Adolescent obesity continues to rise globally, with prevalence doubling over the past three decades.¹ In China, approximately 19% of adolescents were overweight or obese in 2020, mirroring global trends of reduced physical activity; nearly 80% failing to meet the World Health Organization (WHO)’s recommended 60 minutes of daily moderate-to-vigorous exercise.¹ Despite exercise being a cornerstone strategy for adolescent weight control, conventional approaches are often hindered by low motivation, insufficient personalization, psychological burden, and engagement barriers.¹ At ATTD-ASIA 2025, Professor Li Huating from Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, China, presented how virtual reality (VR) sports can serve as an innovative approach to support weight management in adolescents by delivering structured, personalized and engaging exercise experiences.¹

A VR sports system, Real Exercise and VR Exercise Research in Education (REVERIE), was developed to deliver structured exercise within an immersive and interactive environment.¹ Unlike traditional video games that lack training intensity and methodological rigor, REVERIE is underpinned by professional motion modelling, using precise motion capture to construct standardized biomechanical templates that emulate real sports.¹ Deep reinforcement learning drives virtual coach agents that provide personalized guidance, supported by real-time feedback and an adaptive loop-back mechanism that continuously optimizes user performance.¹ Collectively, this template-driven, feedback-oriented, deep reinforcement learning-based sports guidance system supports empathetic sports intervention.¹ Technical assessments also demonstrated low cybersickness, strong immersion, effective artificial intelligence (AI)-human interaction for individualized guidance, and biomechanical performance comparable to conventional sports.¹

REVERIE was evaluated in a randomized controlled trial of 240 adolescents aged 11-17 years old with excess body weight for a duration of 8 weeks.¹ Participants were assigned to either physical table tennis, physical soccer, REVERIE table tennis, REVERIE soccer, or a control group continuing routine physical education.¹ Intervention groups underwent moderate-to-high intensity exercise, with intensity maintained at levels equivalent to conventional physical sports (60%-70% of maximum heart rate with real-time armband monitoring), alongside standardized dietary administration across all groups.¹ REVERIE training yielded fat-mass reduction of 4.28kg, comparable to physical sports.¹ Both VR and physical modalities demonstrated improvements in lean mass, liver enzymes, low-density lipoprotein (LDL)-cholesterol, and overall physical fitness.¹

Beyond physical outcomes, psychological domains showed consistent gains across both active groups, including improvements in self-efficacy, self-esteem, sleep quality, and dietary habits.¹ Importantly, adolescents in the VR groups demonstrated higher willingness to sustain regular physical activity at six-month follow-up, suggesting that the immersive and personalized REVERIE experience fosters a positive feedback loop, where adaptive coaching and real-time engagement reinforce motivation and adherence, an area where traditional exercise programs often fall short.¹

Distinct cognitive benefits were observed with REVERIE VR training.¹ Participants in the REVERIE group outperformed those in physical sports on olfactory sensitivity, olfactory identification, accuracy, and reaction-time tasks, with reaction speed increasing by 21.25%.¹ Functional MRI further revealed reduced activation in frontal and cingulate regions during working-memory tasks, indicating that these improvements were supported by enhanced neural efficiency.¹ More pronounced changes in functional connectivity were detected in networks associated with memory, attention, and executive processing following REVERIE training, reflecting enhanced neuroplasticity as compared to physical sports.¹ These changes included selective disengagement between frontal executive regions under low cognitive load, increased working-memory demands, strengthened visual-executive integration, modulation of limbic system connectivity, and broader functional reorganization of the brain.¹

Multi-omics profiling further differentiated the biological impact of each intervention.¹ Physical sports elicited prominent proteomic alterations, whereas VR training induced more substantial metagenomic, metabolomic, and lipidomic shifts.¹ These molecular signatures correlated more strongly with cognitive enhancements in the VR group, particularly within frontal, temporal, and precuneus regions.¹ These effects are attributed to two potential mechanisms: modulation of the gut-brain axis through changes in vagal tone, microbiome composition, and metabolite signaling, or direct circulating molecular influences on neural pathways that support cognitive function.¹ Building on these results, the research team is extending VR-based interventions to additional domains, including the development of an augmented-reality Tai Chi platform (i-TaiChi) for individuals with diabetes-associated cognitive impairment.¹

In conclusion, the evidence suggests that VR sports offer a multidimensional and scalable strategy to address adolescent obesity by simultaneously improving metabolic parameters, physical fitness, psychological well-being, and cognitive performance.¹ These findings represent a significant advancement in digital exercise science and a promising direction for supporting long-term behavioral change and healthier lifestyles among adolescents.¹

In an interview with Omnihealth Practice, Professor Li Huating outlined how VR sports offer a physiologically meaningful and highly engaging strategy to counter adolescent obesity and foster sustainable physical-activity habits across diverse youth populations.

Q1. How can VR sports interventions promote long-term exercise habits, particularly for adolescents reluctant to participate in traditional sports?

Professor Li: VR sports create an engaging, individualized environment that allows adolescents to develop competence and confidence in physical activity. Enjoyable, game-like experiences increase adherence. When kids feel challenged but successful, they develop intrinsic motivation, making exercise a habit rather than a chore. By mastering sports skills privately, they are more likely to transition into real-world group activities. Evidence shows that even short-term VR interventions can foster sustained exercise behaviors months later. Notably, these interventions are broadly applicable to all adolescents, regardless of baseline fitness or prior activity levels, and can support skill acquisition, motivation, and long-term habit formation.

Q2. How do VR sports replicate real-world exercise intensity, and what future innovations could enhance their effectiveness?

Professor Li: Effective VR sports interventions replicate the cardiovascular and neuromotor demands of traditional exercise, including elevated heart rate and dopaminergic responses that reinforce motivation and engagement. Unlike conventional video games, maintaining exercise intensity is critical to achieving meaningful physiological and psychological benefits. Looking ahead, AI-driven features such as real-time voice prompts, motion correction, and personalized feedback through live interaction with coaches, can further optimize engagement and adherence, enhancing long-term outcomes for adolescent obesity management.

Q3: How do multidisciplinary collaboration and evolving cost dynamics support the scalable adoption of VR-based sports interventions for adolescents with obesity?

Professor Li: Multidisciplinary input from clinicians, psychologists, educators, and VR developers ensures that programs are medically safe and behaviorally engaging. At the same time, rapid innovation in VR hardware and software, together with expanding commercial markets, is steadily driving down device and development costs. As prices fall, scalability increases, especially when paired with shared hardware models across schools or community centers. Collectively, these scientific and economic enablers make VR sports interventions increasingly viable and cost-effective for broad implementation.