Increasing Physical Activity in Educational Settings Using Mixed Reality Technology: Iterative Formative Study

As physical education classes are lost to budget cuts and recess is canceled to meet standardized testing goals, the modern school day has become dominated by sedentary digital activities. To reverse this trend, current interventions have focused on reducing screen time. However, instead of fighting this digital invasion, this study examined the use of technology, specifically mixed reality, to turn screen time from sedentary into active time, promoting physical activity in a classroom setting.

The primary aim of this study was to iteratively develop and test a mixed reality prototype that promotes physical activity (eg, jumping, squatting, and punching) during a digital classroom activity. The primary outcomes were the percentage of active time during the activity, a breakdown of the intensity of that active time, and an evaluation of the prototype's usability.

Between November 2023 and April 2025, a multidisciplinary research team developed a prototype and evaluated it during 2 rounds of pilot-testing. Participants were aged 10 to 15 years and attended local middle schools. Physical activity was assessed using a medical-grade, hip-worn accelerometer (ActiGraph wGT3X-BT). Acceptability was assessed using a validated questionnaire (the System Usability Scale) that has a maximum score of 100. To collect feedback for prototype improvements, semistructured interviews were conducted after each round of pilot-testing.

In the first round of pilot-testing, students (n=22) were active for 46.0% (6.9, SD 2.7 minutes) of the headset session, which lasted 15 (SD 0) minutes. After improving the prototype using feedback from the first round, students in the second round (n=10) were active for 5.8 (SD 3.1) minutes (62.4%) of the web-based assignment, which lasted 9.3 (SD 2.41) minutes, while still reporting "good" acceptability scores (mean 73.8, SD 17.2). There were no significant differences in acceptability ratings between the 2 pilot-testing rounds (P=.16), nor were there differences between boys and girls in round 1 (P=.79) or round 2 (P=.61).

The results of this iterative study indicate that mixed reality can be used to elicit physical activity in a classroom setting, at least for short assignments. However, further research is needed to determine longer-term use and effectiveness.