Studies

Research question

How effective is a 6-week exergame training on the ICAROS Guardian in healthy older adults?

Study design

Participants

Intervention group (n = 12): 70.9 ± 4.09 years; control group (n = 10): 76.7 ± 7.54 years

Training

6 weeks, 2×/week, 20–25 min each

Design

Intervention and control group, pre–post comparison

Measures

Timed Up and Go, sit-to-stand, gait speed, MoCA, Trail Making Test A & B, dual-task TUG

Measurements

Effect size, leg strength (Cohen’s d)

2.0 (sit-to-stand test)

Effect size, cognition (Cohen’s d)

0.9 (MoCA)

Dual-task Timed Up and Go test

Cohen’s d = 0.92

Key findings

• Leg strength (sit-to-stand) increased significantly, with a large effect size.
• Functional mobility (Timed Up and Go) and gait speed improved.
• Global cognition (MoCA) increased significantly and dual-task ability improved.

Context: Small groups of 10 and 12 people; the figures come from the study presentation of the German Sport University Cologne.

Source

Auswirkungen eines Exergame-basierten Gleichgewichtstrainings auf die Mobilität, Balance, Kognition und Ganggeschwindigkeit bei älteren Erwachsenen. German Sport University Cologne.

Research question

How does exergame training on the ICAROS Guardian affect cognition, mobility and leg strength – in community-dwelling older adults and in geriatric rehabilitation?

Study design

Participants

12 older adults (avg. 71 yrs) and 15 rehab patients (avg. 85 yrs)

Training

6 weeks 2×/week or 3 weeks in rehab, approx. 20–25 min each

Design

Pre–post feasibility study in two settings

Measures

MoCA, Timed Up and Go, gait speed, sit-to-stand

Measurements

Leg strength (sit-to-stand)

+41% (Rehab: 11.5 → 16.2 reps)

Timed Up and Go time

−24% (Rehab: 15.4 → 11.8 s)

Gait speed

+16% (Older adults: 1.74 → 2.01 m/s)

Points in cognitive test (MoCA)

+2 (Older adults: 25.7 → 27.7)

Key findings

• Both groups improved in every test – cognition, mobility, gait speed and leg strength.
• All improvements were statistically significant except dual-task costs in the rehab group.
• The effects appeared despite short sessions of around 20–25 minutes.

Context: Feasibility study without a control group – it lays the groundwork for a randomized follow-up trial.

Source

Massing J, Andac E, Turki A, Koutsompina-Szedlak E, Schulz R, Brixius K. Exergame-Based Training to Promote Mobility and Cognitive Function in Older Adults: A Proof-of-Concept Study. German Sport University Cologne & Center for Geriatric Medicine, Cellitinnen Hospital St. Marien. DOI: 10.5960/dzsm.2026.662

Research question

How does 6 weeks of exergame-based balance training on the ICAROS Guardian affect mobility and cognition in stroke patients?

Study design

Participants

13 stroke patients (35–75 yrs) with mild to moderate impairments in mobility or balance

Training

6 weeks, 2×/week, 15–20 min each on the ICAROS Guardian

Design

Pre–post comparison

Measures

Sit-to-stand test, Timed Up and Go, gait speed

Measurements

Time in sit-to-stand test

−22% (20.5 → 16.1 s)

Time in Timed Up and Go

−10% (12.0 → 10.9 s)

Gait speed

+6% (1.09 → 1.16 m/s)

Key findings

• All three tests improved significantly (sit-to-stand p < 0.001, Timed Up and Go p = 0.002, gait speed p = 0.017).
• The study team observed a steady performance increase over the six weeks.
• According to the study team, this can help patients feel safer and more resilient in daily life.

Context: The study has not been published yet – the figures come from the study presentation of the German Sport University Cologne. The WDR Lokalzeit Bergisches Land report of 18 March 2026 (from minute 17:52, in German) gives an insight.

Source

Effekte von Training auf dem ICAROS Guardian bei Schlaganfallpatienten. German Sport University Cologne.

Research question

What are the immediate effects of a single exergame session on the ICAROS Guardian on gait in people with Parkinson’s disease?

Study design

Participants

12 people with Parkinson’s disease

Training

30 min with 7 balance-focused exergames

Design

Baseline → 30-min rest → pre-test → training → post-test

Measures

12 gait parameters via shoe sensors (4 × 10 m walk)

Measurements

Gait speed

significant increase after training (F(2,22) = 3.48; p = 0.049; η²p = 0.24; post-hoc p = 0.045)

Stance time

significant decrease after training (post-hoc p = 0.006)

Stride time

significant decrease after training (post-hoc p = 0.009)

Key findings

• Gait speed increased significantly after training (p = 0.045).
• Stance time (p = 0.006) and stride time (p = 0.009) shortened at the same time.
• Values remained stable during the rest phase without training – pointing to a training effect rather than a learning effect.

