Background

Cardiovascular disease has risen sharply and causes more premature deaths than cancer, while it represents a major economic burden for healthcare systems and impacts patients' quality of life negatively. Virtual reality has captured the attention of researchers in the field of cardiac rehabilitation. However, the efficacy of virtual reality among individuals undergoing cardiac rehabilitation remain inconclusive.

Objective

To appraise research evidence on the effects of virtual reality for individuals undergoing cardiac rehabilitation.

Design

Systematic review and meta-analysis.

Methods

A systematic search of publications was conducted using Pubmed, Embase, Web of science, Cumulative Index to Nursing and Allied Health Literature database (CINAHL), Cochrane Central Register of Controlled trials and Physiotherapy Evidence Database (PEDro) from inception to 15 May 2022, without language restriction. The Cochrane Risk of Bias Tool was used to examine the methodological quality of the included randomized controlled studies. When feasible, a meta-analysis was performed to calculate the pooled effects using Review Manager (Version 5.4). Otherwise, narrative summaries were performed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria was used to assess the certainty of evidence.

Results

A total of Ten studies were included. Virtual reality probably increased exercise capacity for individuals undergoing cardiac rehabilitation with MD 49.55 (95%CI: 30.59 ~ 68.52, P < 0.00001, moderate certainty) and might result in a reduction in emotional tension (MD = − 6.43, 95%CI: − 9.02 ~ − 3.84, P < 0.00001, low certainty) and intrapsychic stress (MD = − 4.25, 95%CI: − 6.83 to − 1.67, P = 0.001, low certainty). It also seemed to have a positive effect on quality of life, although meta-analysis could not be conducted to pool the results. Virtual reality might reduce depression (SMD = − 0.48, 95%CI: − 0.84 ~ − 0.12, P = 0.009, very low certainty) but the evidence was very uncertain, with similar results of anxiety, general level of stress, external stress, total cholesterol, and low-density lipoprotein. The evidence was very uncertain about the effect of virtual reality on high-density lipoprotein (MD = − 1.79, 95%CI: − 8.96 ~ 5.38, P = 0.62, very low certainty), with similar results of triglycerides and BMI.

Conclusions

Individuals undergoing cardiac rehabilitation may benefit from virtual reality since it can improve exercise capacity and psychological outcomes. More large, and well-designed studies with tailored virtual reality intervention are warranted to confirm the effects of virtual reality on individuals undergoing cardiac rehabilitation.

Tweetable abstract.

Virtual reality may benefit individuals undergoing cardiac rehabilitation since in can improve exercise capacity and psychological outcomes.

中文翻译：

---

虚拟现实在心脏康复中的有效性：随机对照试验的系统评价和荟萃分析

背景

心血管疾病急剧上升，导致的过早死亡人数超过癌症，同时它对医疗保健系统构成重大经济负担，并对患者的生活质量产生负面影响。虚拟现实已经引起了心脏康复领域研究人员的关注。然而，虚拟现实在接受心脏康复的个体中的功效仍然没有定论。

客观的

评估虚拟现实对心脏康复患者的影响的研究证据。

设计

系统评价和荟萃分析。

方法

从开始到 2022 年 5 月 15 日，使用 Pubmed、Embase、Web of science、护理和联合健康文献数据库 (CINAHL)、Cochrane 对照试验中央注册库和物理治疗证据数据库 (PEDro) 对出版物进行了系统搜索，没有语言限制。Cochrane 偏倚风险工具用于检查纳入的随机对照研究的方法学质量。在可行的情况下，使用 Review Manager（5.4 版）进行荟萃分析以计算汇总效应。否则，进行叙述性摘要。推荐评估、制定和评价分级 (GRADE) 标准用于评估证据的确定性。

结果

共纳入十项研究。虚拟现实可能增加了 MD 49.55 的心脏康复患者的运动能力（95%CI：30.59 ~ 68.52，P  < 0.00001，中等确定性），并可能导致情绪紧张降低（MD = -  6.43，95%CI：-  9.02 ~ -  3.84, P  < 0.00001, 低确定性) 和心理压力 (MD = -  4.25, 95%CI: -  6.83 to -  1.67, P  = 0.001, 低确定性)。它似乎对生活质量也有积极影响，尽管无法进行荟萃分析来汇总结果。虚拟现实可能会减少抑郁症 (SMD = −  0.48, 95%CI: −  0.84 ~ −  0.12, P = 0.009，非常低的确定性）但证据非常不确定，焦虑、一般压力水平、外部压力、总胆固醇和低密度脂蛋白的结果相似。关于虚拟现实对高密度脂蛋白的影响的证据非常不确定（MD = -  1.79, 95%CI: -  8.96 ~ 5.38, P  = 0.62, 非常低的确定性），甘油三酯和 BMI 的结果相似。

结论

接受心脏康复的个人可能会从虚拟现实中受益，因为它可以提高运动能力和心理结果。有必要进行更大规模、设计良好的虚拟现实干预研究，以确认虚拟现实对接受心脏康复的个体的影响。

可推文摘要。

虚拟现实可能有益于接受心脏康复的个人，因为它可以提高运动能力和心理结果。