Effects of Virtual Reality on Cardiorespiratory Fitness Test Results
Phase: NA
Conditions: Virtual Reality
Sponsor: Augusta University

 
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Study title: Effects of virtual reality on cardiorespiratory fitness test results 
 
IRB approval number: 2130870 
 
Document date: 2/21/2024 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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Protocol Title: 
Effects of virtual reality on cardiorespiratory fitness test results  
 
Participants 
A power analysis using G*Power version 3.1 will be conducted to determine sample size 
adequacy. We anticipate a moderate-large effect (d = 0.7) of VR on physiological outcomes 
based on past studies using similar designs (Rutkowski et al., 2021). With an alpha level of .05 
and a power level of .80, an estimated 19 participants will be needed to observe a significant 
effect on V̇ O2peak. 
To account for participant dropout and missing data, we will recruit an additional 5 
participants for a total of 24 participants. The primary means of participant recruitment will be 
the posting of approved informational flyers throughout the Forrest Hills, Summerville, and 
Health Science campuses of Augusta University. A secondary means of recruitment will be 
word-of-mouth. Approved study fliers will also be shared with other instructors at the affiliated 
institution so that they may announce the study opportunity to their students and share the flier 
on learning management systems. 
Healthy men and (non-pregnant) women 18 years and older will be recruited to take part 
in this study. Prospective participants will be operationally defined as “healthy” according to 
results of the 7-item Physical Activity Readiness Questionnaire [PAR-Q; Warburton et al. 
(2019)]. Answering “yes” to any of the risk assessment questions will result in exclusion from 
study participation. 
Research design 
A repeated-measures crossover design will be used in which healthy participants 
complete a familiarization session and two experimental trials. Experimental days consisted of a 
maximal graded exercise test with (VR) and without (Control) the use of the immersive VR 
program separated by at least 1 week. The order of the conditions on the experimental trial days 
will be counterbalanced and randomized. Cardiometabolic data and psychological responses 
will be collected during the exercise tests to address the aims of the study. This study will be 
approved by the associated Institutional Review Board (project 2130870). Written informed 
consent for each participant will be obtained prior to their participation.  
 
Instruments  
A stadiometer and scale (Continental Scale Corp., Bridgeview, IL, USA) were used to 
measure height and weight of participants. Body composition will be assessed using the InBody 
570 bioelectrical impedance analysis device (InBody Co., Ltd, Seoul, South Korea). Participants 
removed socks and shoes before stepping onto the device. Body composition analysis will be 
performed according to manufacturer specifications. HR will be measured using a Polar H10 
monitor (PolarElectro, Kempele, Finland), a valid and reliable instrument for measuring HR with 
strong agreement with the electrocardiogram (Schaffarczyk et al., 2022). The H10 monitor is 
worn on an adjustable belt secured at the xiphoid process over the skin as specified by the 
manufacturer.  
All exercise will be completed on a Velotron cycle ergometer (SRAM, Chicago, IL) which 
will be paired with software for the investigator to control the intensity (CompuTrainer Inc., 
Seattle, WA). Expired gases were analyzed in a metabolic cart calibrated on the day of testing 
to manufacturer specifications (Parvo Medics TrueOne 2400, Marray, UT) via gas collection 
apparatus (Hans Rudolph Inc., Shawnee, KS). The Meta Quest 2 virtual reality headset (Meta 
Platforms, Inc., Menlo Park, CA, USA) will be used to run and display the virtual reality video 
during the VR condition GXT. The video will be a clip from www.YouTube.com which will be 

 
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modified using video editing software Adobe Premiere Pro (Adobe Inc., San Jose, CA) to 
increase speed at each stage of the exercise test to align optical flow with work rate.   
The  Preferences for and Tolerance of the Intensity of exercise Questionnaire (PRETIE-Q) 
(Ekkekakis, Hall, & Petruzzello, 2005; Santos & Teixeira, 2023) will be used to assess individual 
preference for different exercise intensities, information which will be to be used as a covariate 
when analyzing maximal exercise test outcomes (Hutchinson et al., 2018). Participants 
completed the questionnaire digitally via the program Qualtrics on a laboratory computer or 
personal cell phone.  
Ratings of perceived exertion (RPE) were collected using the category-ratio 10-point 
scale. Affective valence will be assessed with the Feeling Scale. Both of these scales were 
delivered visually on the VR field of view when measurements were to be taken so that 
participants would be able to see the scale and associated verbal anchors. Remembered 
pleasure will be assessed using a visual analog scale after each exercise test has been 
completed and the VR headset has been removed.  
Subsequent analysis of the metabolic data to identify V̇ O2peak and ventilatory threshold will be 
completed using the software WinBreak, version 3.1.  
 
Procedures 
 
Visit 1 - Familiarization 
During the initial visit to the laboratory, participants will complete the PAR-Q survey, sign 
the informed consent if eligibility criteria were met, and then complete the PRETIE-Q. Height, 
weight, and body composition will be measured and recorded. Instructions for the CR-10 RPE 
scale and the feeling scale will be explained in detail and understanding will be verified by the 
investigator.   
Once the HR monitor has been donned and it is verified to be working properly, the cycle 
ergometer will be adjusted to the comfort and preference of the participant. The seat height and 
handlebar positions will be adjusted until optimized for cycling exercise and the positions will be 
recorded for the participant’s future visits.   
The participant will be fitted for the headgear that will be worn during maximal exercise 
tests on subsequent study visits. Plastic headgear is worn to keep the mouthpiece and gas 
collection hose in place during exercise so that expired air can be analyzed in the metabolic 
cart. The entire gas collection apparatus (headgear, mouthpiece, and gas collection hose) will 
be adjusted and worn for a brief warm-up on the exercise bike. The participant will pedal at a 
cadence of 50-90 rpm at a work rate of 50 Watts for 3 min. Work rate is adjusted and 
maintained at all times during exercise with the use of paired software installed on a computer 
adjacent to the exercise bike (CompuTrainer Inc., Seattle, WA). Responses to the CR-10 RPE 
and Feeling scales will be solicited at the end of minutes 1 and 3, to which participants will 
respond with designated hand gestures indicating the appropriate response. This process will 
be intended to increase the participants’ familiarity with the exercise and gas collection 
equipment, reduce setup complications on future visits, and practice non-verbal communication 
of psychological scale responses.   
An additional exercise stage of 3 min will follow this familiarization warm-up, during 
which the VR headset will be added to the gas collection apparatus. The participant will be 
walked through how to start the accompanying VR application and pedal for the designated time 
to ensure proper fit and function of all pieces of equipment simultaneously. Once this 
familiarization session is complete, the next visit to the lab will be scheduled and the participant 
will be directed from the lab.  
 