Context: Exploratory pilot data with a small sample and small effects; larger controlled long-term studies are to follow.

Source

Maaroufi S, Zeitz F, Brixius K. Instantaneous Effects of an Exergame-Based Training Intervention Using the ICAROS Guardian on Gait in Patients With Parkinson Disease. German Sport University Cologne.

Research question

How does additional ICAROS training in rehab aftercare affect everyday limitations and core strength in patients with lower back complaints?

Study design

Participants

20 patients (avg. 47 yrs): 9 with additional ICAROS training, 11 controls

Training

Additional 10 min on the ICAROS Pro (prototype) over 12 aftercare sessions

Design

Intervention study with control group, pre- and post-test

Measures

Oswestry Disability Questionnaire, isokinetic and isometric trunk strength

Measurements

Isometric trunk flexion (60° and 45°)

significantly improved

Isometric trunk extension (30° flexion)

significantly improved

Strength ratio at 30° flexion

significantly improved

Key findings

• The training group significantly improved isometric trunk strength (flexion at 60° and 45°, extension and strength ratio at 30° flexion).
• Isokinetic strength ratios did not improve significantly – possibly due to pain-related inhibition.
• According to the conclusion, everyday limitations decreased and ICAROS training increased motivation.

Context: Small sample; an early prototype (ICAROS Pro) was tested.

Source

Der Einfluss zusätzlichen Icaros-Trainings in der Reha-Nachsorge von LWS-Patienten auf deren Alltagseinschränkungen und Kraft der Rumpfmuskulatur. Technical University of Munich.

Research question

How high are energy expenditure and muscle activity when training on the ICAROS Pro – compared with an ordinary forearm plank?

Study design

Participants

15 participants (avg. 24.7 yrs)

Training

Three exercises of 1 min each with 8 min rest: kneeling forearm plank, forearm plank, ICAROS test game

Design

Pre-test and comparison of three exercises

Measures

Oxygen uptake (energy expenditure), blood lactate, muscle activity via EMG

Measurements

Muscle stimulation

2× (vs. forearm plank with bent knee)

Calorie consumption

+30% (vs. forearm plank with bent knee)

Key findings

• Muscle stimulation doubled compared with an ordinary forearm plank with bent knee.
• Calorie consumption was 30% higher.
• The combination of playful incentive and high physical load sets the training apart from conventional static exercises.

Context: Early study with the ICAROS Pro in young participants; each individual exercise lasted one minute.

Source

Energieverbrauch und Muskelaktivität beim Training auf dem innovativen Fitnessgerät ICAROS. Technical University of Munich.

Research question

How does full-body exergaming in fully immersive VR affect the cardiovascular system and muscles of young adults?

Study design

Participants

33 young adults (avg. 24 yrs), 25 completed

Training

2 flights of 5 min each in plank position on the ICAROS

Design

Cross-sectional experiment

Measures

Muscle activity (sEMG), heart rate, exertion (RPE), cybersickness, workload, enjoyment (PACES)

Measurements

Average heartbeats per minute

108 (rest: 60 /min, moderate intensity)

Back muscle activation (peak)

27% (means of 21–27% of maximum voluntary isometric contraction)

Exertion (RPE, 6–20 scale)

14.6 (moderate to vigorous)

Key findings

• The plank position activated the dorsal muscle chain, mainly through isometric contraction.
• Participants described the training as moderate to vigorous activity and enjoyed it.
• Immersive VR systems can therefore contribute to muscle-strengthening activities.

Context: Healthy young adults were studied without a control group. 8 of 33 people dropped out (6 due to cybersickness, 2 due to muscle pain from prior injuries) – the authors see room for improvement in software and hardware.

Source

Feodoroff B, Konstantinidis I, Froböse I. Effects of Full Body Exergaming in Virtual Reality on Cardiovascular and Muscular Parameters: Cross-Sectional Experiment. German Sport University Cologne, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation. DOI: 10.2196/12324

Research question

How does VR training with the ICAROS Pro and AIM software affect body composition, muscle function and muscle thickness – and how well is it accepted?

