A randomized controlled trial of virtual reality-based exercise on bone mineral density in hypertensive prostate cancer patients undergoing androgen deprivation therapy

Androgen deprivation therapy (ADT) for prostate cancer, while life-prolonging, induces significant bone loss and frequently coincides with cardiovascular comorbidities such as hypertension, creating a complex management challenge. This randomized controlled trial investigated the efficacy of a 12-week, immersive virtual reality (VR) exercise program on bone mineral density (BMD) and cardiovascular parameters in this specific population. Sixty hypertensive prostate cancer patients undergoing ADT were randomly assigned to either a control group (standard care: daily walking + calcium/vitamin D) or an experimental group (standard care + supervised VR training three times/week). Primary outcomes (lumbar and hip BMD/T-scores via DEXA) and secondary outcomes (blood pressure, body composition, physical function) were assessed at baseline and post-intervention. Both groups showed significant within-group improvements in BMD (p < 0.001). However, the VR group demonstrated significantly greater gains: lumbar spine BMD increased by 11.73% versus 4.63% in controls (between-group p < 0.001), and hip BMD increased by 9.11% versus 3.62% (p < 0.001). The intervention also yielded superior cardiovascular and functional benefits, including a greater reduction in systolic blood pressure (-8.2 mmHg vs. -3.1 mmHg, p=0.003), improved body composition, and enhanced performance in the Timed Up and Go test (p < 0.001). Adherence was significantly higher in the VR group (95% vs. 78%). In conclusion, integrating VR-based training into rehabilitation significantly improves bone health, reduces cardiovascular risk, and enhances physical function in hypertensive prostate cancer patients on ADT, offering a highly engaging and effective multimodal therapeutic strategy.