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Exploring the Potential for Virtual Reality to Engage Adolescents With Physical Activity

By Emma Norris, on 26 September 2019

By Nuša Farič – University College London

The health benefits of performing sufficient physical activity are very well established and include social and psychological benefits, reduced risk of non-communicable diseases, reduced risk of premature mortality, and better mental health. Adolescence is a key developmental stage to target low levels of physical activity as less than 15% of boys and 10% of girls achieving the UK government recommendation for adolescents of at least 60 min of moderate-to-vigorous physical activity (MVPA) per day. Physical activity levels also decline throughout adolescence, particularly in girls.

In recent years, attempts have been made to utilize VR, health and fitness apps to promote physical activity. Virtual reality (VR) involves wearing a headset and motion trackers allowing the user to be immersed and feel present in a virtual environment. VR holds the potential to enhance therapeutic treatment of various mental health conditions such as phobias, dementia, physical rehabilitation but it has also been successful in many areas of learning.

The vEngage study, funded by the Medical Research Council (MRC) and led by Dr Abi Fisher in the UCL Department of Behavioural Science & Health, is an industry collaboration project involving Coventry University, Anglia Ruskin University and a London-based gaming company Six-to-Start.

vEngage team have partnered with a gaming studio Six to Start because the gaming industry has been extremely successful in engaging our target population. Over 90% of adolescents chose to game in their leisure time. The aim of the study is to explore the potential of VR exercise games (otherwise known as ‘exergames’) to engage adolescents (13-17 years) with physical activity. VR can enhance the exergaming experience through immersion and presence contributing to the feeling of absorption, flow, and fun.


The study was composed of several stages:

Firstly, we gathered views of the adolescents, their parents or guardians in London-based schools because we wanted to understand their awareness of VR technology, exergaming and physical activity. The aim was to design an intervention (our VR exergame) in an iterative way by collaborating with Six to Start, as well as our target group (schools) which became our steering committee, helping us co-design our game.

Secondly, we wanted to learn more from the current players of the VR exergames. We looked at their exergame reviews which we obtained from top three VR marketplaces where exergames are sold: Steam (Valve Corporation), Viveport (Valve Corporation) and Oculus (Oculus VR). From a total of 498 player-based reviews of the 29 most popular exergames, we learned that players reached a high level of exertion when playing the VR exergames, and that the immersion in a VR world distracted them from the exercise intensity.

Players preferred highly realistic exergames which closely simulate real-world sport and games that were intuitive in terms of the body movement and controls. Other preferred features included custom music and social aspects of the games (with multiplayer options to include friends or help from experienced players). However, there were reports of bugs, or aspects such as overly complex controls, unresponsive developers and display functions that evoked motion sickness, all of which caused players frustration and had a negative impact on their perceived enjoyment of the games.

Both of these initial development studies have been published in the Journal of Medical Internet Research (JMIR)  and JMIR Serious Games.

Thirdly, incorporating the learning from our development work, Six to Start have built a prototype of a VR exergame which involves tracing and completing patterns in a simulated natural environment.  We have user tested our game with 31 adolescent boys and girls in London based schools.

The feedback we received from our steering group students allowed us to distill elements that should be incorporated into a VR game for health intervention. Aspects of their feedback were similar to what we found with the player’s reviews. They included custom choice of music, ability to create patterns themselves, link with their friends and family and for the game to mimic certain sports such as football, baseball and tennis. There also gave feedback on the use of rewards, novelty and enjoyment in immersive game play, multiplayer options, real-world elements, as well as continual updates and new challenge levels.

Although the use of VR to engage adolescents with physical activity shows promise, here were some notable barriers raised throughout our research, such as price, availability and in the case of the parents, worries around violence or not spending enough time outdoors.  Overall, students reported experiencing excitement, increased motivations and moderate levels of physical exertion when playing our prototype game.

We have since incorporated a number of key behaviour change techniques into the game that we believe are important to increase physical activity (e.g. provide instruction, provide feedback on performance) and have also started to identify real-world physical activity and fitness partners because we believe that a link up with these would encourage adolescents to try new types of activities.

As the fourth component to our study, we had the opportunity to access a large database of users of the world’s most popular running app, Zombies, Run! developed by our gaming industry partner Six to Start. Zombies, Run! is a gamified running app which has  5.5 million downloads overall and about 200,000 monthly active users. This is not a VR exergame, but an app which allows people to feel immersed by listening to a storyline with many characters (as they run or walk), while also participating in the race to “save the world”. The parallels between Zombies, Run! and VR is the immersion, although Zombies, Run!  achieves this via gamification and effects similar to augmented reality.

We created a 36 question online survey which we sent to the users of Zombies, Run! app (across several channels: in the in-app news, in a newsletter and across Zombies, Run! social media pages). We gathered 6300 survey responses and further interviewed 30 participants who specified that the main reason for them using the running app was a positive impact on their mental health. We have a lot of exciting data from Zombies, Run! users including information on what they perceive motivates them to be physically active and why they started running. We also have data on which behavior change techniques drive physical activity and in what format.


The study will be ongoing as part of my PhD project until September 2020, and we are looking for further partnerships and support in order to be able to finalise our game and build upon the existing prototype, and finally test its effects on a bigger scale. This is the first study of its kind involving adolescents who also actively participated in building our VR game.  We are excited about our findings so far and hope to secure funding to further develop the prototype and identify real world physical activity partners for the next stages.



  • Do you think VR will become available mainstream in gyms and fitness centres in the next 5 years?
  • Would you purchase a VR game that would allow you to exercise in a virtual environment/ be it slicing flying fruit, fighting in a real boxing ring, jumping from building-to-building in Manhattan or skating with your favourite celebrities?
  • How do you think VR exergames will evolve to become more accessible to the public in the next 5-10 years?



Nuša Farič (@nushizen) is a PhD student at the Institute of Health Informatics. Her research interests include health psychology (motivation, mental health), women’s health and transpersonal psychology (motivation, will).




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