Visits 2 and 3 – Experimental sessions   

 
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The procedures for the two experimental session visits will be the same, aside from the use of 
the VR equipment in one of the visits. The order of the visits (control and VR) will be 
counterbalanced and randomized prior to the study commencement. Upon arrival to the lab, 
participants verbally confirmed that they had abstained from alcohol and strenuous exercise for 
the previous 24 hours and attained at least 6 hours of sleep the night prior to the visit. They will 
don the HR monitor, review the psychological scales, and adjust the exercise bike as needed. 
The gas collection apparatus will be donned and the collection tube will be connected from the 
mouthpiece to a metabolic cart that has been previously calibrated to the manufacturer 
specifications. The participant will sit on the exercise bike seat and, once ready, pedal against 
no resistance for 3 minutes as a warm-up. The exercise test will begin after the warm-up by 
increasing the resistance to 50 W and increasing the work rate by 25 W each minute thereafter 
until the termination of the exercise test (Bird et al., 2019). RPE and affective valence responses 
will be collected at the end of every odd numbered minute (end of minutes 1, 3, 5, etc.). Heart 
rate will be collected continuously and monitored throughout the test. See Figure 1 for visual 
timeline of data collection. 
The test will be terminated upon volitional exhaustion (when the participant feels that 
they can no longer continue), when the participant fails to maintain cadence > 50 rpm for longer 
than 10 s, or when a plateau in V̇ O2 (<100 ml/min increase with an increase in work rate) is 
observed (Poole, Wilkerson, & Jones, 2008). A cool-down period of 3 min at 0 W (no resistance) 
will immediately follow the termination of the exercise test. At the end of the cool-down, 
participants will complete the remembered pleasure scale. This will mark the end of the visit and 
the participant will be directed from the lab.   
The experimental session visit which for which the VR equipment is used will be identical 
in all ways to the control condition, with the exception that the VR headset will be worn in 
addition to the other previously mentioned equipment. A video displaying natural scenery from 
the viewpoint of a cyclist will be viewed by the participant throughout the exercise test. Once 
both experimental visits have concluded, the participants’ participation in the study is complete.  
 
 
 
Figure 1. Data collection timeline during exercise tests 
 
 
Stage of Exercise Test 
 
Warm-
up 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
… 
Cool 
down 
Work 
Rate (W) 
0 
50 
75 
100 
125 
150 
175 
200 
225 
250 
275 
… 
0 
Duration 
(min) 
3 
1 
1 
1 
1 
1 
1 
1 
1 
1 
1 
1 
3 
HR 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
Metaboli
c data 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
Affective 
Valence 
X 
X 
 
X 
 
X 
 
X 
 
X 
 
X 
 
RPE 
X 
X 
 
X 
 
X 
 
X 
 
X 
 
X 
 
“X” = measurement taken at this time point 
 
 
 

 
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Procedures for risk management 
 
• 
Risk of musculoskeletal injury – The probability of risk will be reduced primarily by 
excluding high-risk individuals from participation in the study via the PAR-Q screening 
questionnaire. Participants will also have a sufficient warm-up time built in to the 
exercise test to minimize the risk of muscle injury. The gradual increase in work rate 
over the course of the test will also ensure that physiological demands are reasonable 
and that risk of muscle injury is limited. 
• 
Risk of lightheadedness and loss of balance – the research team members will be 
standing adjacent to the participant during the exercise test on either side of the 
equipment to prevent the participant from falling off of the bike in the event of excessive 
fatigue and shortness of breath during and following the exercise. The investigator will 
also emphasize that the participant is able to terminate the test at any time for any 
reason, including severe shortness of breath or lightheadedness, simply by ceasing to 
pedal on the bike. A sufficient cool down period (3 minutes of cycling at no resistance) 
will be used to prevent blood from pooling in the veins of the lower body and ensure that 
blood circulation to the brain and the rest of the body continues after the exercise test 
has ended. 
• 
Dehydration – an unopened bottle of drinking water will be made available to the 
participant at the start of the study. The participant will be allowed to drink ad libitum 
before and after the exercise test. Drinking water during the test is not possible when the 
facemask is being worn for data collection purposes. 
• 
Muscle soreness – some muscle soreness after a maximal exercise test is 
unavoidable, but the discomfort participants might encounter will be reduced by ensuring 
participants have a cool down period after the test. 
• 
Dizziness or disorientation using VR equipment – There is a small chance that some 
participants will become disoriented or dizzy when viewing the VR video. A chance to 
use the VR equipment in Visit 1 will allow participants to familiarize themselves with the 
technology, note any adverse symptoms, and decide if further participation is feasible. 
Investigators will be adjacent to participants whenever the VR equipment is used to 
ensure no falls or loss of balance results. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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