BOXVR Versus Guided YouTube Boxing for Stress, Anxiety, and Cognitive Performance in Adolescents: A Pilot Randomized Controlled Trial

Background: Adolescents frequently experience high levels of anxiety and stress, which can impede quality of life and academic performance. Boxing as a form of exercise has been shown to have mental health benefits in adults. Methods: This study investigated the impact of boxing exercise with a virtual reality (VR) game vs. with a guided video on anxiety, stress, and executive function in adolescents. Participants were randomly assigned to 1 of 3 cohorts: Oculus Rift BOXVR game (n = 14), boxing with a guided workout video (n = 14), or a non-intervention control (n = 14). The BOXVR and guided video groups participated in 10-minute exercise sessions, 5 times a week for 3 weeks. Results: The groups were comparable at baseline on all outcomes. Only BOXVR participants exhibited a significant (p < 0.001) reduction in stress and significant improvements on the Trail Making Test (TMT) B at weekly checkpoints and follow up. All cohorts showed improvements in executive function on the TMT A. At the end of the study, the BOXVR group reported significantly lower stress levels than the guided video group, and significantly better TMT A & B scores than the control group. Only the control group showed a significant reduction in anxiety but the groups were not significantly different in anxiety at the end of the study. The BOXVR group reported significantly greater enjoyment after each exercise session than the guided video group. Conclusion: BOXVR was shown to be effective in reducing adolescent stress and improving executive function over a three-week period. While larger studies with real-life functional outcomes are necessary, boxing with an immersive VR game represents a potential non-pharmaceutical mode to reduce stress in adolescents that is easy to implement in school settings.