Is your virtual self as sensational as your real? Virtual Reality: The effect of body consciousness on the experience of exercise sensations

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Highlights

  • VR can be an effective tool to ameliorate pain during exercise.

  • VR can moderate perception of effort during exercise.

  • These effects are apparent regardless of level of Private Body Consciousness.

Abstract

Objectives

Past research has shown that Virtual Reality (VR) is an effective method for reducing the perception of pain and effort associated with exercise. As pain and effort are subjective feelings, they are influenced by a variety of psychological factors, including one's awareness of internal body sensations, known as Private Body Consciousness (PBC). The goal of the present study was to investigate whether the effectiveness of VR in reducing the feeling of exercise pain and effort is moderated by PBC.

Design and methods

Eighty participants were recruited to this study and were randomly assigned to a VR or a non-VR control group. All participants were required to maintain a 20% 1RM isometric bicep curl, whilst reporting ratings of pain intensity and perception of effort. Participants in the VR group completed the isometric bicep curl task whilst wearing a VR device which simulated an exercising environment. Participants in the non-VR group completed a conventional isometric bicep curl exercise without VR. Participants' heart rate was continuously monitored along with time to exhaustion. A questionnaire was used to assess PBC.

Results

Participants in the VR group reported significantly lower pain and effort and exhibited longer time to exhaustion compared to the non-VR group. Notably, PBC had no effect on these measures and did not interact with the VR manipulation.

Conclusions

Results verified that VR during exercise could reduce negative sensations associated with exercise regardless of the levels of PBC.

Introduction

Experiencing pain causes discomfort to the individual as a result of actual or believed tissue injury (Merskey & Bogduk, 1994). As such, pain is both nociceptive and subjective, with the same sensory signal giving rise to different experiences of pain intensity across individuals and situations. Research has shown that psychological factors, such as expectations based on visual information, play a vital role in pain experience (Bayer, Coverdale, Chiang, & Bangs, 1998; Ohrbach, Crow, & Kamer, 1998; Zatzick & Dimsdale, 1990). Moreover, although not all pain represents a danger to the body, the experience of pain may lead to undesirable behavior change. For example, the naturally occurring pain caused by vigorous exercise does not pose physical harm but it may still cause people to steer clear from exercise in order to avoid the painful experience (Mauger, 2014).

Recent research has shown that beyond expectations created on the basis of visual information, the level of pain one experiences depends on other factors such as Private Body Consciousness (PBC), i.e., how well one is aware of internal bodily sensations (Bekker, Croon, van Balkom, & Vermee, 2008; Haugstad et al., 2006; Miller, Murphy, & Buss, 1981). Indeed, studies with both clinical patients and healthy participants have shown that individuals scoring higher on a PBC measure reported greater frequency and intensity of pain symptoms compared to those with lower scores of PBC (Ahles, Pecora, & Riley, 1987; Ferguson & Ahles, 1998; Martin, Ahles, & Jeffery, 1991; Mehling et al., 2009; Pincus, Burton, Vogel, & Field, 2002). These findings suggest that effectiveness of interventions aimed at reducing pain sensations may depend on an individual's PBC level. In the present study we investigate this hypothesis, for an intervention that relies on Virtual Reality (VR) technology.

VR allows users to experience a computer-simulated reality based on visual cues, enhanced with auditory, tactile and olfactory interactions (Li, Montaño, Chen, & Gold, 2011). In recent years, low-cost consumer VR gear has become widely available (e.g., Google Cardboard, Gear VR, Oculus Rift, HTC Vive1), providing a wide range of opportunities for applications, including interventions for reducing exercise-related pain and effort.

Indeed, research shows that VR technology may provide an alternative solution to pain management that does not rely on the use of pharmacological analgesics (Mahrer & Gold, 2009; Malloy & Milling, 2010; Matsangidou, Ang, & Sakel, 2017; Morris, Louw, & Grimmer-Somers, 2009). Although VR has been shown to be effective in reducing the feelings of pain and effort (Matsangidou, Ang, Mauger, Otkhmezuri, & Tabbaa, 2017), the mechanisms by which it does so, remain largely unknown. One possibility is that VR reduces the amount of attention that is allocated to the sensory signal of pain. Our attentional resources are limited and to cope with the vast array of information that gets registered by our senses at any given point in time, we must select only the information that is relevant to our goal and ignore the rest (e.g., Wickens, 2008.) VR provides the senses of the user with a multitude of information while at the same time prevents access to his/her body. This allows the user to be immersed in the virtual environment and disconnect from the actual surroundings (e.g., Eichenberg & Wolters, 2012). As a result, attentional resources may be diverted away from the pain signal, reducing thus the experience of pain (Gold, Belmont, & Thomas, 2007; McCaul & Malott, 1984).

