Participatory Development of a Virtual Reality Exercise Program for People with Chronic Pain.

Background: By describing how a participatory process led to changes in the design of a study of a virtual reality (VR)-guided exercise and mindfulness intervention tailored to people with chronic musculoskeletal pain, this article makes the case for including end user at an early stage when planning research within this field. Methods: A multidisciplinary panel including end-user representatives, researcher, clinicians, and VR developers participated in a 1-day workshop to design a randomized study and a VR-guided intervention. Results: Through the participatory process, changes were made to the original study design with respect to experimental design, duration, content of VR interventions and mode of delivery. Conclusion: This case exemplifies the importance of including end-user participants in the early phases of planning VR interventions for people with chronic pain.

Nature visits during the COVID-19 pandemic in Norway: Facilitators, motives, and associations with sociodemographic characteristics.

Introduction: The COVID-19 pandemic has been linked to increased mental health issues and reduced well-being. Researchers also reports increased frequency of nature visits during the pandemic, proposing it may mitigate some of these negative consequences. Using the case of Norway, a country with ample access to nature and relatively low levels of pandemic-related restrictions, this study sought to (i) understand how the COVID-19 crisis impacted patterns of nature visits and specific nature-based activities, (ii) examine how these patterns varied among different population groups and levels of restrictions, and (iii) explore the motives and facilitators for increased frequency of nature visits. Methods: The data were retrieved from a national cross-sectional survey conducted in June 2021, which was designed to assess participants (n = 1,005, age > 15 years) habits in relation to nature visits and outdoor recreation since the beginning of the COVID-19 crisis, and associated factors. Results: The results showed that 32 % of participants increased their frequency of nature visits during the crisis, while 11 % experienced a decrease. Multivariate logistic regression revealed significant positive associations between increased frequency of nature visits and longer duration of lockdown restrictions (OR [95% CI] = 2.35 [1.28-4.29] and 4.92 [2.77-8.74] for a few weeks and several months of lockdown, respectively). Increased frequency of nature visits was also more likely among women, younger respondents, and individuals from high-income households. A Cochran's Q test showed that the most common motive for increased frequency of nature visits was "To be physically active" (74%). The most commonly reported facilitators were the possibility of using natural environments as an alternative to gyms and organized sports alongside having more time available (58 and 49%, respectively). Conclusion: These findings suggest that nature visits provided important opportunities for physical activity during the COVID-19 crisis, but also that the mental health benefits of nature visits during such times may be under-communicated. This highlights the importance of access to natural environments to promote physical activity and health, but also suggests that campaigns that specifically communicate the beneficial effects of nature visits during lockdowns or similar stressful situations might help people cope with the situation.

Effect of aerobic exercise and low-carbohydrate high-fat diet on glucose tolerance and android/gynoid fat in overweight/obese women: A randomized controlled trial.

The study was designed to compare the effects of weight loss induced by a low-carbohydrate-high-fat diet or a normal diet, with and without exercise, on glucose tolerance measured as area under the curve (AUC), and android (A) and gynoid (G) fat distribution. The study was registered at clinicaltrials.gov; NCT04100356. In total, 57 women classified as overweight or obese (age 40 ± 3.5 years, body mass index 31.1 ± 2.6 kg/m2) were randomly assigned and completed a 10-week intervention using a low-carbohydrate high-fat diet or a normal diet, with or without aerobic interval exercise. An equal deficit of 700 kcal/day was prescribed, either restricting the diet only, or moderately restricting diet and including three 50-min high-intensity bicycle sessions per week. There were thus four groups: normal diet (NORM); low-carbohydrate-high-fat diet (LCHF); normal diet with exercise (NORM-EX); and low-carbohydrate-high-fat diet with exercise (LCHF-EX). Linear mixed models was used to assess differences between groups. With all groups pooled, the intervention resulted in a weight loss of 6.7 ± 2.5% (p < 0.001). The intervention did not result in differences between groups in AUC glucose, nor in fasting glucose or indicis for insulin resistance such as Homeostatic Model Assessment, Matsuda Insulin Sensitivity Index, insulinogenic index and disposition index. Post-intervention android fat was lower in LCHF than NORM (3,223 ± 727 vs. 2,533 ± 535 g, p = 0.041). LCHF reached a lower A/G ratio than NORM (0.94 ± 0.12 vs. 1.04 ± 0.09, p = 0.011) and LCHF-EX (0.94 ± 0.12 vs. 1.09 ± 0.09, p < 0.001) after the intervention. LCHF resulted in lower android fat mass compared to NORM and the lowest A/G ratio compared to the other matched groups, but with no accompanying improvement in AUC glucose. In conclusion, although all groups achieved improvements in glucose tolerance, no superior effect was observed with the LCHF diet, neither with nor without exercise.

