Background: Chronic obstructive pulmonary disease (COPD) and post-COVID syndrome cause persistent
dyspnea and exercise intolerance. Traditional pulmonary rehabilitation (PR) improves outcomes. Virtual
reality (VR)-based PR has been proposed as an engaging alternative. We systematically reviewed randomized trials of VR-based PR programs to evaluate its efficacy and feasibility. Methods: Following
PRISMA guidelines, we searched PubMed, Web of Science, CENTRAL and Google Scholar (2014–Feb
2025) for RCTs comparing VR-assisted PR versus standard PR in patients with COPD or post-COVID
conditions. Based on the selection criteria nine trials (primary search total n 5 552; 488 COPD and
64 post-COVID patients) were included. Six domains were considered: lung function, exercise capacity
(6MWT, STST), dyspnea, quality of life, mental health, and cognitive function. Results: Across nine
RCTs (n 5 552), VR-based pulmonary rehabilitation resulted improvements in exercise capacity in all
studies, with several reporting greater gains in VR groups. A long-duration trial showed meaningful
FEV1 improvement with VR, while shorter trials showed limited changes. Dyspnea and functional
scores improved in both groups without consistent between-group differences. VR tended to yield
greater reductions in anxiety and depression scores, and one trial showed better cognitive function in post-intervention. Quality-of-life outcomes improved in both groups. Conclusion: VR-based PR was
feasible and produced functional gains at least equal to those of traditional PR. VR’s capacity for remote
supervised training and gamification holds promise to improve access and adherence. However, evidence is
limited by small, short-term trials. Larger, longer RCTs are needed to confirm these benefits, optimize VR
protocols, and evaluate cost-effectiveness
