Enhancing physical health and function through immersive exercise

Immersive VR, delivered through HMDs, is increasingly recognised as a valuable tool in geriatric health and rehabilitation. By combining PA with multisensory, interactive environments, VR enhances accessibility and motivation, particularly for older adults with mobility limitations [30, 31]. It complements rather than replaces traditional methods, offering structured and adaptive opportunities for movement.

This subsection explores four key domains of physical health that benefit from immersive VR: balance and fall risk, muscular strength and mobility, pain management, and long-term engagement (motivation and adherence).

Cognitive gains through dual-task integration

VR is increasingly redefining intervention models in geriatric health by combining PA with cognitive stimulation on a single, synergistic platform [39, 40]. Moving beyond its recreational origins, immersive VR has demonstrated the potential to enhance executive function and cognitive flexibility through simulations that activate motor and cognitive systems simultaneously [41–43].

VR-based interventions support not only cognitive health but also physical performance, including improved balance, mobility, and functional capacity. This dual-action approach positions VR as a powerful complement to traditional therapies, with the capacity to promote multidimensional health in older adults [10, 34].

One of the most promising applications of VR lies in dementia care, where immersive exergames have been shown to support both cognitive integrity and physical engagement [44]. These dual-task platforms are gaining traction as innovative therapeutic tools [45, 46] capable of slowing decline and sustaining motivation across the neurocognitive spectrum [4, 21, 22]. Interdisciplinary efforts are now focused on developing tailored VR solutions that integrate advanced sensors, enabling highly personalised environments that promote both neurocognitive stimulation and motor learning [8, 14, 47].

Across the literature, key cognitive outcomes include improved task-switching, stronger inhibitory control, and increased dual-task gait speed – all markers of enhanced executive function [21, 46, 48]. These gains are frequently attributed to paradigms requiring users to engage motor and cognitive faculties simultaneously, thereby strengthening cognitive-motor integration in ecologically valid contexts.

For instance, Liao et al. [49] showed that VR-based gait training significantly improved both executive functioning and gait in older adults with mild cognitive impairment. These findings highlight the interdependence between motor and cognitive domains and the therapeutic potential of dual-task VR interventions [48].

VR has also shown promise in vestibular rehabilitation, improving balance control, cognitive function, and vestibulo-ocular reflex gains in individuals with unilateral vestibular hypofunction, even in those with concurrent cognitive impairments [50]. This suggests that VR can recalibrate postural strategies and reduce fall risk through multisensory training [51].

Recent advances include adaptive VR systems that automatically adjust task difficulty and walking speed based on user performance. These dynamic environments are particularly relevant for individuals with motor-cognitive disorders such as Parkinson’s disease [15] and open up new avenues for biomechanical monitoring and motor-control research.

Emerging studies also point to a bidirectional relationship between cognition and motor function. VR-based cognitive-motor interventions targeting daily-living skills have been linked to improvements in coordination, divided attention, and cognitive flexibility – all critical for maintaining independence [49]. However, much remains unknown. Future research must identify which cognitive subdomains are most responsive to VR and determine the optimal frequency, duration, and complexity of interventions.

Sustained interdisciplinary collaboration is essential to refine protocols, improve usability, and clarify the neurophysiological mechanisms underlying the observed gains [36, 37, 51]. In parallel, rigorous validation studies are needed to evaluate efficacy, safety, and feasibility across diverse populations, paying special attention to headset ergonomics, session length, and instructional clarity, all of which influence user comfort and cognitive load [51].

Neuroimaging work further underscores the cognitive potential of immersive VR. Functional magnetic resonance imaging (MRI) studies reveal task-specific activation and cortical reorganisation consistent with enhanced cognitive functioning after VR interventions [52]. These data suggest that VR is not merely a delivery channel but a transformative modality capable of engaging the brain in novel and potent ways.

As a convergence point among cognitive science, rehabilitation, and gerontology, VR offers a new paradigm for integrated care. Its ability to engage physical and mental faculties simultaneously holds great promise for cognitive resilience and functional autonomy. Yet this promise remains provisional unless supported by robust, standardised research. When grounded in rigorous design and person-centred principles, immersive VR can serve not just as a cognitive training tool, but as a platform for holistic and dignified ageing.

