BACKGROUND: Physical exercises and mindfulness are important components in the management of chronic pain, but pain may reduce exercise adherence. Virtual reality (VR) can provide cognitive inhibition of the ascending pain signal and may thus be a tool for the delivery of pain management during exercise interventions. In this study we assessed a VR-guided intervention seeking to improve physical fitness in individuals with chronic pain. METHODS: Participants in rehabilitation for chronic pain were included in a randomised controlled pilot trial with a cross-over design. In counter-balanced order participants were asked to perform, five minutes of aerobic exercise following identical instructions given through either a VR headset or television (TV) screen. The procedures were then repeated with mindfulness exercises. Heart rate (HR) was monitored throughout all four sessions and participants self-reported perceived exercise intensity, benefit, relaxation, and reward. Paired Student's t-test, Wilcoxon signed rank test and McNemar's test were performed to compare the outcome variables across sessions for individuals, as appropriate. (Clinical trial registration NCT06611566 09.09.24, retrospectively registered). RESULTS: Twenty-seven participants were included in the study. The mean age (SD) was 40.4 (11.3) years, and 17 (63%) were men. Mean HR, the proportion of time spent at moderate-vigorous exercise intensity levels, and all self-reported measurements were comparable between the VRversus TV sessions. No major adverse events were reported. The physiological and perceived exercise outputs of aerobic exercises were thus similar across modes of delivery (VRversus TV) in individuals with chronic pain. CONCLUSIONS: This study confirms the possibilities of VR-guided interventions in the pain management of individuals with chronic pain with comparable levels of exertion to TV-guided exercise and few adverse events. The promise of VR-guided mindfulness in the rehabilitation of patients with chronic pain conditions is also confirmed.

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