# Immersive Virtual Reality Exercise: Effects on Cortisol, Quality of Life, Cognitive Function, and Psychological Symptoms in Fibromyalgia

## TL;DR

A six-week immersive virtual reality exercise program improved quality of life, emotional well-being, and cognitive function in women with fibromyalgia, though it did not affect cortisol levels.

## Contribution

This study is the first to demonstrate the benefits of immersive virtual reality exercise for fibromyalgia patients across multiple psychological and cognitive domains.

## Key findings

- Quality of life, depression, anxiety, and stress significantly improved after the iVRE program.
- Cognitive performance, including visuospatial ability, language, and delayed recall, showed significant improvement.
- No significant changes in salivary cortisol levels were observed despite other positive outcomes.

## Abstract

Background and Objectives: Fibromyalgia (FM) is a chronic and complex condition characterized by widespread pain, fatigue, psychological burden, and cognitive impairment, posing significant challenges for treatment. Immersive virtual reality exercise (iVRE) has been proposed as an innovative therapeutic approach to increase adherence, motivation, and multidimensional benefits, but evidence in FM remains limited. This study aimed to evaluate the effects of a six-week iVRE program on cortisol levels, quality of life, cognitive function, and psychological symptoms in women with FM. Materials and Methods: A quasi-experimental pre–post design was conducted with 21 women (mean age 48.1 ± 10.7 years) diagnosed with FM, who completed twelve 30 min sessions of iVRE using Oculus Quest 2™ and the FitXR platform. Outcomes assessed pre- and post-intervention included salivary cortisol (ELISA), quality of life (FIQR), emotional status (DASS-21), and cognitive function (MoCA). Adherence and safety were monitored throughout. Results: The intervention was well tolerated, with no adverse events and 100% adherence. Statistically significant improvements were observed in FIQR scores (p < 0.001, d = 3.54), depression (p < 0.001, d = 1.19), anxiety (p < 0.001, d = 1.39), and stress (p < 0.001, d = 2.28). Cognitive performance improved significantly, with higher MoCA total scores (p < 0.001, d = 1.52) and better outcomes in visuospatial ability, language, and delayed recall domains. No significant changes were detected in salivary cortisol levels (p = 1.000). Conclusions: A six-week iVRE program is safe and feasible, promoting clinically relevant improvements in quality of life, emotional well-being, and cognitive function in women with FM, despite the absence of changes in cortisol. These findings highlight iVRE as a promising complementary therapeutic strategy within multidisciplinary FM management, warranting further controlled studies with larger samples and long-term follow-up to confirm its efficacy and explore underlying mechanisms.