REVIVE-HF: Rehabilitation with Immersive Virtual Reality and Exercise in Hospitalized Patients with Heart Failure - A Randomized Controlled Trial Protocol

BackgroundHeart failure (HF) is a chronic condition characterized by significant functional limitations, with exercise intolerance as a major determinant of reduced quality of life. Supervised aerobic exercise is a core intervention in cardiac rehabilitation, yet adherence and tolerance may be hindered by physical and motivational factors. Immersive technologies such as virtual reality (VR) have shown potential to increase engagement and positive perceptions during exercise. This study aims to evaluate the influence of VR on tolerance to cycle-ergometer aerobic exercise in hospitalized patients with HF. MethodsWe will conduct a randomized, controlled, parallel-group trial with 1:1 allocation. Adult inpatients with a diagnosis of HF will be screened for eligibility and randomly assigned to two groups: control (cycle-ergometer aerobic exercise) and intervention (the same exercise combined with an Meta Quest 2 VR device). Each participant will complete a single session of up to 20 minutes, consisting of five blocks of three minutes of continuous pedaling interspersed with one-minute passive rests, with early termination in case of intolerance. The primary outcome is effective exercise time (minutes) until interruption due to physical limitation or symptoms. Secondary outcomes include rating of perceived exertion, hemodynamic parameters, exercise enjoyment (PACES), and usability of the technology (SUS, intervention group only). DiscussionThis study will investigate whether VR can improve tolerance to aerobic exercise during hospitalization for HF, potentially providing preliminary evidence to guide the use of immersive technologies in cardiac rehabilitation. If benefits are observed, VR could be incorporated as a complementary tool to optimize adherence, motivation, and safety in supervised exercise programs in this clinical context. Trial registrationBrazilian Clinical Trials Registry (ReBEC): RBR-4hrmkzz. Strengths and limitationsO_LISingle-centre randomized controlled trial with concealed allocation and blinded analysis, enhancing internal validity. C_LIO_LIHighly standardised intervention and control conditions differing only by the presence of immersive VR, isolating the specific effect of VR. C_LIO_LISingle-session, single-centre design with a modest sample size limits generalisability and precludes assessment of long-term clinical outcomes. C_LI