Published February 12, 2026 | Version v1
Journal article Open

A randomized controlled trial of virtual reality-based exercise on bone mineral density in hypertensive prostate cancer patients undergoing androgen deprivation therapy

Authors/Creators

  • 1. Researcher, National Center of Research, Egypt
  • 2. 2Associate Professor, Department of Physical Therapy, Faculty of Allied Medical Science, Middle East University, Jordan; Associate Professor, Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt
  • 3. 3Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah 51452, P.O. Box 6666, Saudi Arabia. Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
  • 4. 4Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah 51452, P.O.Box 6666 Saudi Arabia. Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt
  • 5. 5Professor of Physical Therapy, Faculty of Allied Medical Sciences, Aqaba University of Technology. Professor of Physical Therapy, Faculty of Physical Therapy, Cairo University, Egypt

Description

Androgen deprivation therapy (ADT) for prostate cancer, while life-prolonging, induces significant bone loss and frequently coincides with cardiovascular comorbidities such as hypertension, creating a complex management challenge. This randomized controlled trial investigated the efficacy of a 12-week, immersive virtual reality (VR) exercise program on bone mineral density (BMD) and cardiovascular parameters in this specific population. Sixty hypertensive prostate cancer patients undergoing ADT were randomly assigned to either a control group (standard care: daily walking + calcium/vitamin D) or an experimental group (standard care + supervised VR training three times/week). Primary outcomes (lumbar and hip BMD/T-scores via DEXA) and secondary outcomes (blood pressure, body composition, physical function) were assessed at baseline and post-intervention. Both groups showed significant within-group improvements in BMD (p < 0.001). However, the VR group demonstrated significantly greater gains: lumbar spine BMD increased by 11.73% versus 4.63% in controls (between-group p < 0.001), and hip BMD increased by 9.11% versus 3.62% (p < 0.001). The intervention also yielded superior cardiovascular and functional benefits, including a greater reduction in systolic blood pressure (-8.2 mmHg vs. -3.1 mmHg, p=0.003), improved body composition, and enhanced performance in the Timed Up and Go test (p < 0.001). Adherence was significantly higher in the VR group (95% vs. 78%). In conclusion, integrating VR-based training into rehabilitation significantly improves bone health, reduces cardiovascular risk, and enhances physical function in hypertensive prostate cancer patients on ADT, offering a highly engaging and effective multimodal therapeutic strategy.

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