Effectiveness of virtual reality-based balance training in primary school children: a randomized controlled trial

Balance and coordination are fundamental for children's motor development and injury prevention, yet sedentary lifestyles have contributed to their decline. Conventional balance training can be effective, but maintaining children's engagement remains challenging. Virtual reality (VR)-based programs provide immersive and gamified practice and may offer an alternative way to deliver balance- and coordination-related training in schools. This six-week randomized controlled trial compared immersive VR-based training with conventional training in 129 primary school students (VR: n = 64; control: n = 65). Participants trained three times per week for 30 min per session. Balance and coordination were assessed pre- and post-intervention using the Y-Balance Test (YBT composite score) as the primary dynamic-balance outcome, alongside single-leg stance with eyes closed (SLST-EC) and a 1-minute rope-skipping test. Both groups showed significant pre-post improvements across all outcomes (all p < 0.001), but within-group rope-skipping changes were not reliably interpretable as training effects because of likely test-retest familiarization, and SLST-EC changes were constrained by ceiling effects. Between-group comparisons of change scores showed no statistically significant differences for ΔYBT, ΔSLST-EC, or Δrope skipping (all p > 0.05). An ANCOVA adjusting for baseline YBT also showed no group effect on post-intervention YBT (p = 0.442). Overall, immersive VR did not show a statistically significant advantage over conventional training matched for scheduled frequency and session duration in this six-week school-based trial. Trial registration: ISRCTN Registry, ISRCTN37850916, registered on 30 June 2026. Retrospectively registered.