Study design

Participants

36 men (26–65 yrs)

Training

6 weeks, 3×/week, 10 min each on the ICAROS Pro

Design

Pre-test, training, post-test and questionnaire follow-up

Measures

BMI and bioimpedance, isometric strength (Biering-Sørensen and McGill tests), muscle thickness via ultrasound

Measurements

Muscle activity

59.4% (previously 43.0%)

Muscle functionality

63.3% (previously 37.7%)

Stability

94.6% (previously 93.2%)

Key findings

• Muscle activity: 43.0% → 59.4% (p < 0.001; d = 2.42).
• Muscle functionality: 37.7% → 63.3% (p < 0.001; d = 2.64).
• Stability: 93.2% → 94.6% (p < 0.001; d = 1.40).
• Participants reported less back pain and improved mobility.

Context: Only men were studied, in a pre–post comparison.

Source

Evaluierung von ICAROS VR-Training zur Gesundheitsförderung und Prävention. Center for Health Professions Tyrol.

Research question

Does exergame-based back training in an unstable plank position improve acute back pain, movement function and well-being?

Study design

Participants

Preliminary study: 10 healthy people (avg. 22 and 57 yrs). Pilot: 10 people with acute back pain (4 training, 6 control)

Training

Pilot: 6 weeks, 20 min exergaming + 10 min core stabilisation each; week 1 4×, then 2×/week

Design

Preliminary study and pilot study with control group

Measures

Pain (NRS), movement function, well-being (WHO-5), fingertip-to-floor distance

Measurements

Well-being (WHO-5, max. 25)

≈ +5 points (≈ 20 → 25)

Familiarisation with the device

from day 4 (healthy younger and older people)

Key findings

• Young and older healthy people adapted positively from four days on and became familiar with the device.
• In people with back pain, back muscle functionality improved and well-being rose.
• Pain-related impairments decreased; the study points to a possible reduction of acute back pain.

Context: Very small groups of four to six people – the results are preliminary.

Source

Exergame-basierte Flugsimulation und therapeutisches Training bei unspezifischen akuten Rückenschmerzen – Vorstudie und Pilotstudie. German Sport University Cologne.

Research question

Does immersive VR exercise therapy reduce Post-COVID fatigue more than conventional exercise therapy – and is it safe?

Study design

Participants

100 adults with Post-COVID syndrome and moderate-to-severe fatigue (FSS ≥ 36), randomized 1:1

Training

6 weeks, 12 supervised sessions of 45 min (VR vs. conventional)

Design

Double-blind randomized controlled trial (RCT), follow-up after 3 and 12 months

Measures

Fatigue Severity Scale (FSS), Patient Global Impression of Change, safety

Measurements

Points on the fatigue scale (FSS)

−8.3 (conventional: −5.3)

with symptom worsening

9% (conventional: 22%)

report overall improvement

77% (conventional: 57%)

Walking distance (6-minute walk test)

+40 m (conventional: +26 m)

Key findings

• Fatigue improved in both groups – with no significant difference between them.
• Only the VR group exceeded the minimal important difference (≥ 6.3 points).
• The improvements were sustained at 3 and 12 months.
• Adverse events were mild and transient (e.g. headache, nausea, dizziness).

Context: VR training was not statistically more effective than active conventional training but showed a promising clinical signal; larger multicenter trials are to follow.

Source

Lange H, Schuster AK, Vock S, Eich W, Friederich H-C, Tesarz J. Digital rehabilitation using immersive Virtual Reality for Post-COVID fatigue: a double-blind randomized controlled trial. Heidelberg University & University Medical Center Mainz. DOI: 10.1159/pps/aemag017

Research question

Does exergame-based core training on the ICAROS Health help with chronic back pain – and does it matter whether people train with a tablet or in fully immersive VR?

Study design

Participants

27 people with chronic back pain (15 VR, 12 tablet)

Training

5 weeks 2×/week, 30 min each (20 min core + 10 min exergaming)

Design

Pilot study, VR group vs. tablet group

Measures

Fingertip-to-floor distance, pain (NRS), well-being (WHO-5)

Measurements

Fingertip-to-floor distance (VR group)

significantly improved (p = 0.042)

Difference VR vs. tablet in fingertip-to-floor distance

significant (p = 0.04, medium effect size)

Key findings

• Only the VR group improved mobility significantly (fingertip-to-floor distance, p = 0.042).
• Mobility showed a significant group difference with a medium effect size in favour of VR.
• Fully immersive VR training was well tolerated overall.

Context: Pain and well-being did not change significantly in this low-burden group; follow-up studies are to include participants with higher pain intensity.

Source

Hexel E, Zimmermann K, Hoffmann J, Mansuroglu M, Diebschütz S, Mohr V, Brixius K. Tablet-basiertes versus vollimmersives VR-basiertes Exergaming bei unspezifischen chronischen Rückenschmerzen – Pilotstudie. German Sport University Cologne with PhysioSport Mediapark Cologne & Orthopädie Mediapark.