Among cognitive outcomes, the most consistent findings involve improvements in executive function, attention, and dual-task performance, particularly in older adults with mild cognitive impairment. Nevertheless, most evidence stems from pilot or proof-of-concept trials with small samples, brief durations, and heterogeneous protocols. The absence of validated cognitive batteries, the inconsistent outcome measures, and the undefined dose–response relationships further complicate the evidence base. Without standardised metrics, stratified sampling, and long-term follow-up, claims about VR’s cognitive benefits will remain suggestive rather than conclusive.

Feel-good factor: psychological and emotional well-being

Immersive VR is increasingly viewed as an effective avenue for supporting the psychological and emotional well-being of older adults. Beyond traditional therapies, VR creates immersive environments that offer both digital escapism and affective stimulation – relieving stress, elevating mood, and fostering emotional engagement. In one study, Barsasella et al. [19] found that exposure to calming virtual landscapes significantly reduced symptoms of anxiety and depression, while increasing a sense of presence and emotional connection.

These environments can function both as emotional refuges and as invitations to movement – especially through interactive, nature-based simulations. In this way, VR disrupts the sedentary routines common in later life, encouraging embodied interaction in restorative, digitally mediated settings [34]. This fusion of immersive technology and biophilic design signals a shift in mental-health care, reimagining how therapeutic engagement can occur in ageing populations [53, 54].

While research is still emerging, early findings suggest that VR is feasible, acceptable, and well tolerated. In a pilot study, Drazich et al. [55] reported moderate effects on depressive symptoms in older adults, especially those at higher psychological risk. Though limited by small samples and low baseline distress, the study confirmed that immersive interventions were safe, engaging, and positively received.

VR does not only mitigate negative emotional states; it also promotes positive psychological outcomes such as increased self-esteem and greater motivation for PA [33, 56]. Through real-time feedback, goal-oriented tasks, and accessible scenarios, VR can create a sense of progress and mastery – key drivers of self-efficacy, particularly among adults with limited prior engagement in structured exercise.

Emerging research on the Proteus effect – the idea that users’ self-perception shifts according to their avatar – offers further insight. Lin and Wu [57] showed that avatar embodiment in exercise contexts significantly influenced motivation and affective experience in older users. These findings highlight avatar design not merely as a technical detail but as a powerful psychological lever in personalised health promotion.

Social connection also plays a central role in emotional well-being and sustained engagement. Høeg et al. [14] examined social interaction in a VR ‘buddy biking’ game, where participants reported greater emotional involvement and enjoyment when activities were shared. Expressive avatars and synchronised tasks enhanced interaction quality and perceived connection – although limitations in avatar realism still posed barriers to deeper emotional exchange.

Together, these studies suggest that VR may help address affective needs in ageing populations. Documented benefits include mood enhancement, reduced anxiety and depressive symptoms, increased confidence, and higher motivation for movement. Still, to move beyond feasibility, VR must be integrated with broader strategies – including social support, physical rehabilitation, and community-based initiatives.

Nonetheless, several challenges remain. Issues of accessibility, digital safety, and emotional appropriateness must be addressed. Barriers such as cost, limited digital literacy, cybersickness, and discomfort with hardware still hinder widespread adoption [58]. Ensuring inclusive use will require age-friendly interfaces, simplified onboarding, and ongoing technical support.

Ethical concerns – particularly around privacy, consent, and emotional vulnerability – must also be taken seriously as VR becomes more integrated into mental-health care [59]. Transparent data practices, clear informed-consent procedures, and built-in emotional safeguards should be embedded into both design and delivery.

While immersive VR holds early promise for enhancing psychological resilience and improving quality of life, the evidence remains preliminary. Reported improvements in mood and motivation tend to be modest and inconsistent, and are often drawn from pilot studies with small samples, brief exposures, and limited control conditions. Moreover, effects may be influenced by novelty, short-term emotional uplift, and user expectations – factors rarely tracked over time. Without longitudinal data, it remains unclear whether VR’s emotional benefits are sustainable, clinically meaningful, or best suited as adjuncts to broader interventions.

