Virtual Reality Exercise Alleviates Postprandial Vascular and Metabolic Impairment in Adolescents With Congenital Heart Disease: A Randomized Controlled Crossover Trial

Background and Objectives: Adolescents with congenital heart disease (CHD) are at increased cardiovascular risk, exacerbated by high-fat meals (HFMs) and sedentary behavior. While exercise is recommended to mitigate this risk, adherence can be challenging. Virtual reality (VR) exergaming has emerged as a potentially motivating alternative. This study examined whether a single session of VR exergaming could attenuate vascular and metabolic impairment induced by an HFM and prolonged sitting in adolescents with CHD. Methods: In a randomized crossover design, 10 adolescents with CHD (mean age, 12.6±3.3 years) completed 2 trials after an HFM with 4 hours of sitting: (1) 30 minutes of VR cycling, and (2) uninterrupted sitting. Vascular and metabolic markers were assessed at baseline and 4 hours, including flow-mediated dilation (FMD), augmentation index (AIx), carotid-femoral pulse wave velocity, blood pressure (BP), glucose, lipids, and triglyceride-glucose index (TyG). Results: FMD was preserved in the VR trial and decreased in the sitting trial, with a significant interaction (p=0.008). Systolic BP showed a significant interaction (p=0.022), with reductions observed only after VR exercise. AIx was significantly lower in the VR trial compared with sitting (p=0.002), but no interaction was observed. The postprandial increase in TyG index was attenuated in the VR trial (interaction p=0.040). Conclusions: A single session of VR exergaming attenuated vascular and metabolic impairment induced by an HFM and prolonged sitting in adolescents with CHD. These findings suggest that VR exergaming may serve as an alternative to traditional exercise for vascular health in CHD.