Seasonal Variations in the Effectiveness of Immersive Virtual Nature.

AIM: The aim of this study was to assess whether the outcomes of immersive virtual nature (IVN) varies between seasons. BACKGROUND: IVN has received increased interest in recent years due to its potential applications within health and design. However, factors influencing people's responses to IVN are largely unknown. Seasons affect a variety of human processes and behaviors including levels of affect and blood pressure, also in the context of human-nature interactions. These seasonal variations might influence how people interact and respond to IVN, especially since IVN allow for representations of nature that are not representative of the current real-life season. METHODS: A secondary analysis of data retrieved from two previous studies, which included three IVN conditions, was conducted. All IVNs represented late spring conditions. Measures included perceived environmental restorativeness, affect, enjoyment, heart rate, and blood pressure. A meta-analytic approach was used to assess whether there were consistent differences between participants who were exposed to the IVN in spring/summer (early June to mid-September) and autumn/winter (mid-September to December) across the three different conditions. RESULTS: There was a consistent effect of season only for one component of affect (fatigue), with larger reductions in fatigue when exposed to IVN during autumn/winter compared to spring/summer. No other significant effects of season were observed. CONCLUSION: IVNs are feasible to use across all seasons but might be more effective in reducing the feeling of fatigue during autumn and winter compared to other seasons.

Taking real steps in virtual nature: a randomized blinded trial.

Studies show that green exercise (i.e., physical activity in the presence of nature) can provide the synergistic psychophysiological benefits of both physical exercise and nature exposure. The present study aimed to investigate the extent to which virtual green exercise may extend these benefits to people that are unable to engage in active visits to natural environments, as well as to promote enhanced exercise behavior. After watching a video validated to elicit sadness, participants either performed a treadmill walk while exposed to one of two virtual conditions, which were created using different techniques (360° video or 3D model), or walked on a treadmill while facing a blank wall (control). Quantitative and qualitative data were collected in relation to three overarching themes: "Experience," "Physical engagement" and "Psychophysiological recovery." Compared to control, greater enjoyment was found in the 3D model, while lower walking speed was found in the 360° video. No significant differences among conditions were found with respect to heart rate, perceived exertion, or changes in blood pressure and affect. The analysis of qualitative data provided further understanding on the participants' perceptions and experiences. These findings indicate that 3D model-based virtual green exercise can provide some additional benefits compared to indoor exercise, while 360° video-based virtual green exercise may result in lower physical engagement.

The relationship between postural stability and cybersickness: It's complicated - An experimental trial assessing practical implications of cybersickness etiology.

