Stationary Cycling Exercise With Virtual Reality to Reduce Depressive Symptoms Among People With Mild to Moderate Depression - Randomized Controlled Trial

Aug 23, 2026

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Virtual reality (VR) stationary cycling may improve adherence and reduce depressive symptoms, yet robust evidence is needed to support clinical implementation. This 12-week, three-arm randomized controlled double-blind trial evaluated depressive symptom changes in sedentary adults with mild to moderate depression. Participants received VR high-intensity, VR moderate-intensity, or non-VR moderate-intensity stationary cycling. Depressive symptoms were measured by HAMD-17 from baseline to week 12, with response, remission, satisfaction, compliance, and adverse events assessed post-intervention.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Background and rationale

Study objective

Methods

Trial design

Participants and groups

Outcomes and analysis

Results

Depressive symptom changes

Response and remission

Satisfaction, compliance, and safety

Conclusions

| JOURNAL OF MEDICAL INTERNET RESEARCH Zhang et al
Original Paper
Stationary Cycling Exercise With Virtual Reality to Reduce Depressive Symptoms Among People With Mild to Moderate Depression: Randomized Controlled Trial | | --- | | | | Na Zhang1,2 , MS; Chenlu Hong3 , MEd; Yuejia Wang1 , MBBS; Haiqin Chen 1 ; Yueli Zhu 1 , MBBS; Miao Da 1 , MS; Zhongxia Shen 1 , MD; Xudong Zhao 1 , MS; Jiali Xu 1 , MS; Jiaxiu Sheng 1 , MBBS; Yanan Luo3 , PhD; Meiying Xu 1 | | 1Huzhou Third Municipal Hospital, Huzhou, Zhejiang, China 2School of Medicine and Nursing, Huzhou University, Huzhou, China 3School of Medicine and Nursing, Peking University, Beijing, China
Corresponding Author:
Meiying Xu
Huzhou Third Municipal Hospital
No. 2088 Tiaoxiao East Road, Wuxing District, Huzhou City, Zhejiang Province Huzhou, Zhejiang, 313000
China
Phone: 86 13757289010
Email: [syxmy@126.com](syxmy@126.com)
Abstract | Background: Virtual reality (VR) stationary cycling provides a potential solution to enhance adherence and reduce depressive symptoms, particularly for people with depression. However, high-quality evidence is needed to support its implementation in clinical practice. Objective: This study evaluated the clinical effects of a 12-week VR-based stationary cycling program on depressive symptoms in sedentary adults with mild to moderate depression. Methods: This study is a 12-week, 3-arm randomized controlled double-blind trial. Participants (aged 18‐60 years) with depression were recruited from a clinic and randomly assigned (1:1:1) to the VR high-intensity stationary cycling, VR moderate-intensity stationary cycling, or non-VR moderate-intensity stationary cycling group to receive face-to-face intervention. The primary outcome was the change in depressive symptoms measured by the Hamilton Depression Rating Scale (HAMD-17) between baseline and 12 weeks. Response rate, remission rate, satisfaction, compliance, and adverse events were assessed post intervention. Outcomes were analyzed using an ITT approach. Results: Between January 2023 and June 2024, a total of 114 participants were enrolled and randomly assigned to 3 groups (38 per group), with 101 completing the trial (33 in non-VR moderate-intensity stationary cycling, 35 in VR moderate-intensity cycling, and 33 in VR high-intensity cycling) . All 114 randomly assigned participants were included in the ITT analysis. After the 12-week intervention, all groups showed significant improvements in depressive symptoms, as reflected by the mean difference in HAMD-17 scores within groups from baseline to week 12: non-VR moderate intensity (mean difference within groups: 10.9, 95% CI 9.3-12.5; response rate: 58%, remission rate: 40%); VR moderate intensity (mean difference within groups: 14.2, 95% CI 12.7-15.8; response rate: 84%, remission rate: 74%); and VR high intensity (mean difference within groups: 14.4, 95% CI 13.0-15.8; response rate: 92%, remission rate: 74%) . VR-based groups showed greater reductions than the non-VR group (mean difference between groups: 3.3, 95% CI 1.9-4.9, for VR moderate-intensity; mean difference between groups: 3.9, 95% CI 2.5-5.2, for VR high intensity) . No significant difference in symptom improvement was found between the 2 VR groups, although the moderate-intensity group reported higher satisfaction. Conclusions: The VR stationary cycling program is an efficacious health intervention for alleviating depressive symptoms in participants with mild to moderate depression. These findings could facilitate incorporating VR health intervention into clinical practice, enhance the response of cycling-based interventions, and improve patient adherence, supporting its use as a complementary treatment for depression. Trial Registration: Chinese Clinical Trial Registry ChiCTR2500095241; [https://www.chictr.org.cn/showpro](https://www.chictr.org.cn/showpro)jEN.html?proj=252188 [https://www.jmir.org/2025/1/e72021](https://www.jmir.org/2025/

FAQs

What was the main objective of this randomized controlled trial?

To evaluate the clinical effects of a 12-week VR-based stationary cycling program on depressive symptoms in sedentary adults with mild to moderate depression.

How were participants assigned to the intervention groups?

Participants aged 18 to 60 with depression were recruited from a clinic and randomly assigned (1:1:1) to VR high-intensity cycling, VR moderate-intensity cycling, or non-VR moderate-intensity cycling.

What outcomes were used to assess depressive symptom improvement?

The primary outcome was change in depressive symptoms measured by HAMD-17 between baseline and 12 weeks, and response rate, remission rate, satisfaction, compliance, and adverse events were also assessed post-intervention.

Aug 23, 2026

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