Cardiovascular responses and cybersickness induced by virtual reality in undergraduate medical students.
Resumo
Introduction: Virtual reality (VR) is an emerging technological and educational resource that is increasingly being used in medical education for the development of technical skills through an immersive environment. VR has shown clinical benefits in reducing perioperative anxiety in patients and also allowing educational experiences to pregrade students on different topics like anatomy and basic life support training. Even though VR has benefits, adverse effects such as cybersickness have been reported, with limited evidence regarding the exposure time for onset and its physiological impact. Measuring and analyzing these parameters is important to establish safe exposure times for VR simulations. Objective: Evaluate changes in heart rate, blood pressure, and cybersickness symptoms after a 15-minute exposure to a VR environment (Anatomy and Physiology Lab on META Quest 2) in pre-graduate medical students, by comparing physiological parameters and applying the Simulator Sickness Questionnaire (SSQ) before and after immersion. Methods: Observational, descriptive, cross-sectional study in which vital signs (heart rate, respiratory rate, and blood pressure) were recorded before and after exposure to a VR environment. The qualitative data were analyzed using frequencies and percentages, and the quantitative data with medians and ranges. Chi-square and Student’s t tests were applied to assess differences between time points. Results: No significant changes were found in heart rate (p = 0.1754). Respiratory rate increased after exposure (p = 0.0017), as did systolic blood pressure (p = 0.0329), while diastolic pressure remained unchanged (p = 0.7025). Regarding cybersickness, symptoms occurred in 20% of participants, with no association to VR experience (p > 0.05). Conclusions: VR exposure may increase respiratory rate and systolic blood pressure without affecting heart rate. Further research is needed to determine optimal immersion duration and predisposing factors that may contribute to adverse effects in order to ensure a safe and effective immersive experience in medical education.
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Referências
1. Chheang V, Fischer V, Buggenhagen H, Huber T, Huettl F, Kneist W, et al. Toward interprofessional team training for surgeons and anesthesiologists using virtual reality. Int J Comput Assist Radiol Surg. 2020, 15 (12), 2109–18. https://doi.org/10.1007/s11548-020-02276-y
2. Vogt L, Klasen M, Rossaint R, Goeretz U, Ebus P, Sopka S. Virtual Reality Tour to Reduce Perioperative Anxiety in an Operating Setting Before Anesthesia: Randomized Clinical Trial. J Med Internet Res. 2021, 23(9), e28018. https://doi.org/10.2196/28018
3. Stanney KM, Lawson BD, Oman CM, editores. Cybersickness in Virtual Reality Versus Augmented Reality. Frontiers Media SA, 2021, [citado el 23 de julio de 2025]. Disponible en: https://www.frontiersin.org/research-topics/12692/cybersickness-in-virtual-reality-versus-augmented-reality. https://doi.org/10.3389/frvir.2021.759682
4. Biswas N, Mukherjee A, Bhattacharya S. “Are you feeling sick?” – A systematic literature review of cybersickness in virtual reality. ACM Comput Surv. 2024, 56 (11), 1–38. https://doi.org/10.1145/3670008
5. Cipresso P, Giglioli IAC, Raya MA, Riva G. The Past, Present and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of Literature. Front Psychol. 2028, 9, 2086. https://doi.org/10.3389/fpsyg.2018.02086
6. Ntakakis G, Plomariti C, Frantzidis C, Antoniou PE, Bamidis PD, Tsoulfas G. Exploring the use of virtual reality in surgical education. World J Transplant. 2023, 13 (2), 36–43. https://doi.org/10.5500/wjt.v13.i2.36
7. Huang Q, Yan SY, Huang J, Guo Y, Zeng XT, Jin YH. Effectiveness of simulation-based clinical research curriculum for undergraduate medical students - a pre-post intervention study with external control. BMC Med Educ. 2024, 24 (1), 542. https://doi.org/10.1186/s12909-024-05455-6
8. Ang S, Quarles J. Reduction of cybersickness in head-mounted display use: A systematic review and taxonomy of current strategies. Front Virtual Real 2023 [citado el 24 de julio de 2025]; Disponible en: https://www.frontiersin.org/articles/10.3389/frvir.2023.1027552/full https://doi.org/10.3389/frvir.2023.1027552
9. Page D, Lindeman RW, Lukosch S. Identifying Strategies to Mitigate Cybersickness in Virtual Reality Induced by Flying with an Interactive Travel Interface. Multimodal Technol Interact. 2023, 7 (5): 47. https://doi.org/10.3390/mti7050047
10. Martin JL, Saredakis D, Hutchinson AD, Crawford GB, Loetscher T. Virtual Reality in Palliative Care: A Systematic Review. Healthcare. 2022, 10 (7), 1222. https://doi.org/10.3390/healthcare10071222
11. Brekke IJ, Puntervoll LH, Pedersen PB, Kellett J, Brabrand M. The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. Patman S, editor. PLoS One. 2019, 14 (1), e0210875. https://doi.org/10.1371/journal.pone.0210875
12. Navarro Acebes X. Fisiología del sistema nervioso autónomo. Rev Neurol. 2002, 35(06):553-62.
13. Kim YS, Won J, Jang SW, Ko J. Effects of Cybersickness Caused by Head-Mounted Display–Based Virtual Reality on Physiological Responses: Cross-sectional Study. JMIR Serious Games. 2022, 10 (4), e37938. https://doi.org/10.2196/37938
14. Simón-Vicente L, Rodríguez-Cano S, Delgado-Benito V, Ausín-Villaverde V, Cubo Delgado E. Cybersickness. A systematic literature review of adverse effects related to virtual reality. Neurología. 2024 39 (8), 701–9. https://doi.org/10.1016/j.nrleng.2022.04.007
15. Campo-Prieto P, Rodríguez-Fuentes G, Cancela Carral JM. Traducción y adaptación transcultural al español del Simulator Sickness Questionnaire (Translation and cross-cultural adaptation to Spanish of the Simulator Sickness Questionnaire). Retos. 2021, 43, 503–9. https://doi.org/10.47197/retos.v43i0.87605
16. Kennedy RS, Lane NE, Berbaum KS, Lilienthal MG. Simulator Sickness Questionnaire: An enhanced method for quantifying simulator sickness. Int J Aviat Psychol. 1993, 3 (3), 203-20. https://doi.org/10.1207/s15327108ijap0303_3
17. Pawełczyk W, Olejarz D, Gaweł Z, Merta M, Nowakowska A, Nowak M, et al. Understanding cybersickness and presence in seated VR: a foundation for exploring therapeutic applications of immersive virtual environments. J Clin Med. 2025, 14, 2718. https://doi.org/10.3390/jcm14082718
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