To improve symptoms and reduce poor outcomes related to heart failure (HF), international guidelines recommend cardiac rehabilitation (CR), particularly for those with a reduced ejection fraction. Unfortunately, patient adherence to rehabilitation programs remains suboptimal, with dropouts ranging from 15.4 to 63.3%. An innovative and promising intervention that could improve adherence to rehabilitation is virtual reality (VR). This study aims to evaluate the effects of VR in patients with HF who undergo CR using this technology in terms of adherence (primary outcome), functional capacity, perceived exertion, angina, quality of life, heart rate, oxygen saturation, blood pressure, maximum oxygen uptake, minute ventilation/carbon dioxide production slope, oxygen pulse, blood values of NT-proBNP and HF related rehospitalization rates (secondary outcomes). A randomized controlled trial will be conducted in a sample of 80 patients referred to CR. Participants will be enrolled in a cardiological rehabilitation unit of a large university hospital in Italy and randomized (1:1) to the experimental intervention consisting of CR performed with high-quality immersive VR with PICO 4® Head Mounted Display headset and TREADMILL XR® software (Arm 1) or standard CR (Arm 2). Patients, according to guidelines, will perform 30-min of CR sessions with moderate intensity, twice a week for one month. Significant improvements in primary and secondary outcomes are expected in patients in the intervention group. If proven to be effective, VR could be an innovative, safe, and easy digital health intervention to improve adherence to CR in patients with HF, as well as important clinical outcomes.

Cardiac procedures often induce pain and anxiety in patients, adversely impacting recovery. Pharmachological approaches have limitations, prompting exploration of innovative digital solutions like virtual reality (VR). Although early evidence suggests a potential favourable benefit with VR, it remains unclear whether the implementation of this technology can improve pain and anxiety. We aimed to assess by a systematic review and meta-analysis the effectiveness of VR in alleviating anxiety and pain on patients undergoing cardiac procedures. Our study adhered to the PRISMA method and was registered in PROSPERO under the code CRD42024504563. The search was carried out in the PubMed, Web of Science, Scopus, and the Cochrane Library databases in January 2024. Four randomized controlled trials were included (a total of 382 patients). Risk of bias was employed to assess the quality of individual studies, and a random-effects model was utilized to examine the overall effect. The results showed that VR, when compared to the standard of care, had a statistically significant impact on anxiety (SMD = -0.51, 95 % CI: -0.86 to -0.16, p = 0.004), with a heterogeneity I2 = 57 %. VR did not show a significant difference in terms of pain when compared to standard care (SMD= -0.34, 95 % CI: -0.75 to -0.07, p = 0.10). The included trials exhibited small sample sizes, substantial heterogeneity, and variations in VR technology types, lengths, and frequencies. VR effectively lowers anxiety levels in patients undergoing cardiac procedures, however, did not show a statistically significant difference on pain.

Virtual reality offers a multisensory experience to patients, allowing them to hear, watch, and interact in a virtual environment. Immersive virtual reality is particularly suitable for the purpose of completely isolating patients from the external environment to transport them away from the suffering related to the disease. On this state of the art, we summarize the available literature on the effectiveness of virtual reality on various physical and psychological outcomes in patients with atherosclerotic cardiovascular disease. Virtual reality has been employed in the cardiovascular field in various settings such as cardiac rehabilitation, interventional cardiology, and cardiac surgery. This technology offers promising opportunities to improve several outcomes related to cardiovascular disease, but further research is needed to entirely capture its benefits and to standardize the intervention.

A primary challenge impeding optimal health outcomes in patients with disabilities is the lack of rehabilitation adherence. Immersive virtual reality emerges as a promising intervention with the potential to significantly enhance this key health outcome. This paper presents a situation-specific theory that outlines the mechanisms through which immersive virtual reality can promote rehabilitation adherence. Outcomes of immersive virtual reality encompass psychological (ie, motivation, self-efficacy, mood state) as well as physical responses (ie, pain management, muscle strength). Mechanisms by which immersive virtual reality influences outcomes are explained by proximal and distal mediators (attention, sense of presence, enjoyment). Possible moderators of these mechanisms (ie, age, gender, social support, trust in technology, cognitive status) are also described.

Background: To alleviate symptoms and reduce adverse outcomes associated with heart failure, international guidelines strongly recommend cardiac rehabilitation. However, patient adherence to rehabilitation programs remains suboptimal, leading to unfavorable effects on key cardiac outcomes. Immersive virtual reality (iVR) is a promising intervention to improve adherence to cardiac rehabilitation and enhance clinical outcomes. This study aims to explore patients’ experiences with iVR during cardiac rehabilitation.Methods: A qualitative descriptive study was embedded within a randomized controlled two-arm trial involving twenty-two patients who were referred to undergo eight cardiac rehabilitation sessions, held twice a week for 30 min each. The intervention group experienced iVR in natural settings, while the control group received standard care. Semi-structured individual interviews were conducted in person after the intervention group’s eighth rehabilitation session. These interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis.Results: Data from twenty-two interviews reached saturation. Content analysis generated four main categories and nine subcategories: (1) cognitive and emotional benefits of iVR (acceptability and enrichment of the rehabilitation experience, positive emotions, cognitive engagement); (2) impact on rehabilitation (physical engagement, perceived effort); (3) customizable intervention (variety of scenarios, quality and beauty of the videos); (4) negative aspects of the iVR (discomfort with the equipment, negative feelings toward the iVR devices).Conclusion: IVR is an innovative and customizable intervention that enhances the rehabilitation experience by providing cognitive, emotional, and physical benefits. It improves key aspects of rehabilitation, including time perception, motivation, enjoyment, effort perception, and anxiety management, highlighting its potential in cardiac rehabilitation. However, certain technological challenges, such as discomfort with the equipment, must be addressed to optimize the user experience.

Cardiac telerehabilitation (tele-CR) uses home-based or hybrid delivery to provide multidisciplinary cardiac rehabilitation reducing travel and time barriers. However, tele-CR outcomes may be influenced by engagement, therapeutic relationships, and contextual and implementation constraints. This narrative review synthesizes evidence on psychological, social, and implementation factors that optimize tele-CR uptake, adherence, and effectiveness. We conducted a targeted literature search in PubMed, Scopus, PsycINFO, and Embase (January 2021-January 2026). We included randomized and observational studies, qualitative and mixed-methods research, and systematic reviews/meta-analyses involving adults with cardiovascular disease participating in home-based, hybrid, or fully remote tele-CR. Reporting followed the Scale for the Assessment of Narrative Review Articles (SANRA). Tele-CR is a sociotechnical, biopsychosocial intervention in which outcomes emerge from the integration of digital tools (monitoring, feedback, interfaces), clinical workflows, and patients' everyday contexts. Self-monitoring and structured feedback can strengthen self-efficacy and habit formation when data are interpretable and linked to actionable guidance. Remote delivery can reduce non-verbal cues, but continuity may improve through routine check-ins and responsive follow-up. An equity-by-design approach tailors delivery to connectivity, privacy, health literacy, language needs, and caregiver capacity. Across studies, feasibility and acceptability were associated with usability, support, and perceived value. Tele-CR can broaden access to cardiac rehabilitation, but scalable benefit requires relationship-centred, equity-oriented service design. Priorities include calibrating monitoring to clinical actionability, reducing cognitive load through plain-language interfaces and structured onboarding, integrating routine mental health screening and patient-reported outcomes, supporting caregivers as end-users, and embedding implementation metrics and continuous quality improvement alongside clinical outcomes.