{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:53:54Z","timestamp":1790927634463,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004752","name":"State Government of Victoria","doi-asserted-by":"publisher","award":["VMRAF7"],"award-info":[{"award-number":["VMRAF7"]}],"id":[{"id":"10.13039\/501100004752","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001781","name":"Swinburne University of Technology","doi-asserted-by":"publisher","award":["Research Training Program scholarship"],"award-info":[{"award-number":["Research Training Program scholarship"]}],"id":[{"id":"10.13039\/501100001781","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Virtual reality\u2010based exercise is an emerging tool in mental health care; however, its application and effectiveness in treating Major Depressive Disorder (MDD) remain unclear. This systematic review evaluated the effectiveness of virtual exercise interventions for adults with MDD, focusing on depressive symptoms, functional outcomes, and the certainty of the available evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA 2020 guidelines, four databases (PubMed, Embase, CINAHL, AMED) were systematically searched for studies evaluating virtual exercise interventions in adults with MDD. Two reviewers independently performed study selection, data extraction, methodological quality assessment using Cochrane's Risk of Bias 2 (RoB 2) and Risk of Bias in Non\u2010randomized Studies (ROBINS\u2010I) tools. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 603 articles, four studies met the inclusion criteria, evaluating the VRelax, Pacifica, and CORE interventions. Pacifica and CORE demonstrated moderate improvements in depressive symptoms compared with control groups, while VRelax primarily improved stress and negative affect. The interventions were generally well accepted, with high participant engagement and adherence. Overall certainty of evidence ranged from moderate to low\u2010moderate and was limited by relatively small sample sizes, methodological limitations, and short follow\u2010up periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Virtual exercise intervention may represent a promising adjunct to conventional therapy for MDD. Although current evidence supports improvements in depressive symptoms and emotional well\u2010being, further randomized controlled trials with larger samples, longer follow\u2010up, and objective neurobiological outcome measures are needed to confirm long\u2010term efficacy and clinical applicability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73038","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:21:12Z","timestamp":1786512072000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Virtual Exercise Intervention in Adults With Major Depressive Disorder: A Systematic Review"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8798-6334","authenticated-orcid":false,"given":"Radietya","family":"Alvarabie","sequence":"first","affiliation":[{"name":"Department of Biomedical Health and Exercise Sciences, School of Health Sciences, Swinburne University of Technology Hawthorn Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8526-6076","authenticated-orcid":false,"given":"Elissa","family":"Burjawi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Health and Exercise Sciences, School of Health Sciences, Swinburne University of Technology Hawthorn Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4320-2855","authenticated-orcid":false,"given":"Junhua","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Biomedical Health and Exercise Sciences, School of Health Sciences, Swinburne University of Technology Hawthorn Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"World Health Organization. Depression: World Health Organization; 2023 [April 17 2025].https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/depression."},{"key":"e_1_2_11_3_1","unstructured":"Australian Bureau of Statistics. National Study of Mental Health and Wellbeing: Australian Bureau of Statistics; 2023.https:\/\/www.abs.gov.au\/statistics\/health\/mental-health\/national-study-mental-health-and-wellbeing\/latest-release."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2006.163.11.1905"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.02.026"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004366.pub6"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2018.17111194"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1102526"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.03.063"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/20556683241252092"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/17434440.2020.1825939"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S003329171700040X"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1037\/1072-5245.10.3.203"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.2196\/12869"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-89639-3_5"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_11_18_1","unstructured":"J.Higgins JPTT J.Chandler M.Cumpston T.Li M. 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