NexerciseVR: Enhancing Intrinsic Motivation and Enjoyment in Neck Exercise through a Narrative-Based VR Exergame

Objective: This study presents NexerciseVR, a VR-based exergame designed to enhance motivation and engagement in neck exercise, addressing the low adherence often observed in conventional rehabilitation routines.<br/>Background: Neck pain is one of the most prevalent musculoskeletal disorders worldwide, and regular neck exercises are known to be effective for pain reduction and functional improvement. However, the repetitive and monotonous nature of these exercises frequently leads to decreased motivation and poor long-term adherence.<br/>Method: NexerciseVR integrates narrative elements and gamified mechanics into a VR environment to transform repetitive exercise into an interactive and engaging experience. The system guides users through four neck motions (cervical flexion, side-flexion, rotation, and extension) within story-driven microgames designed around the<br/>metaphorical journey of a turtle seeking neck health. A within-subject experiment with 20 healthy adults compared NexerciseVR with conventional neck exercises using the Intrinsic Motivation Inventory (IMI) and the Exergame Enjoyment Questionnaire (EEQ).<br/>Results: Participants reported significantly higher scores for interest/enjoyment and perceived choice in the NexerciseVR condition, indicating enhanced intrinsic motivation and autonomy. EEQ results revealed high ratings in control, immersion, and exercise factors, demonstrating both usability and positive engagement. Qualitative feedback highlighted the importance of narrative immersion and suggested content variety and reward structures as key factors for long-term adherence.<br/>Conclusion: NexerciseVR effectively increased motivation and engagement in neck exercise through narrative-driven gamification, suggesting its potential as a sustainable and enjoyable digital healthcare solution for promoting regular neck exercise.<br/>Application: NexerciseVR can serve as an engaging digital rehabilitation tool in both clinical and home-based contexts. By incorporating adaptive feedback, narrative driven progression, and gamified rewards, it may support sustained adherence to neck exercise among patients with chronic neck pain or office workers at risk of musculoskeletal strain.