Virtual reality (VR) is known to cause cybersickness, and studies report that deteriorations of postural stability coincides with the onset cybersickness. It is unclear whether these deteriorations are the cause or a consequence of cybersickness. Thus, it is also unclear whether measures of postural stability may either predict susceptibility (cause) or objectively measure (consequence) the malaise. To examine whether deteriorations of postural stability can either predict or objectively measure cybersickness, healthy active adults (n = 50) were exposed to one of two different 10 min 360˚ VR videos. Postural stability was assessed, using a force platform, before exposure with eyes open (baseline) and eyes closed, during the first and last minute of exposure, and approximately 10 min after exposure. The deterioration of postural stability from baseline to the first minute of exposure was larger in participants who reported cybersickness, compared to those who did not, for both total trace length (p = 0.017) and standard deviation velocity (p = 0.008). However, there was substantial individual variation and overlap between sick and well participants. Deteriorations of postural stability from baseline to the eyes closed condition did not differ between sick and well participants (trace length, p = 0.270; standard deviation velocity, p = 0.112). There was a significant correlation between the severity of cybersickness and the change of postural stability from the first to the last minute of VR exposure for trace length (rs=0.32, p = 0.027), but not standard deviation velocity (rs=0.20, p = 0.187). The deteriorations had returned to baseline levels 10 min after exposure. These findings suggest that deteriorations of postural stability was both a predictor and objective measure at a group level. However, the large individual variation, substantial overlap between sick and well participants, and the limited strength of correlations suggest that deterioration of postural stability has limited practical value as both a predictor and objective measure. These findings emphasize the complicated nature of the relationship between cybersickness and postural stability.

Sprint Interval Running and Continuous Running Produce Training Specific Adaptations, Despite a Similar Improvement of Aerobic Endurance Capacity-A Randomized Trial of Healthy Adults.

The purpose of the present study was to investigate training-specific adaptations to eight weeks of moderate intensity continuous training (CT) and sprint interval training (SIT). Young healthy subjects (n = 25; 9 males and 16 females) performed either continuous training (30-60 min, 70-80% peak heart rate) or sprint interval training (5-10 near maximal 30 s sprints, 3 min recovery) three times per week for eight weeks. Maximal oxygen consumption, 20 m shuttle run test and 5·60 m sprint test were performed before and after the intervention. Furthermore, heart rate, oxygen pulse, respiratory exchange ratio, lactate and running economy were assessed at five submaximal intensities, before and after the training interventions. Maximal oxygen uptake increased after CT (before: 47.9 ± 1.5; after: 49.7 ± 1.5 mL·kg-1·min-1, p < 0.05) and SIT (before: 50.5 ± 1.6; after: 53.3 ± 1.5 mL·kg-1·min-1, p < 0.01), with no statistically significant differences between groups. Both groups increased 20 m shuttle run performance and 60 m sprint performance, but SIT performed better than CT at the 4th and 5th 60 m sprint after the intervention (p < 0.05). At submaximal intensities, CT, but not SIT, reduced heart rate (p < 0.05), whereas lactate decreased in both groups. In conclusion, both groups demonstrated similar improvements of several performance measures including VO2max, but sprint performance was better after SIT, and CT caused training-specific adaptations at submaximal intensities.

Enable, Reconnect and Augment: A New ERA of Virtual Nature Research and Application.

Being exposed to natural environments is associated with improved health and well-being, as these environments are believed to promote feelings of "being away" from everyday struggles, positive emotional reactions and stress reduction. Despite these positive effects, humanity is becoming increasingly more distanced from nature due to societal changes, such as increased urbanization and the reduced accessibility of natural environments. Technology is also partly to blame, as research suggests that people replace nature contact with increased screen time. In this cross-section between nature and technology, we find technological nature which is progressing towards a point where we may be capable of simulating exposure to real nature. Concerns have been raised regarding this technology, as it is feared it will replace real nature. However, research suggests that virtual nature may have a more positive impact on society than a mere replacement of real nature, and this review propose several areas where virtual nature may be a beneficial addition to actual nature (Enable), help people reconnect with the real natural world (Reconnect) and "boost" human-nature interactions (Augment). Based on the current research and theoretical framework, this review proposes guidelines for future research within these areas, with the aim of advancing the field by producing high quality research.

Low-Carbohydrate High-Fat Diet and Exercise: Effect of a 10-Week Intervention on Body Composition and CVD Risk Factors in Overweight and Obese Women-A Randomized Controlled Trial.

