Effect of virtual reality during cycle ergometer session in the intensive care unit: A pilot randomised cross-over trial

Background: Early mobilisation, including a cycle ergometer, is a cornerstone of best practices in the intensive care unit (ICU). Virtual reality (VR) has increasingly been integrated into healthcare, showing benefits in reducing depressive symptoms, improving mobility, and managing pain. However, the combined use of VR and cycle ergometry to enhance physical performance in the ICU has not been investigated. Objectives: The primary objective of this study was to assess whether a single session of VR-based cycle ergometry increases active cycling distance (ACD) compared with a conventional session. Secondary objectives were to examine its effects on motivation, immersion, and perceived exertion and to monitor the occurrence of adverse events. Methods: This single-centre, randomised, open-label, two-period crossover trial compared two 30-min cycle ergometer sessions, one with VR and one without, delivered in a randomised order. Eligible participants were adults (aged ≥18 years) admitted to a surgical ICU for more than 48 h, with a Glasgow Coma Scale score of 15 and the ability to sit in a chair. The primary outcome was ACD (km) per session. Secondary outcomes included adverse events and self-reported perceived effort, sense of immersion, and motivation, assessed using 11-point visual analogue scale (0–10). Results: Estimated mean difference in ACD between VR and no-VR sessions was 0.25 km (95% confidence interval [CI]: −0.50 to 1.00; p = 0.50). No period effect was observed (p = 0.15). No serious adverse events occurred. VR did not significantly affect perceived effort (mean difference: 0.53; 95% CI: −1.29 to 0.23; p = 0.163). VR significantly increased sense of immersion (mean difference: 4.08; 95% CI: 2.80 to 5.36; p < 0.0001) and motivational state (mean difference: 1.15; 95% CI: 0.16 to 2.14; p = 0.024). Conclusions: VR did not significantly increase ACD, it substantially enhanced subjective immersion and motivation. These findings support further investigation of immersive technologies as adjuncts to early rehabilitation strategies in the ICU.