This study aimed to systematically compare the physiological responses generated by walking exercises conducted in a VR environment versus those performed on a treadmill, with a specific focus on their impacts on the autonomic nervous system and fatigue levels

This study was designed as a single-blind, randomized controlled trial. It was conducted in accordance with the Declaration of Helsinki, adhering to ethical principles for medical research involving human participants. Faculty of health sciences students from İstanbul Atlas University were invited to participate in this study. The inclusion criteria were as follows: aged between 18 and 25 years; classified as inactive or minimally active according to the International Physical Activity Questionnaire score; voluntary consent to participate; and a body mass index (BMI) of ≤30 kg/m².

Participants were excluded from the study if they met any of the following conditions: presence of visual, auditory, vestibular, or neurological deficits; a history of inflammatory diseases, surgeries, or cancer; any cardiopulmonary disorders, including asthma, within the last six months; major musculoskeletal injuries sustained within the last six months; other health issues that could compromise safety during exercise; or conditions known to affect autonomic nervous system (ANS) function, such as diabetes mellitus or autonomic neuropathy or current smoking status or failure to adhere to the experimental procedures of our study.

Our study comprehensively examines the effects of virtual reality (VR) walking exercise and traditional treadmill walking on autonomic nervous system (ANS) and fatigue levels during recovery.

Investigations into the physiological responses elicited by VR exercise interventions underscore a critical gap in our understanding of how VR modalities produce distinct responses compared with conventional exercise forms, particularly treadmill walking.

Inclusion Criteria:

• classified as inactive or minimally active according to the International Physical Activity Questionnaire score
• voluntary consent to participate
• body mass index (BMI) of ≤30 kg/m²

Exclusion Criteria:

• presence of visual, auditory, vestibular, or neurological deficits
• a history of inflammatory diseases, surgeries, or cancer
• any cardiopulmonary disorders, including asthma, within the last six months
• major musculoskeletal injuries sustained within the last six months
• function, such as diabetes mellitus or autonomic neuropathy
• current smoking status