VRCycle: the clinical translation of a virtual reality cycling program to enhance exercise engagement in people with knee osteoarthritis

High-quality evidence supports exercise as a core treatment for knee osteoarthritis, improving osteoarthritis symptoms and overall health. However, most people with knee osteoarthritis are inactive and report barriers to exercise engagement. Technologies such as virtual reality (VR) may be used to improve the exercise experience and thus, promote engagement in effortful physical exercise, but clinical translation is difficult. In collaboration with knee osteoarthritis participants (n = 15) and clinicians (n = 6), we adapted a novel VR cycling system to a clinical setting (Study 1). Then, using a randomised cross-over experimental design, we evaluated the preliminary efficacy of VR cycling relative to a No-VR cycling control condition on exercise engagement, enjoyment, and pain in people with knee osteoarthritis (n = 25; Study 2). Both studies evaluated the credibility, acceptability, safety, and usability of the VR cycling system. The clinically-adapted VR cycling system resulted in greater exercise enjoyment (U = 0.82, p < 0.001) and engagement (increased time spent cycling: t₂₄ = 2.53, p = 0.02; and greater total work t₂₄ = 2.13, p = 0.04) than No-VR cycling. The VR cycling system was safe (no adverse events) and had high credibility and acceptability in people with knee osteoarthritis, although clinicians reported some usability/technical issues. These findings support clinical potential of the VR cycling system, although further technical refinement to maximise the usability of this technology is likely required to ensure clinician uptake. Future work to evaluate the long-term efficacy of a prolonged VR cycling intervention is warranted.