The Intervention Effects of Different Intensities of Virtual Reality Exergaming on Loneliness among Rural Left-Behind Children in China (Preprint)

<sec> <title>BACKGROUND</title> Virtual reality (VR) exergaming has attracted growing attention as a promising approach to promoting both physical activity and psychosocial well-being. </sec> <sec> <title>OBJECTIVE</title> This study investigated whether VR exergaming at varying intensity levels could reduce loneliness among rural left-behind children in China—a population particularly vulnerable to social isolation. </sec> <sec> <title>METHODS</title> A 12-week randomized controlled trial was conducted with primary school children who had experienced parental separation for at least six months. Participants were randomly assigned to one of four groups: a control group, or low-, moderate-, or high-intensity VR exergaming groups. Each intervention included four 45-minute sessions per week, comprising warm-up, immersive VR gameplay, and cooldown phases. Six commercially available VR games were classified into intensity categories using heart rate reserve (%HRR) thresholds. Loneliness was assessed using the Children’s Loneliness Scale (CLS). </sec> <sec> <title>RESULTS</title> Repeated-measures ANOVA indicated significant effects of time, group, and time × group interaction (all p &lt; .01). Simple effects analysis showed that loneliness scores significantly declined in the moderate-intensity group (p &lt; .001), while no significant change was observed in the control group (p = .829). </sec> <sec> <title>CONCLUSIONS</title> Moderate-intensity VR exergaming demonstrated the greatest efficacy in reducing loneliness among left-behind children. These findings underscore the importance of tailoring VR-based interventions by exercise intensity to optimize psychological outcomes and provide evidence for integrating calibrated VR protocols into youth mental health strategies. </sec>