We assessed the effect of weight-loss induced with a low-carbohydrate-high-fat diet with and without exercise, on body-composition, cardiorespiratory fitness and cardiovascular risk factors. A total of 57 overweight and obese women (age 40 ± 3.5 years, body mass index 31.1 ± 2.6 kg∙m-2) completed a 10-week intervention using a low-carbohydrate-high-fat diet, with or without interval exercise. An equal deficit of 700 kcal∙day-1 was prescribed, restricting diet only, or moderately restricting diet and adding exercise, producing four groups; normal diet (NORM); low-carbohydrate-high-fat diet (LCHF); normal diet and exercise (NORM-EX); and low-carbohydrate-high-fat diet and exercise (LCHF-EX). Linear Mixed Models were used to assess between-group differences. The intervention resulted in an average 6.7 ± 2.5% weight-loss (p < 0.001). Post-intervention % fat was lower in NORM-EX than NORM (40.0 ± 4.2 vs. 43.5 ± 3.5%, p = 0.024). NORM-EX reached lower values in total cholesterol than NORM (3.9 ± 0.6 vs. 4.7 ± 0.7 mmol/L, p = 0.003), and LCHF-EX (3.9 ± 0.6 vs. 4.9 ± 1.1 mmol/L, p = 0.004). Post intervention triglycerides levels were lower in NORM-EX than NORM (0.87 ± 0.21 vs. 1.11 ± 0.34 mmol/L, p = 0.030). The low-carbohydrate-high-fat diet had no superior effect on body composition, V˙O2peak or cardiovascular risk factors compared to a normal diet, with or without exercise. In conclusion, the intervention decreased fat mass, but exercise improved body composition and caused the most favorable changes in total cholesterol and triglycerides in the NORM-EX. Exercise increased cardiorespiratory fitness, regardless of diet.

Camera Stabilization in 360° Videos and Its Impact on Cyber Sickness, Environmental Perceptions, and Psychophysiological Responses to a Simulated Nature Walk: A Single-Blinded Randomized Trial.

Immersive virtual environments (IVEs) technology has emerged as a valuable tool to environmental psychology research in general, and specifically to studies of human-nature interactions. However, virtual reality is known to induce cyber sickness, which limits its application and highlights the need for scientific strategies to optimize virtual experiences. In this study, we assessed the impact of improved camera stability on cyber sickness, presence, and psychophysiological responses to a simulated nature walk. In a single-blinded trial, 50 participants were assigned to watch, using a head-mounted display, one of two 10-min 360° videos showing a first-person nature walk: one video contained small-magnitude scene oscillations associated with cameraman locomotion, while in the other video, the oscillations were drastically reduced thanks to an electric stabilizer and a dolly. Measurements of cyber sickness (in terms of both occurrence and severity of symptoms), perceptions of the IVE (presence and perceived environmental restorativeness), and indicators of psychophysiological responses [affect, enjoyment, and heart rate (HR)] were collected before and/or after the exposure. Compared to the low-stability (LS) condition, in the high-stability (HS) condition, participants reported lower severity of cyber sickness symptoms. The delta values for pre-post changes in affect for the LS video revealed a deterioration of participants' affect profile with a significant increase in ratings of negative affect and fatigue, and decrease in ratings of positive affect. In contrast, there were no pre-post changes in affect for the HS video. No differences were found between the HS and LS conditions with respect to presence, perceived environmental restorativeness, enjoyment, and HR. Cyber sickness was significantly correlated with all components of affect and enjoyment, but not with presence, perceived environmental restorativeness, or HR. These findings demonstrate that improved camera stability in 360° videos is crucial to reduce cyber sickness symptoms and negative affective responses in IVE users. The lack of associations between improved stability and presence, perceived environmental restorativeness, and HR suggests that other aspects of IVE technology must be taken into account in order to improve virtual experiences of nature.

A cross-sectional study to examine the association between self-reported sleep and the frequency, duration and intensity of exercise.

