Virtual reality (VR) and augmented reality (AR)-enhanced exercise training is a novel approach to promoting health. Previous systematic reviews have focused on the effectiveness of VR interventions in clinical settings. The present study was the first systematic review to investigate the effectiveness of exercise-based VR and AR training as preventive measures in improving physical activity, psychological outcomes, and physical performance of a healthy population when compared with traditional programs and no-exercise controls. This study included 22 research articles published between 1997 and 2017, involving 1,184 participants aged 18 to 79. The results showed a large effect on physical activity (Hedges’ g = 0.83, SE = 0.18), a small to moderate effect on physical performance (Hedges’ g = 0.31, SE = 0.09), and no significant effect on psychological outcomes. VR training programs were particularly shown to be effective for enhancing frequency of physical activity and strength of physical performance. Only two studies examined the effectiveness of AR training programs on physical performance, and the findings concerning those effects were not separately reported. A list of plausible moderators was tested but that variable was not significantly associated with the effects of VR on the three outcomes. Limitations and future directions are discussed.

Introduction

While health authorities around the world have been actively promoting physical exercise in the past decades, the global prevalence of physical inactivity was found stable in the period between 2001 and 2016 (Guthold, Stevens, Riley, & Bull, 2018). About 25% of the world’s adults and 80% of adolescents are physically inactive (WHO, 2018), which may be attributable to urbanization and environmental factors such as high-density traffic and lack of recreation facilities, which in turn hinders participation in physical activity (WHO, n. d.). Physical inactivity is one of the main risk factors for major noncommunicable diseases, causing about 10% of the burden of disease from breast cancer, 10% of colon cancers, 6% of coronary heart disease, and 7% of type 2 diabetes, thus increasing the premature mortality rate by 9% (I.- M. Lee et al., 2012; WHO, 2018). Those factors also correlate with a substantial global economic burden, contributing to $53.8 billion in health care costs, $13.7 billion in productivity losses, and $13.4 million disability-adjusted life-years for a year (Ding et al., 2016). Five hundred thousand deaths are estimated to be preventable annually if participation in physical activity increases by 10% (I.-M. Lee et al., 2012). Research has also shown that physical activity improves mental well-being (e.g., Ho et al., 2017; Ho, Louie, Chow, Wong, & Ip, 2015). The use of virtual and augmented reality technology has been recently considered as a new approach to promoting physical activity and health behavior (Ahn & Fox, 2017). While exercise activities could be affected by environmental factors such as weather, light, and traffic (Salmon, Owen, Crawford, Bauman, & Sallis, 2003), virtual and augmented reality technology with exercise as the innovative intervention may counteract the negative environmental influences on physical activity and enhance the motivation to exercise (Plante, Aldridge, Su, et al., 2003). Reese and Nass (1996) suggest that our human brain is not fully evolved in our responses to mediated representations, thus limiting the capability to distinguish between real and virtual stimuli.