Incongruent virtual reality attenuates breathlessness and leg fatigue during stationary cycling

Abstract Previously we showed that discordant stimulation in virtual reality (VR) could manipulate feelings of breathlessness during stationary cycling. We were interested in developing this as a tool to help respiratory and cardiac patients better engage with exercise rehabilitation. Therefore, in a cohort of healthy volunteers we tested whether the paradigm could attenuate (rather than simply manipulate) feelings of breathlessness and leg fatigue. We explored factors associated with interindividual differences in response. We subsequently investigated clinical acceptability in cardiac and respiratory patients through extensive engagement with relevant stakeholders and a feasibility study. Healthy participants study: 48 healthy people took part in a double-blind, randomised controlled study with two sessions. Participants cycled with a VR headset to compare discordant VR, where visual slope was always less than pedal resistance, against a concordant control. Physical and mental wellbeing were also assessed via questionnaires. Patient and Public Involvement (PPI): The paradigm was demonstrated to 66 patients and caregivers from relevant clinical communities, who then gave feedback in focus groups, panels or one-to-one structured interviews. Patient Study: 9 patients took part in a single session, observational study with a scaled-down version of the cycling paradigm to assess tolerance and acceptability. Healthy participants study: Discordant VR was associated with reduced breathlessness and leg fatigue (breathlessness: effect size estimate = 0.39, SE = 0.04, p