Incongruent virtual reality attenuates breathlessness and leg fatigue during stationary cycling

This study tests whether creating incongruence between visual stimuli and pedalling resistance in virtual reality (VR) cycling can attenuate breathlessness and leg fatigue. We performed a trial in healthy participants, patient and public involvement (PPI) activities, and a feasibility study with patients with cardiac and respiratory conditions. Healthy Participants Study: Forty-eight healthy individuals engaged in a double-blind, randomized trial comparing incongruent VR (visual slope less than pedal resistance) with a congruent control. Incongruent VR significantly reduced breathlessness and leg fatigue (effect size = 0.39, SE = 0.04, p < 0.001 for both). Depression and health anxiety influenced these effects, with notable associations for breathlessness (effect size = 0.29, SE = 0.138, p = 0.04) and leg fatigue (effect size = 0.44, SE = 0.135, p = 0.002). PPI and Patient Study: Sixty-six stakeholders, including patients and caregivers, provided feedback on the paradigm's potential through focus groups and structured interviews. A subsequent observational study with nine patients demonstrated acceptability and tolerability of the VR cycling paradigm. The findings demonstrate that incongruent VR can attenuate breathlessness and fatigue perception, highlighting its promise for use in clinical settings, such as cardiac and pulmonary rehabilitation.