If indeed VR helps to distract users away from the pain signal, then its effectiveness for reducing the feelings of pain would depend on how well the user can inhibit information about his/her body and how well s/he can immerse in the virtual environment. Given that people with higher PBC are believed to be better attuned to their internal physiology and are more affected by nociceptive stimuli (Fenigstein, Scheier, & Buss, 1975; Miller et al., 1981), it may be that VR is less effective in reducing their pain and effort perception compared to those with low PBC. This hypothesis has not yet been tested as, to our knowledge, no study so far has investigated whether PBC can moderate the positive effect of VR on exercise-related pain perception. Therefore, the goal of the current study is (1) to verify that VR can be effective in reducing the feeling of exercise-induced pain, and (2) to examine whether its effect depends on PBC. If PBC influences the levels of presence/immersion in the virtual environment and as a result the attention allocated to pain signal, participants with low PBC scores are expected to report less pain and effort compared to participants with high PBC scores. Alternatively, if PBC does not moderate the effect of VR, based on past VR studies enhanced with several psychological intervention strategies (Mahrer & Gold, 2009; Malloy & Milling, 2010; Morris et al., 2009), we still expect the VR group to report lower pain and effort than the non-VR control group.

Section snippets

Participants

Twenty-one males and 59 females, with a mean age of 23 years (SD = 5) participated in the study. Participants' one-repetition maximum (1RM2), for 180° of dominant arm elbow flexion ranged from 5 to 30 kg, with a mean at 11.9 kg (SD = 6.2). More than half of the participants reported not engaging in regular (3–7 days per week), structured resistance or aerobic exercise (no regular resistance training = 52/80, no regular aerobic training = 51/80 during the

Results

To evaluate the main hypothesis of the study, i.e., that the influence of VR on time to exhaustion (TTE), pain (PIR1 and PIR2, and mPIR) and effort (RPE1, RPE2, mRPE) perception depends on PBC, we conducted a series of one-way ANCOVAs. Additional one-way ANCOVAs were also conducted on ISO HR (HR1 and HR2), mean (mHR) and on end of exercise (fHR) variables, with VR condition as the independent variable and the PBC as a covariate. We present these analyses for each measure of interest.

Discussion

The aim of the present study was to examine whether VR technology reduces the perception of pain and effort during exercise and whether PBC moderates this effect. Findings revealed that VR was effective in reducing exercise-induced pain for this sample of 18–45-year old adults of both genders. Indeed, results showed a substantial decrease in participant PIR and RPE during exercise in VR compared to the control condition of exercise without VR. Notably, this was apparent from the first minute of

References (46)

  • C.E. Rutter et al.

    Sustained efficacy of virtual reality Distraction

    The Journal of Pain: Official Journal of the American Pain Society

    (2009)
  • T.A. Ahles et al.

    Self-focused attention, symptoms, and chronic pain: A hypothesis

    Southern Psychologist

    (1987)
  • V. Ainley et al.

    Body conscious? Interoceptive awareness, measured by heartbeat perception, is negatively correlated with self-objectification

    PLoS One

    (2013)
  • A.H. Astokorki et al.

    Tolerance of exercise-induced pain at a fixed rating of perceived exertion predicts time trial cycling performance

    Scandinavian Journal of Medicine & Science in Sports

    (2016)
  • M.H. Bekker et al.

    Predicting individual differences in autonomy-connectedness: The role of body awareness, alexithymia, and assertiveness

    Journal of Clinical Psychology

    (2008)
  • G. Borg

    Borg's perceived exertion and pain scales

    (1998)
  • M. Botvinick et al.

    Rubber hands ‘feel’ touch that eyes see

    Nature

    (1998)
  • G.H. Bower

    Mood and memory

    American Psychologist

    (1981)
  • L.L. Cohen et al.

    Nurse coaching and cartoon Distraction: An efective and practical intervention to reduce child, parent, and nurse distress during immunizations

    Journal of Pediatric Psychology

    (1997)
  • D.B. Cook et al.

    Naturally occurring muscle pain during exercise: Assessment and experimental evidence

    Medicine & Science in Sports & Exercise

    (1997)
  • L.M. Dahlquist et al.

    Virtual-reality distraction and cold-pressor pain tolerance: Does avatar point of view matter?

    Cyberpsychology, Behavior, and Social Networking

    (2010)
  • C. Eichenberg et al.

    Virtual realities in the treatment of mental disorders: A review of the current state of research

    Virtual Reality in Psychological, Medical and Pedagogical Applications

    (2012)
  • A. Fenigstein et al.

    Public and private self-consciousness: Assessment and theory

    Journal of Consulting and Clinical Psychology

    (1975)
  • Cited by (0)

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