4. Discussion
overweight middle-aged, depression, stroke, depressive symptoms
STROKE
The results of this randomized controlled trial showed that the 8-week virtual reality exercise program positively affected the BMI and the levels of depression, exercise fun, and exercise immersion in overweight middle-aged women.A significant interaction was observed between time and the groups, including a difference in all three groups’ BMI, following the 8-week intervention. After 8 weeks of exercise, the mean BMI and body weight decreased by 1.39 kg/mIn this study, depression symptoms were measured and analyzed using the Korean version of the PHQ-9. The average depression score at baseline was 5.8, suggesting that the exercise program participants had mild depression. After the 8-week intervention, the number of participants with a PHQ-9 score of 5 or higher decreased from 11 to 1 in the virtual reality exercise group and from 16 to 8 in the indoor bicycle exercise group. Additionally, there was a significant difference in the depression scores among the three groups; compared with the indoor bicycle exercise and control groups, the virtual reality exercise group showed a statistically significant decrease in depression scores after the intervention. Therefore, the exercise intervention using virtual reality was found to be more effective in reducing depression. It is difficult to identify the underlying mechanism by which the virtual reality exercise program improved depressive symptoms as it involves psychological and neurobiological interactions. However, this is a common result, with several studies reporting a more significant effect on depression when virtual reality training was applied to patients with stroke [Regarding the levels of exercise fun and exercise immersion in this study, the interaction between time and group was significant, indicating a difference in exercise fun and exercise immersion scores among the three groups according to time. The application of an exercise intervention using a virtual reality therapy method was effective as the post-hoc analysis revealed a significant difference between the virtual reality exercise and indoor bicycle exercise groups. As one of the technological fields that will lead the next generation, virtual reality attracts attention as a technology that can provide improved engagement and value [There are some limitations to the study. While the duration of the intervention was the same as in the exercise program, the prolonged experimental period made it difficult to control for differences in individual living environments and diets, which may have affected the variables. Therefore, to control the variables of BMI, it is necessary to investigate them more objectively, in future studies, including nutritional records. Furthermore, when applying immersive virtual reality, it was difficult for participants to observe surrounding objects, predisposing them to possible cybersickness and requiring the investigator’s attention. For the virtual reality exercise program to be continuously applied and to promote of the continuation of exercise, it is necessary to further develop various programs.