Sanal Gerçeklik Destekli Aerobik Egzersizlerin Yaşlılarda Denge Performansı ve Teknolojiye Karşı Tutum Üzerine Etkisi: Randomize Kontrollü Pilot Çalışma

Öz

Bu pilot randomize kontrollü çalışma, sanal gerçeklik (VR) destekli aerobik egzersizin yaşlı yetişkinlerde teknolojiye yönelik tutumlar, denge performansı ve kardiyak otonom fonksiyon üzerindeki etkilerini araştırmayı amaçlamıştır. Toplumda yaşayan 22 yaşlı yetişkin (ortalama yaş 73,4 ± 5,6 yıl), rastgele olarak sanal gerçeklik grubuna (VRG, n=12) veya kontrol grubuna (CG, n=10) atanmıştır. Her iki grup da 6 hafta boyunca haftada iki kez, seans başına 30 dakika süren denetimli aerobik egzersiz programını tamamlamıştır. VRG grubu, her aerobik seansın hemen ardından başa takılan bir ekran kullanarak 10 dakika daha VR denge oyunları (Beat Saber, Tai Chi VR, FitXR) oynamıştır. Sonuç ölçütleri arasında Teknolojiye Yönelik Tutum Ölçeği (teknoloji coşkusu ve teknoloji kaygısı alt ölçekleri), Berg Denge Ölçeği (BBS), dinlenme kalp hızı ve egzersiz sırasındaki en yüksek kalp hızı yer almıştır. Değerlendirmeler başlangıçta ve müdahale sonrası yapılmıştır. Gruplar arası karşılaştırmalar Mann-Whitney U testi kullanılarak analiz edildi. VRG, kontrollere kıyasla teknolojiye olan ilgide anlamlı derecede daha büyük iyileşmeler (Δ=5,1±1,4 vs. 1,6±2,4, p=0.002) ve teknoloji kaygısında azalmalar (Δ=-2,5±1,5 vs. 2,0±1.3, p=0,001) gösterdi. VRG'de dinlenme kalp hızı anlamlı derecede azaldı (Δ=-4,6±2,1 vs. -1,9±1,2, p=0,004), egzersiz sırasındaki en yüksek kalp hızı ise anlamlı derecede arttı (Δ=8,5±3,3 vs. 0,1±6,7, p=0,003). Denge puanları VRG grubunda daha fazla iyileşme gösterdi (Δ=5,1±2,1'e karşı 2,9±2,9), ancak gruplar arası fark istatistiksel olarak anlamlı değildi (p=0,063). Katılımcı geri bildirimleri yüksek kabul edilebilirlik gösterdi; %91,7'si keyif aldığını ve fayda gördüğünü, %100'ü ise VR'ı tekrar kullanmaya istekli olduğunu belirtti. Bu bulgular, VR destekli aerobik egzersizin yaşlı yetişkinlerde teknolojiyle ilgili tutumları ve kardiyak otonom fonksiyonu olumlu yönde etkilediğini, aynı zamanda uygulanabilirliğini ve kabul edilebilirliğini gösterdiğini düşündürmektedir. Potansiyel denge iyileşmelerini doğrulamak için daha büyük örneklem grupları ve daha uzun müdahale süreleri ile daha fazla araştırmaya ihtiyaç vardır.

Anahtar Kelimeler

• Sanal gerçeklik
• Yaşlı
• Denge
• Aerobik egzersiz
• Teknoloji tutumu

The Effect of Virtual Reality-Supported Aerobic Exercises on Balance Performance and Attitudes Toward Technology in Older Adults: A Randomized Controlled Pilot Study

Öz

This pilot randomized controlled study aimed to investigate the effects of virtual reality (VR)-supported aerobic exercise on technology attitudes, balance performance, and cardiac autonomic function in older adults. Twenty-two community-dwelling older adults (mean age 73.4 ± 5.6 years) were randomly assigned to either a virtual reality group (VRG, n=12) or a control group (CG, n=10). Both groups completed a 6-week, twice-weekly supervised aerobic exercise programme lasting 30 minutes per session. The VRG performed an additional 10 minutes of VR balance games (Beat Saber, Tai Chi VR, FitXR) using a head-mounted display immediately following each aerobic session. Outcome measures included the Attitudes Towards Technology Scale (techno-enthusiasm and techno-anxiety subscales), Berg Balance Scale (BBS), resting heart rate, and peak heart rate during exercise. Assessments were conducted at baseline and post-intervention. Between-group comparisons were analysed using the Mann-Whitney U test. The VRG demonstrated significantly greater improvements in techno-enthusiasm (Δ=5.1±1.4 vs. 1.6±2.4, p=0.002) and reductions in techno-anxiety (Δ=-2.5±1.5 vs. 2.0±1.3, p=0.001) compared to controls. Resting heart rate significantly decreased in the VRG (Δ=-4.6±2.1 vs. -1.9±1.2, p=0.004), while peak heart rate during exercise significantly increased (Δ=8.5±3.3 vs. 0.1±6.7, p=0.003). Balance scores improved more in the VRG (Δ=5.1±2.1 vs. 2.9±2.9), but the between-group difference did not reach statistical significance (p=0.063). Participant feedback revealed high acceptability, with 91.7% reporting enjoyment and perceived benefits, and 100% expressing willingness to reuse VR. These findings suggest that VR-enhanced aerobic exercise positively influences technology-related attitudes and cardiac autonomic function in older adults, while demonstrating feasibility and acceptability. Further research with larger samples and longer intervention periods is needed to confirm potential balance improvements.

