Effectiveness of Virtual Exercise Intervention in Adults With Major Depressive Disorder: A Systematic Review

Virtual reality-based exercise is an emerging tool in mental health care; however, its application and effectiveness in treating Major Depressive Disorder (MDD) remain unclear. This systematic review evaluated the effectiveness of virtual exercise interventions for adults with MDD, focusing on depressive symptoms, functional outcomes, and the certainty of the available evidence.

Following PRISMA 2020 guidelines, four databases (PubMed, Embase, CINAHL, AMED) were systematically searched for studies evaluating virtual exercise interventions in adults with MDD. Two reviewers independently performed study selection, data extraction, methodological quality assessment using Cochrane's Risk of Bias 2 (RoB 2) and Risk of Bias in Non-randomized Studies (ROBINS-I) tools. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Of the 603 articles, four studies met the inclusion criteria, evaluating the VRelax, Pacifica, and CORE interventions. Pacifica and CORE demonstrated moderate improvements in depressive symptoms compared with control groups, while VRelax primarily improved stress and negative affect. The interventions were generally well accepted, with high participant engagement and adherence. Overall certainty of evidence ranged from moderate to low-moderate and was limited by relatively small sample sizes, methodological limitations, and short follow-up periods.

Virtual exercise intervention may represent a promising adjunct to conventional therapy for MDD. Although current evidence supports improvements in depressive symptoms and emotional well-being, further randomized controlled trials with larger samples, longer follow-up, and objective neurobiological outcome measures are needed to confirm long-term efficacy and clinical applicability.