Virtual Reality Exercise Game Feasible for Patients With Fibromyalgia

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A virtual reality (VR) exergame to assist patients with fibromyalgia in performing physical activity was found to be feasible and may reduce depression, stress and anxiety, while boosting motivation and relaxation in both healthy participants and those with fibromyalgia.¹

“Exergames are video games that require physical exercise to progress, offering low-impact, controlled movements that can effectively distract players from pain. A VR exergame can combine the characteristics of physical training with the benefits of VR and make players perform specific movements recommended in motor rehabilitation. Recent studies have explored immersive and non-immersive systems in contexts such as motor training, relaxation, cognitive-behavioral therapy support, pain awareness, and spatial memory research²,” lead investigator Cassandra Lucia Bardelli, Human-Computer Interaction Lab, Department of Mathematics, Computer Science, and Physics, University of Udine, Italy, and colleagues wrote.¹

The small pilot study included 3 female participants with fibromyalgia and 4 healthy female participants, with ages ranging from 14 to 69 years. Investigators assessed exertion, pain levels, and psychological states qualitatively during the VR session, as well as device comfort.¹

Bardelli and colleagues found observed improvements in perceived exertion and pain intensity during the VR exergame session compared with pre-exergame levels, as well as reductions in depression, stress and anxiety levels while using the VR immersive system. They found that most participants experienced increased relaxation and positive emotions during the exergame.

Specifically, 3 reported a slight reduction in pain from baseline to peak levels, 2 showed stable values, and the remaining 2 reported a mild and a more pronounced increase, respectively. A reduction in fatigue and stiffness was observed in 4 participants and a minor increase was recorded in 3. Muscle strength declined in 4, was stable in 1, and improved in 2. Tiredness and stress improved in 5 and mildly worsened in 2. Anxiety and depression improved in 4; anxiety remained stable in another 2 and mildly worsened in 1 and depression remained stable in 3.¹

One of the 3 participants with fibromyalgia was not able to complete all levels of the exergame due to musculoskeletal pain exacerbation. This patient still reported an improvement in motivation and enjoyment during the gameplay. Many also reported having greater motivation to perform the exercises in the VR environment compared to traditional training methods.¹

“The potential to use a low-cost, self-contained headset at home to independently perform immersive exergame interventions, combined with the opportunity to offer a wide variety of exercises across adjustable difficulty levels in customizable, engaging virtual environments, may improve treatment adherence and sustain patient motivation over the long term. Indeed, longitudinal efficacy studies in fibromyalgia patients with longer durations, as well as clinical trials comparing exergames with traditional physical exercise, are necessary to confirm the possible benefits suggested by our exploratory pilot study,” Bardelli and colleagues wrote.¹

The investigators noted the main limitations of the study’s small sample size and very heterogeneous population outside of sex, since all participants were female. The study also did not include a comparison of the same exercise without the exergame and was conducted with a single VR session. Although this pilot study shows promise of using an exergame to support physical activity in patients with fibromyalgia, larger studies are needed to confirm this benefit.

REFERENCES

1. Bardelli CL, Chittaro L, Longhino S, Quartuccio L. An immersive virtual reality exergame as a patient education approach in fibromyalgia: Pilot study. Digital Health.2025;11. doi:10.1177/20552076241304904

2. Polat M, Kahveci A, Muci B, et al. The effect of virtual reality exercises on pain, functionality, cardiopulmonary capacity, and quality of life in fibromyalgia syndrome: a randomized controlled study. Games Health J 2021; 10: 165–173.