Anahtar Kelimeler

• Virtual reality
• Elderly
• Balance
• Aerobic exercise
• Technology attitude

Kaynakça

1. Ahmad, M. A., Gouveia, É. R., and Bermudez i Badia, S. (2024). A virtual reality-based simulation tool for assessing the risk of falls in older adults. Applied Sciences, 14(14), 6251. https://doi.org/10.3390/app14146251
2. Anderberg, P., Eivazzadeh, S., and Berglund, J. S. (2019). A novel instrument for measuring older people's attitudes toward technology (TechPH): Development and validation. Journal of Medical Internet Research, 21(5), e13951. https://doi.org/10.2196/13951
3. Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955
4. Calleja, N., Vilas, L., and Del Ser, T. (2024). Effectiveness of virtual reality-based training versus conventional exercise programs on fall-related functional outcomes in older adults with various health conditions: A systematic review. Healthcare, 12(17), 1716. https://doi.org/10.3390/healthcare12171716
5. Chen, C. Y., Chen, F., and Tsai, C. E. (2025). Exploring older people’s user experiences with VR: A case study of Taiwanese seniors. Entertainment Computing, 55,100974. https://doi.org/10.1016/j.entcom.2025.100974
6. Cho, G. H., Hwangbo, G., and Shin, H. S. (2014). The effects of virtual reality-based balance training on balance of the elderly. Journal of Physical Therapy Science, 26(4), 615-617.
7. De Andrade, P. E., Do Amaral, J. A. T., De Paiva, L. S., Gonçalves, D. G., Garner, D. M., and Valenti, V. E. (2023). Cardiac behavior and heart rate variability in elderly hypertensive individuals during aerobic exercise: A non-randomized controlled study. International Journal of Environmental Research and Public Health, 20(2), 1292. https://doi.org/10.3390/ijerph20021292
8. Dilanchian, A. T., Andringa, R., and Boot, W. R. (2021). A pilot study exploring age differences in presence, workload, and cybersickness in the experience of immersive virtual reality environments. Frontiers in Virtual Reality, 2, 736793. https://doi.org/10.3389/frvir.2021.736793

