Using virtual reality urban greenness with peer support to reduce stress and enhance social connection in older adults with mild depression: a pilot randomized controlled trial

Shiyu Lu; Cheryl Chui; Linyan Li

doi:10.1093/geroni/igag044

Using virtual reality urban greenness with peer support to reduce stress and enhance social connection in older adults with mild depression: a pilot randomized controlled trial

Shiyu Lu^*
, Cheryl Chui
, Linyan Li

^*Corresponding author for this work

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

Abstract

Background and Objectives: Virtual reality (VR) urban greenspace (UGS) presents an innovative strategy to enhance the mental well-being of older individuals in urban environments. However, knowledge regarding the design of VR UGS interventions to effectively reduce stress among older adults while fostering social connections remains unclear. We conducted a 3-arm cluster-randomized controlled trial to evaluate the effectiveness of a social prescribing model in reducing stress and enhancing social connection among older people with mild depressive symptoms.

Research Design and Methods: The 3-arm cluster-randomized controlled trial (25 participants per arm) consisted of VRUGS without peer support (VRUGS), VRUGS with peer support (VRUGS-PS), and a control group (CG; non-biophilic VR intervention without peer supporters). The study captured subjective (e.g., self-reported stress) and objective measurements (e.g., heart rate [HR]) of stress and social connection assessments pre- and post-intervention.

Results: Mixed linear modeling revealed that compared to the CG, VRUGS group experienced significant reductions in self-reported anxiety (β = −2.72, p = .009) and negative emotions (β = −1.16, p = .039). The VRUGS-PS group showed a significant increase in social connection (β = 0.76, p = .017). Compared to CG, the VRUGS group showed a significant HR decrease during the intervention (β = −1.93, p < .001), while the VRUGS-PS group exhibited a significant HR reduction post-intervention (β = −0.60, p = .035), experiencing stress relief.

Discussion and Implications: This study provides preliminary evidence that virtual nature-based social prescribing model’s effectiveness in reducing stress and enhancing social connections among older adults.

© The Author(s) 2026. Published by Oxford University Press on behalf of the Gerontological Society of America.

Original language	English
Article number	igag044
Number of pages	12
Journal	Innovation in Aging
Volume	10
Issue number	7
Online published	4 May 2026
DOIs	https://doi.org/10.1093/geroni/igag044
Publication status	Published - Jul 2026

Funding

This work is fully supported by a research project led by Shiyu Lu as the Principal Investigator, entitled “Social prescribing of virtual reality urban greenness with peer support model to promote mental health among aging population: an effectiveness and feasibility study” and funded by the Hong Kong Research Grants Council (RGC), under the University Grants Committee, through the Healthy Longevity Catalyst Awards (Reference No: HLCA/H-106/23). The programme is part of the global Healthy Longevity Initiative in collaboration with the U.S. National Academy of Medicine since 2022.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 11 Sustainable Cities and Communities

Research Keywords

Mental health
Social technology
Virtual age-friendly community

Publisher's Copyright Statement

This full text is made available under CC-BY-NC-ND 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/

RGC Funding Information

RGC-funded

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10.1093/geroni/igag044

500860337.pdfFinal Published version, 1.21 MBLicence: CC BY-NC-ND

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title = "Using virtual reality urban greenness with peer support to reduce stress and enhance social connection in older adults with mild depression: a pilot randomized controlled trial",

abstract = "Background and Objectives: Virtual reality (VR) urban greenspace (UGS) presents an innovative strategy to enhance the mental well-being of older individuals in urban environments. However, knowledge regarding the design of VR UGS interventions to effectively reduce stress among older adults while fostering social connections remains unclear. We conducted a 3-arm cluster-randomized controlled trial to evaluate the effectiveness of a social prescribing model in reducing stress and enhancing social connection among older people with mild depressive symptoms. Research Design and Methods: The 3-arm cluster-randomized controlled trial (25 participants per arm) consisted of VRUGS without peer support (VRUGS), VRUGS with peer support (VRUGS-PS), and a control group (CG; non-biophilic VR intervention without peer supporters). The study captured subjective (e.g., self-reported stress) and objective measurements (e.g., heart rate [HR]) of stress and social connection assessments pre- and post-intervention. Results: Mixed linear modeling revealed that compared to the CG, VRUGS group experienced significant reductions in self-reported anxiety (β = −2.72, p = .009) and negative emotions (β = −1.16, p = .039). The VRUGS-PS group showed a significant increase in social connection (β = 0.76, p = .017). Compared to CG, the VRUGS group showed a significant HR decrease during the intervention (β = −1.93, p < .001), while the VRUGS-PS group exhibited a significant HR reduction post-intervention (β = −0.60, p = .035), experiencing stress relief. Discussion and Implications: This study provides preliminary evidence that virtual nature-based social prescribing model{\textquoteright}s effectiveness in reducing stress and enhancing social connections among older adults. {\textcopyright} The Author(s) 2026. Published by Oxford University Press on behalf of the Gerontological Society of America.",

keywords = "Mental health, Social technology, Virtual age-friendly community",

author = "Shiyu Lu and Cheryl Chui and Linyan Li",

year = "2026",

month = jul,

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language = "English",

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Using virtual reality urban greenness with peer support to reduce stress and enhance social connection in older adults with mild depression: a pilot randomized controlled trial. / Lu, Shiyu; Chui, Cheryl; Li, Linyan.
In: Innovation in Aging, Vol. 10, No. 7, igag044, 07.2026.

