Immersive Virtual Reality Applied to Therapeutic Physical Exercise in Cellular Therapy

The time (in seconds) required to stand up from a chair, walk 3 meters, turn around, walk back, and sit down. Lower values indicate better functional mobility.

The time (in seconds) required for a participant to rise from a standard chair and sit down five consecutive times as quickly as possible without using the upper limbs for assistance. Lower values indicate better lower-extremity muscle strength and functional performance.

andgrip strength is assessed using a handheld dynamometer. Participants perform a maximal voluntary isometric grip contraction according to standardized testing procedures. The highest value recorded is expressed in kilograms (kg). Higher values indicate greater muscle strength.

Participants march in place for 2 minutes, raising each knee to a predetermined height midway between the patella and iliac crest. The outcome is the total number of times the right knee reaches the target height during the test, expressed as the number of steps. Higher values indicate better aerobic endurance and functional capacity.

The total number of scheduled exercise sessions completed by each participant during hospitalization. Higher values indicate greater adherence to the exercise intervention.

The total number of exercise sessions considered feasible according to the participant's clinical condition during hospitalization, recorded as the number of sessions.

The total number of clinically feasible exercise sessions that were completed by the participant during hospitalization, recorded as the number of sessions.

The percentage of clinically feasible exercise sessions that were completed during hospitalization, calculated as: (completed feasible sessions / clinically feasible sessions) × 100. Higher values indicate greater compliance with the sessions considered feasible.

Duration of each completed exercise session, measured in minutes. Higher values indicate longer exercise exposure per session.

Adherence to the exercise intervention, calculated as the percentage of completed exercise sessions relative to the number of scheduled exercise sessions: (completed sessions / scheduled sessions) × 100. Higher values indicate greater adherence to the intervention.

Participant sex recorded at baseline and categorized as male or female.

Age of the participant at study enrollment, measured in years.

Type of hematological treatment received, categorized as autologous hematopoietic stem cell transplantation, allogeneic hematopoietic stem cell transplantation, or chimeric antigen receptor T-cell (CAR-T) therapy.

Primary hematological diagnosis recorded at baseline and classified according to diagnostic category.

Body mass index calculated as weight in kilograms divided by height in meters squared (kg/m²). Higher values indicate greater body mass relative to height.

Anxiety symptoms assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). Scores range from 0 to 21, with higher scores indicating greater anxiety symptoms.

Depressive symptoms assessed using the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D). Scores range from 0 to 21, with higher scores indicating greater depressive symptoms.

Health-related quality of life assessed using the EORTC QLQ-C30 questionnaire. Scores are transformed to a 0-100 scale according to EORTC scoring procedures. Higher scores on the global health status and functional scales indicate better quality of life, whereas higher scores on symptom scales indicate greater symptom burden.

Quality of life related to bone marrow transplantation assessed using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) questionnaire. Higher scores indicate better quality of life and well-being.

Pain intensity assessed using the Visual Analog Scale (VAS). Participants rate their perceived pain on a scale from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain.

Type of analgesic treatment prescribed according to the analgesic ladder classification: Level I (non-opioid analgesics), Level II (weak opioids), Level III (strong opioids), and Level IV (advanced analgesic interventions).

Simulator sickness symptoms assessed using the Simulator Sickness Questionnaire (SSQ). The total score ranges from 0 to 48, with higher scores indicating greater severity of simulator sickness symptoms.

User experience during the game-based intervention assessed using the Game Experience Questionnaire (GEQ). The questionnaire evaluates four dimensions: Positive Experiences (mean score of items 1, 5, 7, 8, 12, and 16), Negative Experiences (mean score of items 2, 4, 6, 11, 14, and 15), Fatigue (mean score of items 10 and 13), and Return to Reality (mean score of items 3, 9, and 17). Each subscale is scored from 0 to 4, with higher scores indicating greater intensity of the corresponding experience.

Participant satisfaction with the immersive virtual reality (IVR) intervention assessed using an ad hoc satisfaction questionnaire. The questionnaire evaluates overall experience, perceived positive and negative aspects, willingness to repeat the intervention, recommendation of the intervention to others, and perceived usefulness of the intervention. Responses include qualitative feedback and categorical responses (yes/no). Higher satisfaction is indicated by positive responses regarding the experience, willingness to repeat, recommendation, and perceived usefulness.

Characteristics of adverse events occurring during the intervention, including type of event (exercise-related, immersive virtual reality [IVR]-related, or other), severity (mild, moderate, or severe), and causal relationship with the intervention (not related, possibly related, or probably related).

Perceived exertion during exercise sessions assessed using the Modified Borg Rating of Perceived Exertion Scale. Scores range from 1 to 10, with higher scores indicating greater perceived effort during exercise.

Adherence to the prescribed exercise program during the 3-month follow-up period. Adherence is calculated based on frequency adherence (FA = completed exercise sessions / prescribed exercise sessions × 100), duration adherence (DA = completed average session duration / prescribed session duration × 100), and global adherence (GA = [FA + DA] / 2). Adherence is categorized as low (<50%), moderate (51-79%), or high (≥80%).

Proportion of participants who discontinued the exercise program during the 3-month follow-up period. Dropout rate is calculated as: (number of initiated but not completed sessions / total prescribed sessions) × 100.