BACKGROUND: Insufficient sleep is associated with increased risk of several health concerns. Although physical activity is generally considered to improve sleep, the influence of different levels of exercise frequency, duration and intensity respectively, has not been sufficiently examined to allow specific recommendations to the general population. Therefore, our aim was to evaluate the association between different levels of the three cardinal characteristics of exercise and sleep disturbance. METHODS: Data were collected through a Norwegian comprehensive self-report survey. A total of 3763 respondents (46% males, 54% females) with an average age of 47.9 years (range 15-93) completed the questionnaire, whereof 13.7% were categorized as poor sleepers. The exercise characteristics and sleep disturbance were measured on a 6 to 8 and a 4-item Likert scale, respectively. RESULTS: Respondents reporting intermediate levels of exercise frequency, duration and intensity, respectively, had a significantly lower occurrence of sleep disturbance compared to respondents with a sedentary lifestyle. No statistical difference in sleep disturbance was observed between respondents performing exercise corresponding to the lowest and highest levels of the three exercise characteristics and those who were sedentary. CONCLUSIONS: The lack of positive association between the lowest and highest levels of the cardinal exercise characteristic and reduction in sleep disturbance revealed in the present study support a recommendation of intermediate levels of exercise frequency, duration and intensity for preventing sleep disturbance in the general population.

Experiencing Nature through Immersive Virtual Environments: Environmental Perceptions, Physical Engagement, and Affective Responses during a Simulated Nature Walk.

By combining physical activity and exposure to nature, green exercise can provide additional health benefits compared to physical activity alone. Immersive Virtual Environments (IVE) have emerged as a potentially valuable supplement to environmental and behavioral research, and might also provide new approaches to green exercise promotion. However, it is unknown to what extent green exercise in IVE can provide psychophysiological responses similar to those experienced in real natural environments. In this study, 26 healthy adults underwent three experimental conditions: nature walk, sitting-IVE, and treadmill-IVE. The nature walk took place on a paved trail along a large river. In the IVE conditions, the participants wore a head-mounted display with headphones reproducing a 360° video and audio of the nature walk, either sitting on a chair or walking on a manually driven treadmill. Measurements included environmental perceptions (presence and perceived environmental restorativeness - PER), physical engagement (walking speed, heart rate, and perceived exertion), and affective responses (enjoyment and affect). Additionally, qualitative information was collected through open-ended questions. The participants rated the IVEs with satisfactory levels of 'being there' and 'sense of reality,' but also reported discomforts such as 'flatness,' 'movement lag' and 'cyber sickness.' With equivalent heart rate and walking speed, participants reported higher perceived exertion in the IVEs than in the nature walk. The nature walk was associated with high enjoyment and enhanced affect. However, despite equivalent ratings of PER in the nature walk and in the IVEs, the latter were perceived as less enjoyable and gave rise to a poorer affect. Presence and PER did not differ between the two IVEs, although in the treadmill-IVE the negative affective responses had slightly smaller magnitude than in the sitting-IVE. In both the IVEs, the negative affective responses were mainly associated with cyber sickness, whereas PER was positively associated with enjoyment. From the qualitative analysis, it emerged that poor postural control and lack of a holistic sensory experience can also hinder immersion in the IVE. The results indicate that IVE technology might in future be a useful instrument in green exercise research and promotion, but only if image quality and cyber sickness can be addressed.

Sprint interval running increases insulin sensitivity in young healthy subjects.

High intensity cycling training increases oxidative capacity in skeletal muscles and improves insulin sensitivity. The present study compared the effect of eight weeks of sprint interval running (SIT) and continuous running at moderate intensity (CT) on insulin sensitivity and cholesterol profile in young healthy subjects (age 25.2 ± 0.7; VO(2max) 49.3 ± 1.2 ml·kg(-1)·min(-1)). SIT and CT increased maximal oxygen uptake by 5.3 ± 1.8 and 3.8 ± 1.6%, respectively (p < 0.05 for both). Oral glucose tolerance test (OGTT) was performed before and 60 h after the last training session. SIT, but not CT, reduced glucose area under curve and improved HOMA ß-cell index (p < 0.05). Insulin area under curve did not decrease significantly in any group. SIT, but not CT, reduced LDL and total cholesterol. In conclusion, sprint interval running improves insulin sensitivity and cholesterol profile in healthy subjects, and sprint interval running may be more effective to improve insulin sensitivity than continuous running at moderate intensity.