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

TY - JOUR

T1 - Using virtual reality urban greenness with peer support to reduce stress and enhance social connection in older adults with mild depression

T2 - a pilot randomized controlled trial

AU - Lu, Shiyu

AU - Chui, Cheryl

AU - Li, Linyan

PY - 2026/7

Y1 - 2026/7

N2 - Background and Objectives: Virtual reality (VR) urban greenspace (UGS) presents an innovative strategy to enhance the mental well-being of older individuals in urban environments. However, knowledge regarding the design of VR UGS interventions to effectively reduce stress among older adults while fostering social connections remains unclear. We conducted a 3-arm cluster-randomized controlled trial to evaluate the effectiveness of a social prescribing model in reducing stress and enhancing social connection among older people with mild depressive symptoms. Research Design and Methods: The 3-arm cluster-randomized controlled trial (25 participants per arm) consisted of VRUGS without peer support (VRUGS), VRUGS with peer support (VRUGS-PS), and a control group (CG; non-biophilic VR intervention without peer supporters). The study captured subjective (e.g., self-reported stress) and objective measurements (e.g., heart rate [HR]) of stress and social connection assessments pre- and post-intervention. Results: Mixed linear modeling revealed that compared to the CG, VRUGS group experienced significant reductions in self-reported anxiety (β = −2.72, p = .009) and negative emotions (β = −1.16, p = .039). The VRUGS-PS group showed a significant increase in social connection (β = 0.76, p = .017). Compared to CG, the VRUGS group showed a significant HR decrease during the intervention (β = −1.93, p < .001), while the VRUGS-PS group exhibited a significant HR reduction post-intervention (β = −0.60, p = .035), experiencing stress relief. Discussion and Implications: This study provides preliminary evidence that virtual nature-based social prescribing model’s effectiveness in reducing stress and enhancing social connections among older adults. © The Author(s) 2026. Published by Oxford University Press on behalf of the Gerontological Society of America.

AB - Background and Objectives: Virtual reality (VR) urban greenspace (UGS) presents an innovative strategy to enhance the mental well-being of older individuals in urban environments. However, knowledge regarding the design of VR UGS interventions to effectively reduce stress among older adults while fostering social connections remains unclear. We conducted a 3-arm cluster-randomized controlled trial to evaluate the effectiveness of a social prescribing model in reducing stress and enhancing social connection among older people with mild depressive symptoms. Research Design and Methods: The 3-arm cluster-randomized controlled trial (25 participants per arm) consisted of VRUGS without peer support (VRUGS), VRUGS with peer support (VRUGS-PS), and a control group (CG; non-biophilic VR intervention without peer supporters). The study captured subjective (e.g., self-reported stress) and objective measurements (e.g., heart rate [HR]) of stress and social connection assessments pre- and post-intervention. Results: Mixed linear modeling revealed that compared to the CG, VRUGS group experienced significant reductions in self-reported anxiety (β = −2.72, p = .009) and negative emotions (β = −1.16, p = .039). The VRUGS-PS group showed a significant increase in social connection (β = 0.76, p = .017). Compared to CG, the VRUGS group showed a significant HR decrease during the intervention (β = −1.93, p < .001), while the VRUGS-PS group exhibited a significant HR reduction post-intervention (β = −0.60, p = .035), experiencing stress relief. Discussion and Implications: This study provides preliminary evidence that virtual nature-based social prescribing model’s effectiveness in reducing stress and enhancing social connections among older adults. © The Author(s) 2026. Published by Oxford University Press on behalf of the Gerontological Society of America.

KW - Mental health

KW - Social technology

KW - Virtual age-friendly community

UR - https://www.scopus.com/pages/publications/105043375477#tab=impact

UR - https://www.scopus.com/pages/publications/105043375477

U2 - 10.1093/geroni/igag044

DO - 10.1093/geroni/igag044

M3 - RGC 21 - Publication in refereed journal

SN - 2399-5300

VL - 10

JO - Innovation in Aging

JF - Innovation in Aging

IS - 7

M1 - igag044

ER -

Using virtual reality urban greenness with peer support to reduce stress and enhance social connection in older adults with mild depression: a pilot randomized controlled trial

Abstract

Funding

UN SDGs

Research Keywords

Publisher's Copyright Statement

RGC Funding Information

Access Output

Other Access Options

Permanent Link

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Fingerprint

HLCA: Social Prescribing of Virtual Reality Urban Greenness with Peer Support Model to Promote Mental Health among Aging Population: An Effectiveness and Feasibility Study

Cite this

Using virtual reality urban greenness with peer support to reduce stress and enhance social connection in older adults with mild depression: a pilot randomized controlled trial

Abstract

Funding

UN SDGs

Research Keywords

Publisher's Copyright Statement

RGC Funding Information

Access Output

Other Access Options

Permanent Link

Other Files and Links

Fingerprint

Projects

HLCA: Social Prescribing of Virtual Reality Urban Greenness with Peer Support Model to Promote Mental Health among Aging Population: An Effectiveness and Feasibility Study

Cite this