# Virtual Reality High-Intensity Interval Training Exergaming Compared to Traditional High-Intensity Circuit Training Among Medical Students: Pilot Crossover Study PMID: 39773879 Journal: JMIR Serious Games Published: 2025-01-07 Authors: Merola P, Cardoso MB, Barreto G, Chagas MC, Farias Oliveira Saunders L, Saunders B, Cortozi Berton D ## Question How does a VR HIIT boxing exergame compare with traditional high-intensity circuit training for acute physiological responses, motivation, perceived exertion, and simulator symptoms? ## Summary In 30 healthy medical students, a single VR HIIT boxing exergame session produced higher mean and peak heart rate than a traditional 7-minute bodyweight circuit, while the bodyweight circuit produced higher postexercise lactate. Motivation scores were mostly similar, and no adverse effects, including motion sickness, were reported. The study was acute, used highly specific VR software, and included conflicts of interest because two authors created the game/startup. ## Population - Thirty healthy medical students aged 18-30 from Federal University of Rio Grande do Sul School of Medicine; mean age 24 +/- 3 years, 18 male and 12 female, BMI 24.1 +/- 2.8. Participants were free from major psychiatric, cardiovascular, serious chronic, binocular vision, neuromuscular, recent injury, flu-like, or infectious conditions that could hinder HIIT. - Sample size: 30 - Age: 24 +/- 3 years - Sex: 18 male, 12 female - Fitness level: Healthy medical students; 53% high IPAQ, 20% moderate, 27% low - Health status: Healthy; screened free of major health and HIIT-limiting issues ## Methodology - Pilot randomized crossover study - Two acute test sessions 48 h apart after familiarization - School of Medicine at Clinics Hospital of Porto Alegre - Randomized and controlled study design. ## Protocol - VR boxing HIIT exergame; details: VR HIIT used the Move Sapiens Oculus Quest 2 exergame: 12 x 16 sec all-out punching bouts with 20 sec passive rest, approximately 7 min total plus 1 min cooldown. The game provided start/stop cues, scoring, and a futuristic exoskeleton punching task encouraging as many punches as possible. - Modality: VR shadow-boxing HIIT and traditional bodyweight HICT. - Work intervals: VR HIIT 16 sec; HICT 30 sec. - Recovery: VR HIIT 20 sec passive rest; HICT 10 sec transition. - Sets or repetitions: VR HIIT: 12 sets; HICT: 12 bodyweight exercises. - Intensity: Self-selected all-out punching in VR; HICT self-selected effort in standardized circuit. - Session duration: Approximately 7 min plus 1 min cooldown for VR HIIT; approximately 7 min for HICT. - Program length: Single acute comparison after familiarization. - Progression: No progression; acute crossover. - Traditional high-intensity circuit training; details: Traditional HICT used 12 exercises: jumping jacks, wall sits, push-ups, abdominal crunches, step-ups onto a chair, squats, triceps dips, planks, high knees running in place, lunges, push-up and rotation, and side planks. Each was performed for 30 sec with 10 sec transition, about 7 min total. - Modality: VR shadow-boxing HIIT and traditional bodyweight HICT. - Work intervals: VR HIIT 16 sec; HICT 30 sec. - Recovery: VR HIIT 20 sec passive rest; HICT 10 sec transition. - Sets or repetitions: VR HIIT: 12 sets; HICT: 12 bodyweight exercises. - Intensity: Self-selected all-out punching in VR; HICT self-selected effort in standardized circuit. - Session duration: Approximately 7 min plus 1 min cooldown for VR HIIT; approximately 7 min for HICT. - Program length: Single acute comparison after familiarization. - Progression: No progression; acute crossover. ## Outcomes ### Mean heart rate Status: improved VR HIIT had higher mean HR than HICT: emmean 162 bpm (95% CI 157-166) vs 143 bpm (95% CI 138-147); p<.001, d=2.07. 95% CI 157-166) vs 143 bpm (95% CI 138-147) ### Peak heart rate Status: improved VR HIIT had higher peak HR: 182 bpm (95% CI 178-187) vs 175 bpm (95% CI 170-180); p=.001, d=1.20. 95% CI 178-187) vs 175 bpm (95% CI 170-180) ### Postexercise lactate Status: improved Postexercise lactate was higher after HICT: 10.6 mmol/L (95% CI 9.14-12.0) vs VR HIIT 8.83 mmol/L (95% CI 7.43-10.2); p=.006, d=.80. 95% CI 9 ### Perceived exertion Status: improved RPE was higher for VR HIIT: 16 (95% CI 15-17) vs HICT 15 (95% CI 14-16); p=.03, d=.61. 95% CI 15-17) vs HICT 15 (95% CI 14-16) ### Motivation and fatigue Status: no clear change No significant differences were found for intrinsic motivation, identified regulation, external regulation, or amotivation; fatigue symptom was higher after VR HIIT. ## Practical Insights - Gamified VR can elicit vigorous cardiovascular intensity in a short session while preserving immediate intrinsic motivation. - Traditional bodyweight HICT may impose greater metabolic/lactate stress even with lower HR than VR boxing. - Conflict-of-interest context should be surfaced when using this evidence for product claims. ## Limitations - Acute pilot crossover only; no long-term adherence or health outcomes. - Highly active/healthy medical student sample may create ceiling effects for motivation. - Simulator sickness and motivation questionnaires lacked baseline symptom/motivation measurement. - Comparison was VR HIIT vs HICT rather than VR HIIT vs non-VR matched boxing HIIT. - Financial/product conflicts related to the studied exergame. ## Safety And Adherence - No adverse effects were reported, particularly concerning motion sickness. - Chewing gum was provided only at familiarization as an initial motion-sickness preventive measure; no participants reported motion-sickness symptoms. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/39773879/) (pubmed) - [DOI](https://doi.org/10.2196/63461) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731695/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.