Abstract
Purpose Virtual reality (VR) reduces experimental and clinical pain, but whether these effects extend to naturally occurring muscle pain (NOMP) during exercise remains unclear. This study examined whether immersive nature-based VR attenuates NOMP and improves motor performance during prescribed and self-regulated exercise. Methods Two within-participant crossover studies were conducted involving 12 (Study 1) and 24 (Study 2) healthy participants. In Study 1, participants completed a stepped incremental cycling task to exhaustion. In Study 2, participants performed self-regulated intermittent isometric handgrip contractions at light (13/100) and strong (50/100) perceived effort. Tasks were completed under immersive VR (nature scene), two-dimensional sham, and no-intervention control conditions in pseudo-randomised, counterbalanced orders. Pain onset, NOMP intensity, perceived effort, and time to exhaustion were assessed in Study (1) Muscle pain intensity and force production were measured in Study (2) Repeated measures ANOVAs and assessed main condition effects. Results Immersive VR did not delay pain onset $$\:(p=.159)$$ , prolong time to exhaustion $$\:(p=.204)$$ , or lower perceived effort compared within sham or control conditions $$\:({p}^{{\prime\:}}s>.215)$$ . A small, yet practically meaningful, reduction in NOMP intensity occurred early during cycling $$\:({F}_{\text{2,22}}=4.518,p=.023,\:{\eta\:}_{p}^{2}=0.291[\text{0.002,0.500}\left]\right)$$ but was not sustained at later phases of the task $$\:({p}^{{\prime\:}}s . In Study 2, NOMP intensity $$\:(p=.815)$$ and force production measures $$\:({p}^{{\prime\:}}s were similar across conditions. Conclusion Nature-based immersive VR had limited effects on NOMP and motor performance. Pain types that are peripherally driven, like NOMP, may be less affected by VR interventions which target central mechanisms of pain modulation. Thus, hypoalgesia effects with VR are potentially pain-type dependent.