The effect of a 12-week tele-exercise using immersive virtual reality on functional capacity in adolescents with cystic fibrosis: A randomized controlled, single (assessor) - blind study

Background: Adolescents with cystic fibrosis (CF) have lower levels of physical activity compared to their peers. Risk of cross-contamination limits participation in face-to-face sport activities. Tele-exercise (TE) is a good alternative to deliver exercise remotely, without risk of infection. Immersive virtual reality (VR) could be a motivating method to improve the functional capacity. The primary aim was to evaluate the effect of a 12-week VR exercises on 6-min walk distance (6MWD). The secondary aims were to assess its effects on pulmonary function, muscle strength, quality of life, feasibility, and enjoyment. Methods: In this randomized controlled study, clinically stable participants aged between 12 and 18 years were included and randomized to a VR-based tele-exercise (VR-TE) or a TE group. Exercises were conducted in groups of 6 participants for 30 min, 3 days/week for 12 weeks in both groups. Outcome measures were 6MWD, FEV1, hand grip, shoulder flexor and knee extensor muscle strength, Cystic Fibrosis Questionnaire Revised (CFQ-R), physical activity enjoyment scale and system usability scale. Results: Twenty-one participants completed the study. Baseline pulmonary function tests, 6MWD, muscle strength, and CFQ-R scores were similar between groups. In the VR-TE group, post-training 6MWD was significantly higher than pre-training 6MWD (z = -2.93, p = 0.003). However, no statistical improvement was observed in pulmonary function, muscle strength, or quality of life. Feasibility, enjoyment, adherence, and adverse effects were similar between groups. Conclusion: Virtual reality and tele-exercise are feasible and motivating methods to facilitate the participation in exercise and improve functional capacity in adolescents with CF. Longer duration of VR-based exercise might be needed to improve muscle strength and quality of life. Clinical trials registration number: NCT05850351.