9. Drazich, B. F., McPherson, R., Gorman, E. F., Chan, T., Teleb, J., Galik, E., and Resnick, B. (2023). In too deep? A systematic literature review of fully-immersive virtual reality and cybersickness among older adults. Journal of the American Geriatrics Society, 71(12), 3906–3915. https://doi.org/10.1111/jgs.18553
10. Giovannini, S., Brau, F., Galluzzo, V., Santagada, D. A., Loreti, C., Biscotti, L., ... and Bernabei, R. (2022). Falls among older adults: screening, identification, rehabilitation, and management. Applied Sciences, 12(15), 7934. https://doi.org/10.3390/app12157934
11. Gómez-Donate, M., Arnáiz-Lasheras, F., Cano-Cuenca, N., and Rodrigo-Huedo, M. (2024). Effectiveness of virtual reality therapy on balance and gait in the elderly: A systematic review. Healthcare, 12(2), 158. https://doi.org/10.3390/healthcare12020158
12. Huang, G., Gibson, C. A., Tran, Z. V., and Osness, W. H. (2005). Controlled endurance exercise training and VO2max changes in older adults: A meta-analysis. Preventive Cardiology, 8(4), 217–225. https://doi.org/10.1111/j.0197-3118.2005.04324.x
13. Huang, G., Shi, X. I. A. N. G. R. O. N. G., Davis-Brezette, J. A., and Osness, W. H. (2005). Resting heart rate changes after endurance training in older adults: a meta-analysis. Medicine and Science in Sports and Exercise, 37(8), 1381-1386.
14. Huygelier, H., Schraepen, B., Van Ee, R., Vanden Abeele, V., and Gillebert, C. R. (2019). Acceptance of immersive head-mounted virtual reality in older adults. Scientific Reports, 9(1), 4519. https://doi.org/10.1038/s41598-019-41200-6
15. Ip, W. K., Soar, J., James, C., Wang, Z., and Fong, K. N. (2024). Innovative virtual reality (VR) application for preventing of falls among Chinese older adults: a usability and acceptance exploratory study. Human Behavior and Emerging Technologies, 2024(1), 5556767. https://doi.org/10.1155/2024/5556767
16. Karssemeijer, E. E., Aaronson, J. J., Bossers, W. W., Smits, T. T., and Kessels, R. R. (2017). Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia: A meta-analysis. Ageing research reviews, 40, 75-83. https://doi.org/10.1016/j.arr.2017.02.002
17. Lee, Y. S., Tsai, W. C., Chien, W. C., and Hwang, L. C. (2024). Effects of immersive virtual reality training on balance, gait, and mobility in older adults: A systematic review and meta-analysis. Geriatric Nursing, 58, 118–127. https://doi.org/10.1016/j.gerinurse.2024.04.011
18. Li, J., Li, J., and Wang, Y. (2022). Effects of virtual reality combined cognitive and physical interventions on cognitive function in older adults with mild cognitive impairment: A systematic review and meta-analysis. Ageing Research Reviews, 80, 101693. https://doi.org/10.1016/j.arr.2022.101693
19. Li, Y., Shiyanov, I., and Muschalla, B. (2025). Assessing cybersickness in a Virtual Reality intervention among older adults living in nursing homes: a feasibility study. Disability and Rehabilitation: Assistive Technology, 20(7), 2339-2347. https://doi.org/10.1080/17483107.2025.2503909
20. Li, Y., Shiyanov, I.,and Muschalla, B. (2024). Older adults' acceptance of a virtual reality group intervention in nursing homes: Pre-post study under naturalistic conditions. JMIR Human Factors, 11, e56278. https://doi.org/10.1080/17483107.2025.2503909
21. Liu, M., Zhou, K., Chen, Y., Zhou, L., Bao, D., and Zhou, J. (2022). Is virtual reality training more effective than traditional physical training on balance and functional mobility in healthy older adults? A systematic review and meta-analysis. Frontiers in Human Neuroscience, 16, 843481. https://doi.org/10.3389/fnhum.2022.843481
22. Makmee, P., and Wongupparaj, P. (2023). Immersive virtual reality cognitive-based intervention in older adults with and without mild cognitive impairment: A randomized controlled trial with EEG analysis. Clinical Interventions in Aging, 18, 123–138. https://doi.org/10.2147/CIA.S438523
23. Neri, S. G. R., Cardoso, J. R., Cruz, L., Lima, R. M., de Oliveira, R. J., and Iversen, M. D. (2017). Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis. Clinical Rehabilitation, 31(10), 1292–1304. https://doi.org/10.1177/0269215517694677
24. Özgül, E., Döner, N. H., and Çürük, G. N. (2025). Investigating older adults' technology attitudes: Psychometric evaluation and cross-cultural adaptation of the TechPH scale. International Journal of Medical Informatics, 203, 106001. https://doi.org/10.1016/j.ijmedinf.2024.106001
25. Palatini, P., and Julius, S. (2009). The role of cardiac autonomic function in hypertension and cardiovascular disease. Current Hypertension Reports, 11(3), 199–205. https://doi.org/10.1007/s11906-009-0035-4
26. Percy, M., O’Neill, B., and McArdle, S. (2023). Effectiveness of virtual reality-based balance and gait in older adults with fear of movement: A systematic review and meta-analysis. Physiotherapy Research International, 28(4), e2037. https://doi.org/10.1002/pri.2037
