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The use of head-mounted displays (HMD) for virtual reality (VR) application-based purposes including therapy, rehabilitation, and training is increasing. Despite advancements in VR technologies, many users still experience sickness symptoms. VR sickness may be influenced by technological differences within HMDs such as resolution and refresh rate, however VR content also plays a significant role. The primary objective of this systematic review and meta-analysis was to examine the literature on HMD’s that report Simulator Sickness Questionnaire (SSQ) scores to determine the impact of content. User factors associated with VR sickness were also examined. A systematic search was conducted according to PRISMA guidelines. Fifty-five articles met inclusion criteria, representing 3,016 participants (mean age range 19.5-80; 41% female). Findings show gaming content recorded the highest total SSQ mean 34.26 (95%CI 29.57-38.95). VR sickness profiles were also influenced by visual stimulation, locomotion and exposure times. Older samples (mean age ≥35 years) scored significantly lower total SSQ means than younger samples, however these findings are based on a small evidence base as a limited number of studies included older users. No sex differences were found. Across all types of content, the pooled total SSQ mean was relatively high 28.00 (95%CI 24.66-31.35) compared with recommended SSQ cut-off scores. These findings are of relevance for informing future research and the application of VR in different contexts.

Despite continued improvements in virtual reality (VR) technologies, many people still experience adverse symptoms from using head-mounted displays (HMDs). Typically, these symptoms are monitored through self-report measures, such as the Simulator Sickness Questionnaire (SSQ); however, by only using subjective measures many symptoms may be overlooked. In an application-based study, we investigated visual and cognitive aftereffects of using HMDs and their relationship to the reporting of sickness on the SSQ. Visual (accommodation and vergence) and cognitive (reaction time and rapid visual processing) assessments were employed before and after participants engaged in a 30-minute VR table tennis game (VR group, n = 27) or went about their daily activities (control group, n = 28). The data showed changes in accommodation but no concurrent changes in vergence, which likely stems from decoupling accommodation and vergence in VR. Furthermore, larger changes in accommodation were linked to more severe sickness symptoms suggesting that decoupling accommodation and vergence could be more adverse than previously thought. The VR group also had slower decision (cognitive) times, but movement times were unaffected. These findings go beyond the typical self-reporting of sickness in VR studies. Moreover, we demonstrate that even in a high-quality commercial virtual environment, users may experience visual and cognitive aftereffects that may negatively influence their experience with subsequent activities in the real world. Developing an understanding of how VR aftereffects may influence later activities could help to minimise the risk of using HMDs for various applications and may be valuable to obtain a better understanding of user issues and VR safety.

Background Virtual reality (VR) exergaming has the potential to target sedentary behavior. Immersive environments can distract users from the physical exertion of exercise and can motivate them to continue exergaming. Despite the recent surge in VR popularity, numerous users still experience VR sickness from using head-mounted displays (HMDs). Apart from the commonly assessed self-reported symptoms, depth perception and cognition may also be affected. Considering the potential benefits of VR exergaming, it is crucial to identify the adverse effects limiting its potential and continued uptake. Objective This study aims to investigate the consequences of playing one of the most popular VR exergames for 10 and 50 min on aspects of vision, cognition, and self-reported VR sickness. Methods A total of 36 participants played an exergame, called Beat Saber, using an HMD. A repeated measures within-subject design was conducted to assess changes in vision, cognition, and well-being after short (10 min) and long (50 min) durations of VR exposure. We measured accommodation, convergence, decision speed, movement speed, and self-reported sickness at 3 test periods—before VR, immediately after VR, and 40 min after VR (late). Results Beat Saber was well tolerated, as there were no dropouts due to sickness. For most participants, any immediate aftereffects were short-lived and returned to baseline levels after 40 min of exiting VR. For both short and long exposures, there were changes in accommodation (F1,35=8.424; P=.006) and convergence (F1,35=7.826; P=.008); however, in the late test period, participants returned to baseline levels. Measures on cognition revealed no concern. The total simulator sickness questionnaire (SSQ) scores increased immediately after VR (F1,35=26.515; P<.001) and were significantly higher for long compared with short exposures (t35=2.807; P=.03), but there were no differences in exposure duration in the late test period, with scores returning to baseline levels. Although at a group level, participants’ sickness levels returned to baseline 40 min after VR exposure, approximately 14% of the participants still reported high levels of sickness in the late test period after playing 50 min of Beat Saber. We also showed that the participants who experienced a high level of sickness after a short exposure were almost certain to experience a high level of symptoms after a longer exposure. Conclusions Irrespective of the duration of exposure, this study found no strong evidence for adverse symptoms 40 min after exiting VR; however, some individuals still reported high levels of VR sickness at this stage. We recommend that users commit to a waiting period after exiting VR to ensure that any aftereffects have deteriorated. Exergames in HMDs have the potential to encourage people to exercise but are understudied, and the aftereffects of exergaming need to be closely monitored to ensure that VR exergames can reach their full potential.

ObjectiveThe present study investigates skill transfer from Virtual Reality (VR) sports training to the real world, using the fast-paced sport of table tennis.BackgroundA key assumption of VR training is that the learned skills and experiences transfer to the real world. Yet, in certain application areas, such as VR sports training, the research testing this assumption is sparse.DesignReal-world table tennis performance was assessed using a mixed-model analysis of variance. The analysis comprised a between-subjects (VR training group vs control group) and a within-subjects (pre- and post-training) factor.MethodFifty-seven participants (23 females) were either assigned to a VR training group (n = 29) or no-training control group (n = 28). During VR training, participants were immersed in competitive table tennis matches against an artificial intelligence opponent. An expert table tennis coach evaluated participants on real-world table tennis playing before and after the training phase. Blinded regarding participant's group assignment, the expert assessed participants’ backhand, forehand and serving on quantitative aspects (e.g. count of rallies without errors) and quality of skill aspects (e.g. technique and consistency).ResultsVR training significantly improved participants’ real-world table tennis performance compared to a no-training control group in both quantitative (p < .001, Cohen’s d = 1.08) and quality of skill assessments (p < .001, Cohen’s d = 1.10).ConclusionsThis study adds to a sparse yet expanding literature, demonstrating real-world skill transfer from Virtual Reality in an athletic task.