Immersive Virtual Reality-Based Therapeutic Exercise in Women with Fibromyalgia: A Randomized Controlled Trial

Fibromyalgia is a chronic disorder characterized by widespread pain, fatigue, sleep disturbances, cognitive dysfunction, and psychological symptoms. This randomized controlled trial evaluated whether exercise delivered through immersive virtual reality (IVR) provides additional benefits beyond supervised conventional exercise in women with fibromyalgia. Thirty-six participants were randomized to IVR or conventional exercise, with both interventions comprising 12 supervised sessions over six weeks. Sixteen IVR and twelve control participants completed post-intervention assessment. Linear mixed-effects models using all available observations showed greater improvement in fibromyalgia-related impact, assessed using the Fibromyalgia Impact Questionnaire-Revised (FIQR), with IVR (group × time interaction, p = 0.002). Global cognitive screening performance, assessed using the Montreal Cognitive Assessment (MoCA), also improved more with IVR (unadjusted p = 0.005; Holm-adjusted p = 0.025). Sleep quality improved within the IVR group, but the between-group difference did not remain significant after multiplicity adjustment (Holm-adjusted p = 0.080). No significant between-group differences were observed for depression, anxiety, or stress. Retention was 88.9% with IVR and 66.7% with conventional exercise. Both interventions were well tolerated, with only mild transient adverse events and no intervention-related discontinuations. IVR was feasible and well tolerated and may provide additional benefits for fibromyalgia-related impact and global cognitive screening performance. Larger, adequately powered randomized controlled trials are needed to confirm these findings.