Introduction: There are many health benefits for pediatric Solid Organ Transplant (SOT) patients who engage in regular physical activity; however, a major barrier to ongoing participation is a lack of interest. Recently, a patient family within the Multi-Organ Transplant Program at British Columbia Children’s Hospital described their use of virtual reality (VR) gameplay for physical activity. As a follow-up, we conducted a feasibility study to assess VR gameplay as a form of physical activity for our SOT patients.
Methods: All eligible 13-18-year-old SOT patients within our Program were approached for consent. Participants engaged in an 8-week VR exercise program followed by 8-weeks of non-gameplay. The self-directed VR exercise program consisted of three games and a weekly requirement of exercising 3x/week for 30 minutes/session (24 sessions). Heart rate (HR) during VR exercise was recorded using a smart watch. An exercise treadmill test to volitional fatigue was administered prior to the start of the VR exercise program, post-VR program and following the non-gameplay period. Parameters measured during the exercise test included HR, V̇O2peak and other respiratory exchange variables. 
Results: The recruitment rate was 12/59 (20%); 5/12 participated in VR exercise. The median age of participants was 16.1 years (14.3-16.8). Four of five participants met criteria for a maximal exercise test. Peak exercise test HRs ranged from 150 to 203 bpm. Participant Z-scores for absolute V̇O2peak ranged from -2.85 to -1.38 with a relative V̇O2peak of 31.0 to 41.5 mL/min/kg; neither improved with VR exercise. The median number of gameplay sessions completed was 10 (8-22). The duration of gameplay sessions was 31 minutes (26-35). The percentage of time spent at ≥50% of peak HR during gameplay ranged from 85%-100%.  
Conclusion: VR gameplay can elicit an effective exercise stimulus; however, regular weekly exercise in our study was low and this may have contributed to the lack of improvement in V̇O2peak with VR exercise.