{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:51:18Z","timestamp":1793393478018,"version":"4.5.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Coordination of Improvement of Higher Education Personnel\u2014Brazil"},{"DOI":"10.13039\/501100001807","name":"Foundation for Research Support of the State of S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2017\/12254\u20138"],"award-info":[{"award-number":["2017\/12254\u20138"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The purpose of this study was to investigate the effects of adding virtual reality (VR) to maintenance cardiac rehabilitation (CR); it was hypothesized VR would increase adherence, motivation, and engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was a randomized, 1:1 concealed-allocation, single-blinded, 2\u00a0parallel-arm, crossover trial. Blinded assessments were undertaken at baseline (midprogram), 12\u00a0weeks, and 24\u00a0weeks after baseline. The setting was a single CR program of unlimited duration in Brazil. Participants were patients with cardiovascular diseases or risk factors who had been in the program for 3\u00a0months or longer. The CR program consisted of 3 supervised exercise sessions per week. In the VR arm, participants had 1 VR session of the 3 per week during the initial 12\u00a0weeks of the trial; this was withdrawn the subsequent 12\u00a0weeks. Measures were program adherence (% of 3 sessions\/week over 12\u00a0weeks, ascertained in all participants), motivation (Behavioral Regulation in Exercise Questionnaire 3), and engagement (User Engagement Scale, adapted; vigor, dedication, and absorption subscales); all 3 were primary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-one (83.6%) patients were randomly assigned (n\u00a0=\u00a030 to CR\u00a0+\u00a0VR); 54 (88.5%) were retained at 12 and 24\u00a0weeks. At baseline, participants had been in CR on average 7\u00a0years and had high engagement and motivation. CR\u00a0+\u00a0VR resulted in a significant increase in adherence at 12\u00a0weeks (baseline\u00a0=\u00a072.87%; 12\u00a0weeks\u00a0=\u00a082.80%), with significant reductions at 24\u00a0weeks when VR was withdrawn (65.48%); in the usual CR care arm, there were no changes over time. There was a significant effect for arm, with significantly higher adherence in the CR\u00a0+\u00a0VR arm than usual CR at 12\u00a0weeks (73.51%). Motivation decreased significantly from baseline to 12\u00a0weeks (4.32 [SD\u00a0=\u00a00.37] vs 4.02 [SD\u00a0=\u00a00.76]) and significantly increased from 12 to 24\u00a0weeks in the CR\u00a0+\u00a0VR arm (4.37 [SD\u00a0=\u00a00.36]). Absorption was significantly lower at 12\u00a0weeks in the CR\u00a0+\u00a0VR arm (6.79 [SD\u00a0=\u00a00.37] vs 6.20 [SD\u00a0=\u00a01.01]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although VR increased program adherence, interspersing it with usual CR sessions actually decreased patient motivation and absorption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>Supplementing a maintenance CR program with VR using \u201cexergames\u201d resulted in significantly greater adherence (8% increase or 3 of 36 sessions), and this was quite a robust effect given it was extinguished with the removal of VR. However, contrary to the hypotheses, offering 1 session of VR per week and 2 of usual CR exercise was related to lower motivation and absorption, which has implications for how clinicians design programs for this patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ptj\/pzab071","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T15:12:13Z","timestamp":1613833933000},"source":"Crossref","is-referenced-by-count":47,"title":["A Randomized, Controlled, Crossover Trial of Virtual Reality in Maintenance Cardiovascular Rehabilitation in a Low-Resource Setting: Impact on Adherence, Motivation, and Engagement"],"prefix":"10.1093","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3955-9149","authenticated-orcid":false,"given":"Mayara Moura Alves","family":"da Cruz","sequence":"first","affiliation":[{"name":"Department of Physiotherapy , S\u00e3o Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Laura","family":"Ricci-Vitor","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy , S\u00e3o Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna Lombardi Bonini","family":"Borges","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy , S\u00e3o Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula Fernanda","family":"da Silva","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy , S\u00e3o Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nat\u00e1lia","family":"Turri-Silva","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy , University of Brasilia,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy , S\u00e3o Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry L","family":"Grace","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy , Faculty of Health, York University, Toronto, Ontario,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Carlos Marques","family":"Vanderlei","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy , S\u00e3o Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"2026041420175181800_ref1","first-page":"29","article-title":"World Health statistics 2017: monitoring health for the SDGs status of the health-related SDGs","volume":"52","author":"WHO","year":"2017","journal-title":"UWES Man\u2014Port BR"},{"key":"2026041420175181800_ref2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1590\/S1413-81232012000100002","article-title":"A promo\u00e7\u00e3o da sa\u00fade e a preven\u00e7\u00e3o integrada dos fatores de risco para doen\u00e7as cardiovasculares","volume":"17","author":"Ribeiro","year":"2012","journal-title":"Ci\u00eanc Sa\u00fade Coletiva"},{"key":"2026041420175181800_ref3","first-page":"1","article-title":"Diretriz em Cardiologia do Esporte e do Exerc\u00edcio da Sociedade Brasileira de Cardiologia e da Sociedade Brasileira de Medicina do Esporte","volume":"100","author":"Ghorayeb","year":"2013","journal-title":"Arq Bras Cardiol"},{"key":"2026041420175181800_ref4","first-page":"CD001800","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","volume":"2016","author":"Anderson","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2026041420175181800_ref5","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1161\/CIR.0b013e318235eb4d","article-title":"AHA\/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update. 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