Virtual reality based cognitive-motor training and metabolomics: a potential protocol for rehabilitation and enhancement

Abstract

Virtual reality (VR)-based cognitive-motor training has emerged as a promising tool for enhancing cognitive and motor functioning. Its underlying cellular metabolic mechanisms remain poorly understood, however. This thesis investigated (1) whether a virtual reality (VR)- based cognitive-motor learning (CML) intervention improves cognitive-motor speed efficacy (CMSE) by enhancing processing speed and/or decision-making, and (2) the urinary metabolomic response to VR training in healthy young adults. Sixty-two participants, assigned to experimental and control conditions, completed a 12-week VR-based CML protocol consisting of a baseline assessment, eight weekly training sessions, a post-test, and a transfer test. Performance was evaluated using response time, decision accuracy, CMSE, and composite indices. Urine samples were collected bi-weekly and analyzed using 1H-NMR spectroscopy with univariate and multivariate methods. The experimental group demonstrated CML, whereas controls showed only practice effects. Learning gains transferred to a similar task and were driven primarily by faster response times rather than improved decision-making. Both groups exhibited significant metabolomic shifts from baseline to training end, with females showing greater alterations; moreover, sex-dependent metabolic changes persisted at transfer. Key disrupted pathways involved carbohydrate, butanoate, and amino acid metabolism. These findings demonstrate the efficacy of a novel CML protocol in promoting processing speed and decision-making. Moreover, VR training induced measurable urinary metabolomic changes reflecting energy and oxidative stress regulation, with distinct sex-dependent adaptations. Together, they provide a foundation for future applications of biomarkers for monitoring cognitive-motor learning and personalized strategies in athletic performance optimization and neurorehabilitation.