To establish a credible role for VR in emotional care, future studies must adopt robust designs with standardised affective measures, stratified recruitment, and extended follow-up periods. Only then can we determine whether VR is best deployed as a preventive tool, a therapeutic supplement, or a short-term motivational enhancer. With continued interdisciplinary collaboration, ethical design, and inclusive implementation, immersive VR may become a core component of holistic ageing care – integrating physical vitality with emotional depth and social presence.

Social connections and quality of life

As social isolation becomes a pressing challenge in ageing societies, VR offers a novel and potentially powerful solution for [restoring] and enriching interpersonal connections. Platforms like Alcove VR, Meta Quest 2, and EngageVR create immersive social environments where older adults can engage in shared activities, maintain relationships, and form new ones – often overcoming the physical and geographic barriers that limit face-to-face interaction [38, 54, 59]. These virtual experiences range from collaborative games to cultural exploration, collectively promoting a sense of community and reducing loneliness.

Beyond mere connection, VR is evolving into a medium for meaningful, sustained social engagement. In a study by Høeg et al. [14], participants in a VR cycling game reported greater emotional involvement and enjoyment when challenges were undertaken collaboratively. Real-time communication during scenic virtual rides helped (re-create) genuine social dynamics, even in the absence of physical presence. These experiences suggest that VR can support emotionally rich interactions and reframe digital spaces as sites of community and shared meaning. Nevertheless, the same study also noted technological limitations: avatar expressiveness and gesture nuance remain insufficient for conveying complex social cues, (sometimes) limiting the depth of connection and highlighting the need for more emotionally intelligent design features.

Another promising feature of VR is its ability to facilitate purposeful digital escapism. Far from being merely distracting, VR can transport older adults to emotionally significant spaces, such as a childhood neighbourhood, a world-class museum, or a cherished seasonal festival. These simulations can rekindle autobiographical memory, evoke affective resonance, and reinforce a sense of identity, agency, and continuity in later life [43, 60].

To fully leverage this potential, future research must explore the specific social needs and preferences of older adults, including the desire for authentic, emotionally resonant interactions. Longitudinal studies are essential to assess the durability of virtual relationships, their impact on offline social integration, and their role in intergenerational connection – for example, playing VR games with grandchildren. Features that support shared goals, such as team-based challenges, progress tracking, and cooperative rewards, may also enhance motivation and deepen social ties [35].

Yet these possibilities must be balanced against practical and ethical concerns. Barriers to access persist: many older adults face limited digital literacy, hardware discomfort, and skepticism about technology. Addressing these issues will require inclusive design principles, simplified user interfaces, ergonomic hardware, and reliable technical support [58, 59]. Without such accommodations, VR may inadvertently deepen digital exclusion, especially among those it aims to serve.

Moreover, most current studies on social VR benefits rely on small, non-representative samples and short-term interventions. While some report reductions in loneliness and increased connectedness, these findings are often drawn from brief exposures, with limited attention to sustainability, relational depth, or translation to real-world outcomes. Critically, the experience of social presence – essential to VR’s relational success – is highly sensitive to variables like avatar realism, response latency, and environmental stability. These elements are seldom reported or standardised, making it difficult to compare findings or develop best practices.

To build a solid foundation, future research must employ validated interactional metrics, stratify participant characteristics, and assess whether virtual relationships contribute to tangible improvements in offline well-being. Studies should also distinguish between passive co-presence and active engagement, and investigate how virtual social bonds evolve over time. Until such evidence is available, the role of VR in addressing social isolation must be considered promising yet preliminary – a tool with clear potential, but not yet an established therapeutic modality.

To summarise the multidimensional benefits of immersive VR for older adults, Table 4 offers a synthesised overview of impacts across the physical, cognitive, emotional, and social domains.

