REGaitVR

How do virtual landscapes influence well-being during rehabilitation? Can digital natural and urban environments make gait training for older adults more enjoyable and motivating?

The REGaitVR research project investigates the use of immersive virtual landscapes in gait rehabilitation for older adults. The project aims to develop and scientifically evaluate highly realistic virtual reality environments based on three-dimensional laser-scanning data of real-world landscapes, known as point clouds. These virtual environments were specifically designed for therapeutic use and tested in a clinical study involving geriatric patients.

Background

Gait instability and falls are among the most common health challenges in later life. They can lead to injuries, reduced mobility, and a loss of independence. At the same time, many older adults have limited access to restorative natural environments due to physical impairments.

Research in environmental psychology has shown that landscapes can positively influence well-being, reduce stress, and support restorative processes. REGaitVR combines these insights with modern virtual reality technologies and investigates how virtual landscapes can be used in therapies addressing gait instability and mobility impairments.

The Project

Within REGaitVR, real-world landscapes were captured using terrestrial and airborne laser scanning and transformed into highly realistic 3D point-cloud environments. These environments were complemented with spatial audio recordings to create immersive experiences.

Three distinct landscape types were developed for the study:

• (1) Urban Landscape (Old Town of St. Gallen) An urban setting with high information density and a wide variety of visual stimuli.
• (2) Rural Landscape (Hinter Guldenen Nature Reserve, Zurich Canton) An open and tranquil environment characterized by broad views and low visual complexity.
• (3) Forest Landscape (Käferberg Forest, Zurich) A nature-based environment featuring dense vegetation and a higher degree of spatial complexity.

The developed virtual landscapes make highly realistic representations of real-world environments accessible as safe and controlled therapeutic training spaces.

Clinical Study

The VR application was evaluated in a multicenter randomized controlled trial involving older adults. The study was conducted in collaboration with the Geriatrische Klinik St. Gallen, Spitäler Schaffhausen, and Spital Zollikerberg. Participant recruitment took place between April 2024 and September 2025.

Eligible participants were aged 65 years or older and received gait training as part of their rehabilitation program. Participants were randomly assigned to one of three virtual landscape groups (forest, rural, or urban) or to a control group receiving standard care. In addition to their regular rehabilitation program, participants in the VR groups completed five VR-assisted gait-training sessions over a two-week intervention period.

Each VR training session lasted approximately 25 minutes and consisted of a five-minute familiarization phase followed by a twenty-minute period of active walking and exploration within the virtual environment. Participants were allowed to use walking aids, such as canes or rollators, when required.

The study aimed to investigate how different virtual landscapes are perceived during gait training and how they influence stress, restoration, and user experience. Physiological responses, subjective assessments, gait-related parameters, and eye movements recorded through integrated eye tracking were collected. Participants were also interviewed about their experiences within the virtual environments

Initial Findings

The results indicate that immersive virtual landscapes can be successfully integrated into gait rehabilitation. Participants reported positive user experiences, high levels of acceptance, and increased motivation during training.

Particularly interesting was the observation that both natural and urban environments appear to be therapeutically beneficial. While natural environments were mainly associated with calmness and restoration, urban environments were perceived as especially interesting and stimulating. The findings suggest that different landscape types may contribute to positive rehabilitation experiences through different mechanisms while still producing comparable benefits.

The study provides important evidence that virtual landscapes can support rehabilitation training while also contributing to patient well-being during therapy.
Virtual landscapes may therefore provide access to places that are difficult or impossible to reach because of limited mobility. At the same time, they offer safe training conditions for practicing gait and balance skills and may support the transfer of learned movement patterns to real-world daily life situations.

The findings from REGaitVR suggest that the intentional design of virtual environments has the potential to increase motivation during rehabilitation, reduce stress, provide opportunities for practicing everyday mobility tasks in a safe setting, and promote independence and quality of life among older adults.