Virtual Reality-Supported Cardiac Rehabilitation: Psychological, Functional, and Physiological Perspectives

TSK consists of 17 items designed to assess fear of movement and re-injury (kinesiophobia) in individuals experiencing pain or undergoing rehabilitation. Each item presents a statement regarding beliefs about movement and pain, with respondents indicating their level of agreement on a scale from 1 ("strongly disagree") to 4 ("strongly agree"). Total scores range from 17 to 68, with higher scores indicating greater levels of kinesiophobia. A score above 37 typically suggests a high degree of fear related to movement. Although the TSK primarily measures fear of movement, it can also indirectly reflect barriers to engagement in physical therapy.

SF-36 is a widely used 36-item questionnaire designed to assess health-related quality of life across various populations, including patients with chronic conditions. It evaluates eight domains: physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional health, and mental health. Each domain is scored on a scale from 0 to 100, with higher scores indicating better health status and quality of life.

A nine-item instrument specifically designed for screening and assessing the severity of depression in primary care settings. Each item corresponds to a diagnostic criterion for major depressive disorder and asks respondents to reflect on their experiences over the past two weeks. Responses are scored on a scale from 0 ("not at all") to 3 ("nearly every day"), with total scores ranging from 0 to 27. Higher scores indicate more severe depressive symptoms, with scores of 5 or higher typically suggesting mild depression, and scores above 15 indicating moderate to severe depression.

The exercise conditions will be induced through a RAMP exercise test conducted on a treadmill, starting at a speed of 2.0 km/h with a 0% grade. Every 10 seconds, the speed and grade will increase incrementally by 0.1 to 0.15 km/h and 0.1% to 0.2%, respectively. To assess exercise capacity and endurance, metabolic equivalents (METs) will be calculated by determining the ratio of the metabolic work rate during exercise to the resting metabolic rate.

Autonomic nervous system activity will be assessed using heart rate variability (HRV), a measure that can serve as an indicator of psychological responses to stress. HRV will be recorded using the Polar H10 chest strap during a 5-minute measurement in a seated position. This method provides a reliable assessment of autonomic regulation, reflecting the balance between sympathetic and parasympathetic nervous system activity.

A tool for evaluating the level of perceived stress experienced by patients. This questionnaire consists of 10 items assessing various subjective feelings related to personal issues, life events, behaviors, and coping strategies over the past month. Respondents rate how often they have felt stressed or overwhelmed on a 5-point Likert scale, ranging from 0 ("never") to 4 ("very often"). Higher scores indicate greater levels of perceived stress, making it a valuable measure for understanding the impact of stress on patients' overall well-being.

Functional capacity will be assessed using the 6-Minute Walk Test (6MWT), which measures the distance a patient can walk in six minutes. This test provides valuable insights into exercise tolerance and overall physical ability. It is particularly effective for monitoring treatment efficacy, as improvements in walking distance often correlate with symptom relief and enhanced quality of life. The 6MWT is a submaximal exercise test that reflects the patient's functional capacity during daily activities, making it a practical and reliable measure, especially for individuals with moderate to severe cardiac or pulmonary conditions.

Physical activity levels will be assessed using a pedometer by recording step count with Yamax SW800-SW801 Digi-Walker Pedometer. The pedometer will be assigned to patients upon their qualification for the study, with instructions to use it throughout their entire stay.