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.

Background: Fibromyalgia (FM) is a multidimensional chronic pain condition associated with alterations in sensorimotor processing, body perception, and psychological functioning. Although laterality discrimination impairments have been described for the limbs, evidence regarding craniofacial regions remains limited. This study compared mandibular and lingual laterality discrimination, body esteem, state anxiety, and kinesiophobia between women with FM and healthy controls and examined their associations with clinical variables. Methods: A cross-sectional study included 60 women, 30 with FM and 30 healthy controls. Mandibular and lingual laterality discrimination were assessed using a digital image-recognition task that recorded accuracy and reaction time. Body esteem, state anxiety, kinesiophobia, pain intensity, and FM impact were also evaluated. Between-group comparisons and correlation analyses were performed. Results: In unadjusted analyses, women with FM showed lower mandibular laterality accuracy and longer reaction times during the lingual task; however, these differences did not remain statistically significant after correction for multiple comparisons. Women with FM showed significantly higher state anxiety and kinesiophobia and lower body esteem than healthy controls, with these differences remaining significant after multiplicity adjustment. Conclusions: Women with FM showed marked psychological and body-related differences compared with healthy controls. Between-group differences in craniofacial laterality outcomes were observed in unadjusted analyses, although they did not remain statistically significant after correction for multiple comparisons.

BACKGROUND Immersive virtual reality has considerable potential in gerontology, but intervention designs are often standardised around assumptions of interactive simplicity, overlooking independent and digitally literate older people. OBJECTIVE This study evaluated the usability, acceptability and perceived clinical relevance of a playful immersive intervention using a mixed-methods approach. METHODS A mixed-methods design was used. Twelve older people, with a physically active profile, and seven healthcare professionals were recruited. After a 15-minute exposure to a custom immersive virtual reality therapeutic application, quantitative data from satisfaction questionnaires and the System Usability Scale were triangulated with semi-structured interviews analysed using reflexive thematic analysis. RESULTS Quantitatively, perceived usability was excellent (mean System Usability Scale score: 85/100, standard deviation 10.8). However, although independent users reported a strong initial hedonic response, they criticised the interactive simplicity and aesthetic immaturity of the experience. Future adherence was perceived to depend on gamified progression capable of preventing boredom. In contrast, healthcare professionals interpreted the experience through a frailty-oriented lens, prioritising physical safety, control of dual-task demands and the prevention of falls or cybersickness in the context of non-parameterised visual overstimulation. CONCLUSIONS Immersive virtual reality appears to be a feasible tool for use with older people, but its long-term clinical value may depend less on immediate tolerance than on addressing the tension between active users’ need for challenge and therapists’ emphasis on preventive control. Software should move beyond interactive simplification and incorporate flexible, parameterizable architectures that allow interventions to be co-designed according to each person’s physical capacity and cognitive reserve.

Study design Systematic review and meta-analysis. Objective To determine the effectiveness of transcranial magnetic stimulation (TMS) in improving gait velocity and spasticity in people with spinal cord injury (SCI). Setting Studies included in the review were conducted in various countries; the review was carried out in Spain. Methods A systematic review with meta-analysis was conducted by searching for randomized controlled trials published up to November 2024 comparing the application of TMS with a sham group. Outcome variables were gait velocity and spasticity, measured with the 10 m walking test and the Modified Ashworth Scale (MAS) respectively. PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL and PEDro databases were consulted. Results Fourteen studies were included in the qualitative analysis and twelve in the quantitative analysis, involving 235 participants with SCI. No significant differences were detected for the effect of TMS on gait velocity (SMD = −0.71; 95%CI: −1.62 to 0.20). However, TMS produced a significant decrease in MAS compared to the control group (MD = −0.56 points; 95%CI: −0.82 to −0.30). Although the subgroup analysis based on the number of pulses showed no significant differences between applications of <1000 and ≥1000 pulses, the ≥1000 pulses subgroup showed significant differences (MD = −0.56 points; 95%CI: −0.83 to −0.30) favoring the experimental group, while the <1000 pulses subgroup showed no significant differences (MD = −0.35 points; 95%CI: −2.03 to 1.34). Conclusions TMS is effective in improving spasticity in people with SCI with low certainty of evidence. However, TMS has not demonstrated a significant effect on gait velocity, with very low certainty of evidence. Further studies comparing the number of pulses and their effectiveness are warranted to elucidate the findings of this meta-analysis.

