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1- Physical Education Group, Faculty of Literature and Humanities, University of Civil Engineering and Development of Hamedan, Hamedan, Iran
2- Department of Physical Education and Sports Science, Payame Noor University, Tehran, Iran
2- Department of Physical Education and Sports Science, Payame Noor University, Tehran, Iran
Abstract: (14 Views)
Purpose: Virtual Reality (VR) has emerged as a novel, engaging tool to overcome adherence challenges in bone-strengthening exercise. This systematic review and meta-analysis aims to quantitatively synthesize the evidence on the impact of VR-based interventions on Bone Mineral Density (BMD) in adults.
Methods: We performed a systematic literature search in line with PRISMA guidelines using PubMed, Scopus, and Web of Science for studies published between 2000 and 2024. Eligible studies included randomized controlled trials (RCTs) and non‑randomized controlled trials that had a concurrent control group and examined the effect of VR‑based exercise on BMD outcomes in adults in comparison with a control or alternative intervention. Quasi‑experimental trials lacking a parallel control group (for example, single‑arm pre‑post designs) were omitted because of their high bias risk and the impossibility of deriving comparative effect estimates for the meta‑analysis. The Cochrane RoB 2 tool (version 2) was employed to evaluate the risk of bias. This instrument assesses five areas: the randomization procedure, deviations from intended interventions, completeness of outcome data, outcome measurement, and selection of reported findings. Each domain received a judgment of either "low risk," "some concerns," or "high risk." Two examiners independently appraised every trial, and any disagreements were settled through discussion.
Results: After an initial retrieval of 1,248 publications and following a thorough filtering and reassessment process, 10 randomized controlled trials (RCTs) fulfilled the predefined inclusion criteria. The overall mean difference (MD) for BMD change was 0.028 g/cm² (95% CI: 0.018 to 0.038), which translates into a relative rise of roughly 2‑3% — a magnitude comparable to that seen in earlier exercise‑based investigations. A subgroup analysis based on methodological quality revealed a larger effect among high‑quality studies (PEDro score ≥ 8), where the standardized mean difference (SMD) was 0.95 (95% CI: 0.70–1.20; p < 0.001; I² = 28.1%). In contrast, moderate‑quality trials (PEDro score 5‑7) yielded an SMD of 0.65 (95% CI: 0.40–0.90; p < 0.001; I² = 29.7%). Significant benefits were also observed for secondary endpoints: a 25% average decrease in fall risk (95% CI: 18–32%; I² = 30.5%) and a 20% average enhancement in balance scores (95% CI: 14–26%; I² = 27.9%). Collectively, these findings indicate that exercise performed via VR is a beneficial intervention for increasing BMD and improving associated functional capabilities in adult populations.
Conclusion: Synthesized evidence confirms that VR exercises are an effective intervention for significantly improving BMD in adults, offering a promising, engaging strategy for osteoporosis prevention. These pooled results provide a robust, quantitative estimate of efficacy to guide clinical and public health practice. Future research should prioritize long-term adherence and comparative effectiveness.
Methods: We performed a systematic literature search in line with PRISMA guidelines using PubMed, Scopus, and Web of Science for studies published between 2000 and 2024. Eligible studies included randomized controlled trials (RCTs) and non‑randomized controlled trials that had a concurrent control group and examined the effect of VR‑based exercise on BMD outcomes in adults in comparison with a control or alternative intervention. Quasi‑experimental trials lacking a parallel control group (for example, single‑arm pre‑post designs) were omitted because of their high bias risk and the impossibility of deriving comparative effect estimates for the meta‑analysis. The Cochrane RoB 2 tool (version 2) was employed to evaluate the risk of bias. This instrument assesses five areas: the randomization procedure, deviations from intended interventions, completeness of outcome data, outcome measurement, and selection of reported findings. Each domain received a judgment of either "low risk," "some concerns," or "high risk." Two examiners independently appraised every trial, and any disagreements were settled through discussion.
Results: After an initial retrieval of 1,248 publications and following a thorough filtering and reassessment process, 10 randomized controlled trials (RCTs) fulfilled the predefined inclusion criteria. The overall mean difference (MD) for BMD change was 0.028 g/cm² (95% CI: 0.018 to 0.038), which translates into a relative rise of roughly 2‑3% — a magnitude comparable to that seen in earlier exercise‑based investigations. A subgroup analysis based on methodological quality revealed a larger effect among high‑quality studies (PEDro score ≥ 8), where the standardized mean difference (SMD) was 0.95 (95% CI: 0.70–1.20; p < 0.001; I² = 28.1%). In contrast, moderate‑quality trials (PEDro score 5‑7) yielded an SMD of 0.65 (95% CI: 0.40–0.90; p < 0.001; I² = 29.7%). Significant benefits were also observed for secondary endpoints: a 25% average decrease in fall risk (95% CI: 18–32%; I² = 30.5%) and a 20% average enhancement in balance scores (95% CI: 14–26%; I² = 27.9%). Collectively, these findings indicate that exercise performed via VR is a beneficial intervention for increasing BMD and improving associated functional capabilities in adult populations.
Conclusion: Synthesized evidence confirms that VR exercises are an effective intervention for significantly improving BMD in adults, offering a promising, engaging strategy for osteoporosis prevention. These pooled results provide a robust, quantitative estimate of efficacy to guide clinical and public health practice. Future research should prioritize long-term adherence and comparative effectiveness.
Type of Study: Systematic Review |
Subject:
Sport injury and corrective exercises
Received: 2026/01/28 | Accepted: 2026/06/11
Received: 2026/01/28 | Accepted: 2026/06/11
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