Research question

What are the cardiopulmonary, metabolic and muscular effects of training on the ICAROS Cloud compared with identical training without it?

Study design

Participants

16 recreational athletes (avg. 24 yrs)

Training

Two identical, predefined interval workouts of 12 min – with and without the ICAROS Cloud

Design

Randomized cross-over

Measures

Heart rate, lactate, energy expenditure, muscle activity (EMG), exertion (RPE), muscle soreness (AMS), enjoyment (PACES)

Measurements

prefer training with the Cloud

81%

Energy expenditure

+5% (compared with the mat)

Enjoyment of training (PACES)

significantly higher

Key findings

• Enjoyment (PACES) was significantly higher on the ICAROS Cloud and muscle soreness (AMS) significantly lower.
• Heart rate, lactate, perceived exertion and muscle activity did not differ significantly – the physical stress is comparable to training on a mat.
• The higher motivation may support longer-lasting training adherence; 81% prefer digitally guided training with the Cloud.

Context: Only the conference poster is available so far; the sample is small and each person completed just one short session per condition.

Source

Sippl J, Dmitrieva A, Venzke J, Platen P. Cardiopulmonary, metabolic, and muscular demands of a whole-body wobble board (ICAROS Cloud) training. Ruhr University Bochum, Faculty of Sport Science.

Research question

Does regular training on the ICAROS Cloud increase core strength – and how strong are enjoyment and flow?

Study design

Participants

9 girls (avg. 13 yrs)

Training

3 weeks, 2×/week, 15 min each on the ICAROS Cloud

Design

Pre-test, training, post-test

Measures

Core strength (plank time), exertion (Borg scale), flow state, fun factor

Measurements

Core strength

+16% (+15.85% in plank position)

Fun factor

8.1/10

would keep using and recommend the Cloud

90%

Key findings

• Time in plank position increased significantly by 15.85%.
• The number of push-ups per session rose (medium positive correlation of 0.62).
• Subjectively perceived exertion (Borg scale) did not differ significantly.

Context: Very small sample of nine girls in a pre–post design; the figures come from the study presentation.

Source

Wird die Rumpfkraft durch regelmäßiges Training auf der Icaros Cloud verbessert?. University of Salzburg.

Research question

Can a single, brief VR session on the ICAROS Lightning improve joint position sense in the throwing shoulder of collegiate baseball players?

Study design

Participants

9 collegiate baseball players

Training

2-min VR flight through a ring course

Design

Pre–post pilot study

Measures

Active shoulder joint position sense (internal & external rotation)

Measurements

Position error, external rotation

−75% (6.3° → 1.6°)

Position error, internal rotation

−52% (8.1° → 3.9°)

Training time

2 min (a single session)

Key findings

• Angular error dropped significantly in both rotation directions (p < 0.001).
• Very large effect sizes (Cohen’s dz = 2.70 and 2.23).
• External rotation – the direction most relevant to throwing – improved the most.

Context: Pilot study with a small sample and no control group; it examined the immediate effect of a single session.

Source

Kidwell JA, Hoang J, Greenwood N, Medina Batista D, Bolton M, Mun J, Yamamoto T, Dolezal BA. A Closed Kinetic Chain Task Utilizing an Immersive Virtual Reality-Based Platform Acutely Improves Shoulder Joint Position Sense in Collegiate Baseball Athletes. University of California, Los Angeles (UCLA) & Creighton University. DOI: 10.3390/app16168318

Research question

Is exergaming with the ICAROS I.S.T. Board feasible, safe and accepted for children and adolescents during hemodialysis?

Study design

Participants

9 children and adolescents on chronic hemodialysis (avg. 11.6 yrs)

Training

8 weeks, 2×/week, 20 min each during the first third of dialysis – seated on the I.S.T. Board

Design

Prospective exploratory pilot study at two centers (Cologne, Bonn)

Measures

Feasibility, safety and acceptance; feedback from children, caregivers and physicians

Measurements

Training sessions

123

Serious complications

0

Key findings

• No falls, no shunt-needle dislodgements and no other serious adverse events.
• Minor events were mostly pressure alarms on the dialysis machine; complaints such as headache or abdominal pain resolved without consequences.
• Children, caregivers and physicians rated the programme consistently positively and wanted it to continue.

Context: Exploratory pilot study with nine participants on feasibility, safety and acceptance – effectiveness was not examined. Larger studies are to follow.

Source

Schmidt T, Stegelmann L, Kerstin M, Taylan C, Hoppe B, Brixius K. Exergaming as a promising approach to promote physical activity in children and adolescents during hemodialysis?. German Sport University Cologne & University Hospital Cologne. DOI: 10.1007/s00467-026-07158-0