Background and Objectives: Fibromyalgia is a chronic condition characterized by widespread pain, reduced quality of life, and impaired physical function. Given that physical activity is a primary treatment for musculoskeletal health and overall well-being, VR-based active exercise may offer an innovative way to engage individuals with fibromyalgia in therapeutic movement. Methods: A Systematic Review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials including adult patients with fibromyalgia undergoing active VR-based exercise interventions were included. Databases searched were PubMed, Scopus, Web of Science, CENTRAL, and PEDro from inception up to 18 July 2025. Primary outcomes were pain intensity, fatigue, and symptom severity. Secondary outcomes included depression, anxiety, kinesiophobia, aerobic capacity, muscle strength, and balance. Risk of bias was assessed using Cochrane’s Risk of Bias 2 tool, and certainty of evidence was evaluated using GRADE. Results: Ten randomized controlled trials (203 participants) were included. Active VR interventions significantly reduced pain (SMD = −0.51), fatigue (SMD = −0.53), and symptom severity (MD = −8.41). Moderate effects were found for depression (SMD = −0.51) and anxiety (SMD = −0.41). Non-significant improvements were also observed in aerobic capacity (SMD = 0.28), and muscle strength (SMD = 0.33), while balance slightly favored control group (SMD = −0.19). The overall certainty of evidence for main outcomes was rated low. Subgroup analyses showed VR was superior to both no intervention and other isolated therapies. Conclusions: Active virtual reality-based exercise interventions appear effective for improving physical and psychological outcomes in fibromyalgia, although findings should be interpreted cautiously due to low certainty of evidence.

Background: Population aging poses significant public health challenges. Older adults often face multimorbidity, functional decline, and diminished quality of life. While physical activity can mitigate these effects, adherence remains low. Immersive virtual reality (IVR) has emerged as a promising, engaging tool to promote physical and cognitive health in this population. Objective: The review aims to evaluate the effectiveness of IVR interventions lasting 4 weeks or more on quality of life, physical activity, pain, perceived effort, and adverse events in older adults. Methods: A systematic review and meta-analysis were conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. Literature was searched across PubMed, Web of Science, PEDro, and Scopus, as well as sources of gray literature. Eligible studies included randomized controlled trials involving participants aged >60 years, using IVR via head-mounted display. Outcomes assessed included quality of life, physical activity, pain, perceived effort, and adverse events. Risk of bias and evidence certainty were assessed using Risk of Bias 2.0 and GRADE (Grades of Recommendation Assessment Development and Evaluation), respectively. Results: A total of 14 studies with 839 participants were included in the qualitative synthesis, of which 8 were eligible for quantitative meta-analysis. The pooled analysis showed a statistically significant moderate effect of IVR on quality of life (standardized mean difference [SMD]=0.48, 95% CI 0.1-0.8; P =.007), particularly in interventions lasting 10 to 12 weeks or involving more than 600 minutes of exposure. For physical activity, no significant differences were found between IVR and control groups (SMD=–0.2, 95% CI –0.7 to 0.4; P =.50). Evidence for secondary outcomes (pain, perceived exertion, and adverse events) was limited and largely qualitative, with inconsistent findings. Pain outcomes, assessed in 2 studies, indicated reductions in the IVR group, especially when multimodal approaches were used. Perceived effort was not systematically measured. Adverse events were generally mild, with cybersickness being the most reported issue. Conclusions: IVR interventions of 4 weeks or more appear to moderately improve quality of life in older adults, especially those with clinical vulnerabilities or in institutional settings. Although effects on physical activity were not significant, trends suggest potential with appropriate program design. Preliminary findings support IVR’s use in pain reduction, particularly when incorporating emotional and multisensory elements. The low incidence of adverse events suggests good tolerability. Overall, IVR is a promising and safe tool to support healthy aging, though further high-quality studies are needed to confirm these findings and assess long-term outcomes.

Background: The increasing use of virtual reality (VR) has extended into medical applications, including pain management through immersive mechanisms. This study aimed to evaluate the effectiveness of the Clone Hero for reducing pain intensity, threshold and tolerance. Methods: A randomized crossover trial compared three conditions during a cold pressor test in 25 healthy volunteers over 35 years: playing Clone Hero (interactive), watching Clone Hero (control), or no intervention (placebo). Outcome measures included usability and acceptability (qualitative questionnaire), pain intensity (VAS), pain threshold, pain tolerance, physical activity (IPAQ), and adverse effects. Results: Twenty-five participants completed the study. Overall satisfaction was high, with 92% reporting a positive experience. The Clone Hero group showed significantly lower pain intensity scores (4.9 ± 0.49) than the placebo (5.6 ± 0.48; p = 0.037) and control groups (6.1 ± 0.42; p = 0.004). Pain threshold was higher in the Clone Hero group (74.45 ± 20.7 s) compared to the placebo (62.91 ± 18.58; p < 0.001) and control (43 ± 14.77; p = 0.001). Pain tolerance was also greater (127.6 ± 9.46 s) versus the placebo (p = 0.021) and control (p = 0.001). No serious adverse effects were reported. Conclusions: Interactive pain management interventions demonstrated high levels of acceptability and user satisfaction, and may enhance pain modulation more effectively than passive or control.

