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Effect of virtual reality-based exercise intervention on sleep quality in children with acute lymphoblastic leukemia and healthy siblings: A randomized controlled trial

Published online by Cambridge University Press:  15 March 2022

Müberra Tanriverdi
Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
Erkan Cakir
Pediatric Pulmonology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
Muhammed Emin Akkoyunlu
Department of Pulmonology, İstanbul Medipol University, Istanbul, Turkey
Fatma Betül Cakir*
Pediatric Hematology Oncology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
Author for correspondence: Fatma Betül Cakir, Pediatrics, Division of Pediatric Hematology Oncology, Bezmialem Vakif Universitesi Tip Fakultesi, Istanbul, Turkey. E-mail:



Sleep is one of the important measurements of the quality of life for children especially suffering from a chronic illness such as cancer. Our aim was to determine the changes in sleep quality and to investigate the effect of virtual reality-based exercise (VRBE) approaches on sleep in patients with acute lymphoblastic leukemia (ALL) off treatment.


The participants (ALL and healthy siblings) were evaluated for sleep quality with polysomnography and “Children's Sleep Habit Questionnaire” before and after 12 weeks. The study randomized into two groups: an exercise group who received VRBE in two days in a week, 45 min of each session for 12 weeks and an control group who were managed with supportive measures. The VRBE comprised of aerobic exercise in four different games by Nintendo Wii Fit Plus®.


This randomized controlled trial was carried out on 38 participants. Before intervention, ALL patients (n = 24) and healthy siblings (n = 14) had similar sleep quality in terms of polysomnography and Children's Sleep Habit Questionnaire findings. After intervention, total time asleep (p = 0.023), respiratory disturbance index of hypopnea (p = 0.005), apnea/hypopnea index (p = 0.008), and number of apnea (p = 0.028) statistically significant improved.

Significance of results

Patients with ALL off treatment had similar values of sleep quality with healthy siblings. Novel types of exercises like VRBE have positive effects on sleep disorders in children with ALL and also healthy siblings. Future studies are needed comparing the different types of interventions.

Original Article
Copyright © The Author(s), 2022. Published by Cambridge University Press

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