Background and Objectives: Multiple sclerosis (MS) is characterized by progressive disability and a spectrum of motor and cognitive impairments. Exergames and virtual reality (VR) are proposed as motivating exercise tools, potentially useful for improving adherence and expanding access to rehabilitation. The objectives are to explore the feasibility and safety of a supervised rehabilitation program based on a high-intensity exercise program with immersive virtual reality (IVR) in people with MS and to describe its effects on physical, cognitive, and functional domains, as well as on the serum biomarker neurofilament light chain (sNfL). Materials and Methods: Pre–post exploratory study in five volunteers from a local MS Association Vigo, Spain. Intervention: 8 weeks, two sessions/week, 10 min/session of an IVR boxing-based exergame combined with usual rehabilitation, supervised by a physiotherapist. The variables studied were safety (Simulator Sickness Questionnaire SSQ), usability (System Usability Scale SUS), disability (Expanded Disability Status Scale EDSS), gait (25-Foot Walk Test 25FWT), manual dexterity (9 Hole Peg Test 9HPT), cognition (Symbol Digit Modalities Test SDMT), and axonal damage biomarker (sNfL). Results: The intervention could be feasible and safe (100% adherence, no adverse events (without SSQ symptoms), 95% usability SUS). There were positive changes in all variables studied (mean ± SD): EDSS −0.5 ± 0.9; 25FWT −4.9 ± 9.8 s; right 9HPT −3.3 ± 0.9 s; sNfL −4.4 ± 4.5 pg/mL, except for left 9HPT +0.5 ± 5.0 s and cognition (SDMT −2.4 ± 1.3 points). Conclusions: A brief, supervised exercise program combing an IVR exergame with standard rehabilitation was feasible and safe in people with MS. Although the results seem promising with the proposed design, the clinical and biological changes are merely exploratory, and it is not possible to infer their efficacy. Our findings open the door to future controlled studies including perceived high-intensity exercise programs and larger sample sizes to explore efficacy and estimate clinically relevant effect sizes.
Campo-Prieto et al. (Fri,) studied this question.