While immersive VR offers compelling opportunities to support healthy ageing, current empirical evidence remains uneven across domains. Physical outcomes show the strongest support, with several small-scale trials reporting moderate short-term gains in balance, strength, and mobility. In contrast, cognitive, emotional, and social findings are still drawn largely from pilot work with methodological variability and brief durations.

Across all areas, the field lacks standardised outcome measures, consistent intervention taxonomies, and robust comparisons with conventional care. To move beyond promise, future investigations must employ adequately powered multisite trials and incorporate cost-effectiveness analyses. Stratified sampling and extended follow-up will be essential to evaluate the long-term sustainability, equitable access, and real-world applicability. Only through this level of methodological consolidation can immersive VR become a credible, scalable tool in geriatric care.

If successful, VR may not only support rehabilitation but also help realise a broader vision of ageing – one that is active, participatory, and digitally inclusive. Ultimately, the promise of immersive VR lies not in the technology itself, but in how we choose to shape it around the needs, dignity, and lived experiences of the older adults it is meant to serve.

Promises: engagement, adherence, and well-being

Growing evidence supports the efficacy of immersive VR – particularly HMDs – in promoting PA among older adults [10, 45, 48]. Studies report improvements in balance, mobility, and motivation for sustained engagement [34]. In a study by Syed-Abdul et al. [35], older adults responded positively to VR, citing ease of use, perceived benefits, and enjoyment as key motivators for adoption. Similarly, Campo-Prieto et al. [61] found high user satisfaction, reinforcing the idea that positive affect and intrinsic motivation – the ‘fun factor’ – are critical for adherence.

This success is increasingly driven by interdisciplinary collaboration. Muñoz et al. [47] emphasise the importance of user-centred design and continuous feedback, especially in dementia care, where emotional resonance is pivotal. Drazich et al. [55] further demonstrate that immersive VR interventions are both feasible and acceptable in ageing populations, with strong potential to support moderate-to-vigorous activity and enhance psychological outcomes.

By aligning therapeutic goals with immersive engagement, VR introduces a novel framework for holistic geriatric wellness [16, 50]. Gamifying health behaviours transforms repetitive tasks into meaningful, personalised experiences, fostering both adherence and empowerment [34]. Low dropout rates across studies indicate that well-designed VR interventions can support the long-term preservation of cognitive and physical function [21].

Pitfalls: barriers to widespread adoption

Despite promising results, significant obstacles hinder broad VR integration in geriatric care. These include technological unfamiliarity, high costs, health-related concerns, and broader ethical and regulatory gaps [15, 16].

A critical issue involves the collection and storage of biometric and behavioural data – gaze, physiology, in-app actions. Older users may be especially vulnerable to data misuse or breaches. Ethical deployment demands end-to-end encryption, transparent consent protocols, and data-minimisation practices that prioritise autonomy and control [59].

Interface complexity also deters adoption. Many systems feel unintuitive, with complicated controls, disorienting calibration, or abstract navigation [34, 56]. Solutions include voice-guided menus, streamlined user flows, and age-adapted onboarding. Peer-led training and community tech hubs can further build confidence.

Financial barriers are substantial, particularly for adults on fixed incomes. Potential remedies include subsidies for medically approved devices, insurance reimbursement models, and the development of low-cost standalone systems [62]. Public access points, such as libraries, clinics, and non-governmental organisations, can bridge gaps in underserved areas.

Offline content, ergonomic design, and simple interfaces are also essential for scalability and inclusion. Ultimately, successful implementation depends on participatory design models and institutional support frameworks that promote sustained use and contextual flexibility [63, 64].

Another challenge is cybersickness – dizziness, nausea, or disorientation from sensory mismatch. Although some evidence suggests older adults may be less susceptible [16, 48, 55], user comfort remains paramount. Strategies include shorter sessions, smoother motion, user-controlled pacing, and gradual exposure [14, 65]. Future research should further investigate age-related physiological responses to VR, including baseline assessments and tailored exposure regimens [55].

Finally, there are structural gaps in workforce readiness and regulation. Few training pathways exist for clinicians, and regulators have yet to define clear criteria for certifying immersive VR as a clinical modality.