27. Petersen, R. C., Lopez, O., Armstrong, M. J., Getchius, T. S. D., Ganguli, M., Gloss, D., … Rae-Grant, A. (2018). Practice guideline update summary: Mild cognitive impairment. Neurology, 90(3), 126–135. https://doi.org/10.1212/WNL.0000000000004826
28. Ren, Y., Lin, C., Zhou, Q., Yingyuan, Z., Wang, G., and Lu, A. (2023). Effectiveness of virtual reality games in improving physical function, balance and reducing falls in balance-impaired older adults: a systematic review and meta-analysis. Archives of gerontology and geriatrics, 108, 104924. https://doi.org/10.1016/j.archger.2023.104924
29. Rmadi, H., Maillot, P., Artico, R., Baudouin, E., Hanneton, S., Dietrich, G., and Duron, E. (2023). Tolerance of immersive head-mounted virtual reality among older nursing home residents. Frontiers in Public Health, 11, 1163484. https://doi.org/10.3389/fpubh.2023.1163484
30. Roberts, A. R., De Schutter, B., Franks, K., and Radina, M. E. (2019). Older adults' experiences with audiovisual virtual reality: Perceived usefulness and other factors influencing technology acceptance. Clinical Gerontologist, 42(1), 27–33. https://doi.org/10.1080/07317115.2017.1373177
31. Rubenstein, L. Z. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(Suppl 2), ii37–ii41. https://doi.org/10.1093/ageing/afl084
32. Séba, M., Maillot, P., Hanneton, P., Dietrich, G., & Bouchard, S. (2023). Influence of normal aging and multisensory data fusion on cybersickness and postural adaptation in immersive virtual reality. Sensors, 23(23), 9414. https://doi.org/10.3390/s23239414
33. Sherrington, C., Fairhall, N., Wallbank, G., Tiedemann, A., Michaleff, Z. A., Howard, K., ... and Lamb, S. (2020). Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. British journal of sports medicine, 54(15), 885-891.
34. Szczepocka, E., Mokros, Ł., Kazmierski, J., Nowakowska, K., Łucka, A., Antoszczyk, A., … Bagger, K. (2024). The effectiveness of virtual reality-based training on cognitive, social, and physical functioning in high-functioning older adults (CoSoPhy FX): 2-arm, parallel-group randomized controlled trial. JMIR Research Protocols, 13, (1),e53261. https://doi.org/10.2196/53261
35. Şahin, F., Büyükavcı, R., Sağ, S., Doğu, B., and Kuran, B. (2013). Berg Denge Ölçeği’nin Türkçe versiyonunun inmeli hastalarda geçerlilik ve güvenilirliği. Türk Fiziksel Tıp ve Rehabilitasyon Dergisi, 59, 170–175.
36. Villareal, D. T., Aguirre, L., Gurney, A. B., Waters, D. L., Sinacore, D. R., Colombo, E., … Qualls, C. (2017). Aerobic or resistance exercise, or both, in dieting obese older adults. New England Journal of Medicine, 376(20), 1943–1955. https://doi.org/10.1056/NEJMoa1616338
37. Wei, X., Huang, C., Ding, X., Zhou, Z., Zhang, Y., Feng, X., ... and Lü, J. (2025). Effect of virtual reality training on dual-task performance in older adults: a systematic review and meta-analysis. Journal of NeuroEngineering and Rehabilitation, 22(1),141. https://doi.org/10.1186/s12984-025-01675-z
38. World Health Organization. (2021). Global report on falls prevention in older age. WHO Press.
39. Xu, T., Clemson, L., O’Loughlin, K., Lannin, N. A., Dean, C., and Koh, G. (2021). Risk factors for falls in community-dwelling adults with lower limb amputation: A systematic review. PM&R, 13(10), 1146–1161.
40. Yagi, E., Matsumura, K., Uchigashima, Y., Shiroyama, J., Hase, M., Nanba, T., Nakazawa, G., and Yamashita, J. (2025). Integration of wearables into a cardiac rehabilitation program and its impact on physical activity and exercise capacity in older patients with cardiovascular disease. Advances in Rehabilitation Science and Practice, 14, 27536351251343538. https://doi.org/10.1177/27536351251343538
41. Yalfani, A., Abedi, M., and Raeisi, Z. (2022). Effects of an 8-week virtual reality training program on pain, fall risk, and quality of life in elderly women with chronic low back pain: Double-blind randomized clinical trial. Games for Health Journal, 11(2), 85–92. https://doi.org/10.1089/g4h.2021.0107
42. Yang, Q., Zhang, L., Chang, F., Yang, H., Chen, B., and Liu, Z. (2025). Virtual reality interventions for older adults with mild cognitive impairment: systematic review and meta-analysis of randomized controlled trials. Journal of Medical Internet Research, 27, e59195.. https://doi.org/10.2196/59195
43. Zahedian-Nasab, N., Jaberi, A., Shirazi, F., and Kavousipor, S. (2021). Effect of virtual reality exercises on balance and fall in elderly people with fall risk: A randomized controlled trial. BMC Geriatrics, 21(1), 509. https://doi.org/10.1186/s12877-021-02462-w
44. Zhao, S., Jiang, H., Li, J., Yang, G., Zhang, D., Wei, X., and Feng, X. (2025). Immersive virtual reality versus non-immersive serious games for cognitive training in mild cognitive impairment: A systematic review and network meta-analysis. General Hospital Psychiatry.98,3-13 https://doi.org/10.1016/j.genhosppsych.2025.11.009
45. Zahedian-Nasab, N., Jaberi, A., Shirazi, F., & Kavousipor, S. (2021). Effect of virtual reality exercises on balance and fall in elderly people with fall risk: A randomized controlled trial. BMC Geriatrics, 21(1), 509. https://doi.org/10.1186/s12877-021-02462-w