Cardiovascular disease has risen sharply and causes more premature deaths than cancer, while it represents a major economic burden for healthcare systems and impacts patients' quality of life negatively. Virtual reality has captured the attention of researchers in the field of cardiac rehabilitation. However, the efficacy of virtual reality among individuals undergoing cardiac rehabilitation remain inconclusive.

To appraise research evidence on the effects of virtual reality for individuals undergoing cardiac rehabilitation.

Systematic review and meta-analysis.

A systematic search of publications was conducted using Pubmed, Embase, Web of science, Cumulative Index to Nursing and Allied Health Literature database (CINAHL), Cochrane Central Register of Controlled trials and Physiotherapy Evidence Database (PEDro) from inception to 15 May 2022, without language restriction. The Cochrane Risk of Bias Tool was used to examine the methodological quality of the included randomized controlled studies. When feasible, a meta-analysis was performed to calculate the pooled effects using Review Manager (Version 5.4). Otherwise, narrative summaries were performed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria was used to assess the certainty of evidence.

A total of Ten studies were included. Virtual reality probably increased exercise capacity for individuals undergoing cardiac rehabilitation with MD 49.55 (95%CI: 30.59 ~ 68.52, P < 0.00001, moderate certainty) and might result in a reduction in emotional tension (MD = − 6.43, 95%CI: − 9.02 ~ − 3.84, P < 0.00001, low certainty) and intrapsychic stress (MD = − 4.25, 95%CI: − 6.83 to − 1.67, P = 0.001, low certainty). It also seemed to have a positive effect on quality of life, although meta-analysis could not be conducted to pool the results. Virtual reality might reduce depression (SMD = − 0.48, 95%CI: − 0.84 ~ − 0.12, P = 0.009, very low certainty) but the evidence was very uncertain, with similar results of anxiety, general level of stress, external stress, total cholesterol, and low-density lipoprotein. The evidence was very uncertain about the effect of virtual reality on high-density lipoprotein (MD = − 1.79, 95%CI: − 8.96 ~ 5.38, P = 0.62, very low certainty), with similar results of triglycerides and BMI.

Individuals undergoing cardiac rehabilitation may benefit from virtual reality since it can improve exercise capacity and psychological outcomes. More large, and well-designed studies with tailored virtual reality intervention are warranted to confirm the effects of virtual reality on individuals undergoing cardiac rehabilitation.

Tweetable abstract.

Virtual reality may benefit individuals undergoing cardiac rehabilitation since in can improve exercise capacity and psychological outcomes.