Overcoming these barriers will require multifaceted action that integrates inclusive design, evidence-based development, and institutional support. Only then can VR evolve from a promising innovation into a scalable, trusted pillar of geriatric care.

Pathways toward equitable integration

Beyond the technical and ethical dimensions, integrating VR into geriatric care demands attention to sociocultural and relational factors. While immersive technologies can foster inclusion by enabling shared virtual experiences, they also risk deepening social disconnection if used as substitutes – rather than complements – to real-world interaction. VR should be framed not as a replacement for embodied relationships, but as a tool that expands participation for individuals facing mobility or geographic constraints [53, 54].

Cross-sector collaboration is essential. Clinicians, developers, policymakers, and older adults themselves must engage in co-design processes that yield systems that are both technologically advanced and socially relevant. Inclusive design practices rooted in user diversity and cultural sensitivity align VR applications with the realities, preferences, and capabilities of ageing populations.

Healthcare integration must honour autonomy, dignity, and person-centred care. Interventions should be tailored to individual goals while respecting cognitive thresholds, emotional readiness, and physical limitations. In this context, VR becomes more than a therapeutic modality – it serves as a platform for meaningful engagement, helping older adults reclaim agency and connection in daily life.

In summary, VR holds significant promise as a catalyst for healthy, empowered ageing – enhancing physical function, cognitive resilience, and emotional well-being. Yet realising this potential hinges on overcoming systemic barriers through inclusive innovation, collaborative design, and sustained ethical reflection. When developed with care and implemented equitably, immersive VR can mature into a cornerstone of agefriendly digital-health ecosystems that fosters not only health but also dignity, participation, and connection across diverse older populations [14, 47].

Role of technology: personalised and predictive interventions

A particularly exciting frontier lies in the convergence of VR and artificial intelligence (AI). AI systems can enable real-time adaptation and predictive analytics, dynamically personalising VR-based rehabilitation. By detecting subtle movement patterns, AI-driven platforms can automatically adjust task intensity, refine feedback, and tailor content continuously [68, 69]. This supports not only responsiveness but also preventive care, reducing injury risk and enhancing intervention efficacy.

Future studies should explore how AI can integrate multimodal physiological and behavioural data, such as heart rate variability, gait metrics, and fatigue indicators, to support precision rehabilitation. Predictive models could help clinicians tailor interventions to individual profiles, anticipating plateaus, regressions, and emerging risks [69].

Complementing this, VR’s integration with the Internet of Things (IoT) is creating intelligent, connected rehabilitation ecosystems. Wearable and embedded sensors, like smart insoles, accelerometers, and heart rate monitors, allow real-time tracking of exertion, posture, and motor control [70]. For example, if biometric signals indicate fatigue or cardiovascular stress, the system can immediately lower task demands or initiate rest intervals, enhancing both safety and autonomy.

Augmented Reality (AR) adds another dimension to this evolving landscape. Unlike VR, which immerses users in fully virtual settings, AR overlays digital cues onto physical environments, enabling hybrid simulations. Older adults can rehearse daily tasks, such as cooking or crossing a street, in familiar yet digitally enhanced settings. These ecologically valid scenarios improve engagement and facilitate the transfer of learning to real-world activities [8, 69]. When embedded within exergames, the combination of AR and VR creates multisensory, emotionally engaging experiences that blend physical effort, cognitive challenge, and social interaction. This multifaceted stimulation may enhance adherence and long-term behavioural change, especially when the interventions are personalised and socially meaningful [69].

Building a supportive ecosystem: from technology to community

Technological progress must be matched by the creation of robust social and structural ecosystems. Community-based initiatives, such as VR clubs, peer mentoring, and intergenerational programs, can foster adoption and reduce the technological apprehension common among older adults.

To succeed, these systems must be developed through transdisciplinary collaboration. Involving gerontologists, engineers, clinicians, and policymakers ensures that accessibility, ethical principles, and inclusivity are embedded from interface design to clinical deployment. Such partnerships promote not only functional usability but also cultural and cognitive relevance, aligning VR tools with the diverse realities of ageing.