BACKGROUND Population aging poses significant public health challenges. Older adults often face multimorbidity, functional decline, and diminished quality of life. While physical activity can mitigate these effects, adherence remains low. Immersive virtual reality (IVR) has emerged as a promising, engaging tool to promote physical and cognitive health in this population. OBJECTIVE To evaluate the effectiveness of IVR interventions lasting four weeks or more on quality of life, physical activity, pain, perceived effort, and adverse events in older adults. METHODS A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines. Literature was searched across PubMed, Web of Science, PEDro, and Scopus, as well as sources of grey literature. Eligible studies included randomized controlled trials (RCTs) involving participants aged 60+, using IVR via head-mounted displays (HMDs). Outcomes assessed included quality of life, physical activity, pain, perceived effort, and adverse events. Risk of bias and evidence certainty were assessed using Risk of Bias 2.0 and Grades of Recommendation Assessment Development and Evaluation (GRADE), respectively. RESULTS A total of 14 studies (n= 839 participants) were included in the qualitative synthesis, of which 8 were eligible for quantitative meta-analysis. The pooled analysis showed a statistically significant moderate effect of IVR on quality of life (Standardized Mean Difference (SMD) = 0.48, 95% CI: 0.1 to 0.8, p = 0.007), particularly in interventions lasting 10–12 weeks or involving more than 600 minutes of exposure. For physical activity, no significant differences were found between IVR and control groups (SMD = –0.2, 95% CI: –0.7 to 0.4, p = 0.5). Pain outcomes, assessed in two studies, indicated reductions in the IVR group, especially when multimodal approaches were used. Perceived effort was not systematically measured. Adverse events were generally mild, with cybersickness being the most reported issue CONCLUSIONS IVR interventions of four weeks or more appear to moderately improve quality of life in older adults, especially those with clinical vulnerabilities or in institutional settings. Although effects on physical activity were not significant, trends suggest potential with appropriate program design. Preliminary findings support IVR's utility in pain reduction, particularly when incorporating emotional and multisensory elements. The low incidence of adverse events suggests good tolerability. Overall, IVR is a promising and safe tool to support healthy aging, though further high-quality studies are needed to confirm these findings and assess long-term outcomes.

Background: Sedentary behavior is highly prevalent among older adults, with adherence to exercise being a major challenge. Exercise offers substantial physical, psychological, and social benefits, but enjoyment is a key factor influencing adherence. Technology-based interventions have shown promise in enhancing motivation and participation, demonstrating higher adherence rates than conventional treatments, although challenges such as motivation loss and technological barriers persist. This review evaluates the effectiveness of active video game interventions on enjoyment and satisfaction in older adults. Objective: This systematic review and meta-analysis aims to determine whether active video games are superior to other interventions in generating greater enjoyment or satisfaction in older adults. Methods: PubMed, Cochrane, PEDro, SPORTDiscus, CINAHL, Web of Science, and Scopus databases were searched from inception to September 30, 2024, to identify randomized clinical trials or crossover studies. The primary outcome was enjoyment or satisfaction, assessed using various scales, including the Physical Activity Enjoyment Scale, Intrinsic Motivation Inventory, User Satisfaction Questionnaire, and Likert-type scoring scales. Secondary outcomes included adherence rates and adverse effects. Cochrane Risk of Bias 2 tool was used to evaluate the risk of bias. Results: Five studies were included in the quantitative analysis. The results indicated a significant improvement in enjoyment or satisfaction compared to the control groups (standardized mean difference 0.34, 95% CI 0.05-0.64; P=.02; I²=24%), although the effect size was small. Secondary outcomes could not be analyzed due to insufficient data in the selected studies. Conclusions: Active video game interventions may improve enjoyment and satisfaction in older adults, but the evidence remains of low certainty.

BACKGROUND Sedentary behavior is highly prevalent among older adults, with adherence to exercise being a major challenge. Exercise offers significant physical, psychological, and social benefits, but enjoyment is a key factor influencing adherence. Technology-based interventions, have shown promise in enhancing motivation and participation, demonstrating higher adherence rates compared to conventional treatments, though challenges like motivation loss and technological barriers persist. This review evaluates active videogames interventions' effectiveness in enjoyment and satisfaction. OBJECTIVE This systematic review and meta-analysis aimed to determine whether active video games are superior to other interventions in generating greater enjoyment or satisfaction. METHODS : Pubmed, Cochrane, PEDro, SportDiscus, CINHAL, Web of Science and Scopus databases were searched from inception to October 2024 to identify randomized clinical trials (RCT) or crossover studies. The primary outcome was enjoyment or satisfaction, assessed using various scales, including the Physical Activity Enjoyment Scale (PACES), Intrinsic Motivation Inventory (IMI), User Satisfaction Questionnaire, and Likert-type scoring scales. Secondary ouFive studies were included in the quantitative analysis. RESULTS Five studies were included in the quantitative analysis. The results indicated a significant improvement in enjoyment/satisfaction compared to control groups (SMD: 0.34; 95% CI (0.05 to 0.64); p=0.02; I2=24%), although the size effect was small. Secondary outcomes could not be analyzed due to insufficient data in the selected studies. CONCLUSIONS Active video game interventions may improve enjoyment and satisfaction in older adults, but the evidence remains of low certainty. CLINICALTRIAL CRD42024593212