Reimagining Cardiac Rehabilitation (CR): A Scoping Review on the Role of Extended Reality (XR) in Enhancing Physical, Psychological, and Educational Outcomes

Abstract

Background: Extended Reality (XR), encompassing Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), is gaining attention in healthcare for its potential to enhance physical, psychological, and educational outcomes. In the domain of cardiac rehabilitation (CR), XR technologies offer promising avenues to address key challenges such as low adherence, limited engagement, and motivational barriers.

Objective: This scoping review aims to systematically map and analyze the existing empirical evidence on the use of XR technologies in cardiac rehabilitation and assess their impact on physical performance, psychological well-being, educational outcomes, and patient adherence.

Methods: Following Arksey and O’Malley’s scoping review framework, a comprehensive search of six databases (PubMed, Cochrane Library, CINAHL, Embase, PsycINFO, Web of Science) was conducted for studies published between January 2018 and March 2025. Empirical studies investigating the application of VR, AR, or XR in CR with measurable outcomes were included. A total of 24 eligible studies were identified and subjected to narrative synthesis.

Results: XR interventions were consistently associated with improved physical outcomes, including increased exercise capacity and cardiovascular risk reduction. VR-enhanced home-based programs showed greater adherence and satisfaction compared to conventional rehabilitation. Psychological benefits such as reduced anxiety and depression, improved mood, and enhanced motivation were also documented. XR-based educational interventions contributed to better disease-related understanding and higher knowledge retention among both patients and healthcare professionals. Gamification elements and immersive experiences were found to foster intrinsic motivation and engagement.

Conclusion: XR technologies present a multidimensional opportunity to enhance the effectiveness of cardiac rehabilitation programs. Beyond physical recovery, they facilitate psychological support, patient education, and long-term adherence. However, the current body of evidence is limited by methodological heterogeneity, small sample sizes, and short follow-up durations. Future research should focus on theory-based, pedagogically grounded XR interventions that integrate behavioral and learning science principles to unlock the full potential of immersive technologies in cardiac care.