Reducing Anxiety During Virtual Reality Kayaking in Youth With Intellectual Disabilities.

Background and Rationale:

Virtual reality (VR) exergames offer innovative opportunities for physical activity and engagement among youth with intellectual disabilities. However, novel technological environments can induce high levels of state anxiety in this population. Contextual preparation, bridging the real world with the virtual environment through physical and sensory warm-ups may serve as an effective stress buffer.

Objective:

The primary objective of this randomized controlled trial is to investigate the efficacy of graded physical and sensory preparation on reducing state anxiety during VR kayaking among youth with mild to moderate intellectual disabilities.

Study Design:

This is a three-arm, randomized controlled trial conducted during a summer sports camp. Participants will be randomly allocated to one of three experimental conditions prior to a standardized VR kayaking exergame session:

Control Group (Minimal Context - Group A): Participants will perform a standard physical warm-up, followed by the VR kayaking exergame while seated on a standard cushion without specialized real-world contextual equipment.

Sensory Context Group (Group B): Participants will perform a specialized physical warm-up using a kayak paddle, followed by the VR kayaking exergame while seated on a cushion and wearing a life jacket to enhance sensory feedback.

Full Simulation Context Group (Group C): Participants will perform a specialized warm-up using a kayak paddle, followed by the VR kayaking exergame while seated directly inside a physical, stationary kayak and wearing a life jacket, achieving full real-world contextual alignment.

Intervention Procedure:

All participants will experience the same standardized VR kayaking simulation using Meta Quest 2 headsets. The duration of the immersion will be identical across all three groups.

Measures and Outcomes:

Primary outcome measure: state anxiety will be assessed immediately before (pre-test) and immediately after (post-test) the VR intervention using the 3-point State-Trait Anxiety Inventory for Children (STAIC), adapted for individuals with intellectual disabilities.

Secondary parameters: demographic characteristics, level of intellectual disability, and previous experience with VR technology will be controlled during randomization.

Hypothesis:

It is hypothesized that participants in the groups receiving higher levels of real-world contextual preparation (Groups B and C) will exhibit a significantly greater reduction in state anxiety compared to the minimal context control group (Group A), demonstrating that sensorimotor familiarization acts as a crucial buffer against novelty-induced stress in virtual environments.

Inclusion criteria

• Mild to moderate intellectual disability.
• Age within the specified range (adolescents / youth).
• Participants of a summer sports camp.
• Ability to understand instructions and participate in the VR kayaking session.
• Signed informed consent from parents or legal guardians, and assent from the participant.
• No virtual reality (VR) experience before the study.
• No psychotropic medicines.
• Lack of long-term injuries and fresh injuries.

Exclusion criteria

• Severe intellectual disability preventing completion of the evaluation tasks.
• History of severe motion sickness, epilepsy, or uncorrected visual impairments incompatible with virtual reality headset use.
• Medical or physical conditions that contraindicate participation in physical warm-ups or exergaming.