Virtual reality-based distraction on pain, performance, and anxiety during and after moderate-vigorous intensity cycling

•Cycling induces pain in the quadriceps that increases with exercise intensity.•Virtual reality decreases pain intensity in a wide range of situations.•Those in a low perceptual load VR cycledat a higher intensity despite greater pain.•Those in a high perceptual load VR reported higher pain at a lower intensity.•Cycling in VR without mental effort needs can decrease pain and improve intensity. Purpose: To determine whether increased visual perceptual load (PL) within an immersive virtual environment may help explain previously shown pain-relieving effects of virtual reality (VR) during high intensity cycling. Methods: Using a within-subjects design, participants cycled at a perceptually “hard” intensity for 10 min on three separate occasions. The first session did not use VR (i.e., no perceptual load - NPL). Subsequent sessions employed VR during cycling with either a low or high perceptual load (LPL or HPL). Quadriceps pain intensity (PI) was reported by participants throughout cycling. Results: Data were analyzed for 43 healthy participants (20 females, mean age 21 [SD 1.4]). For PI, ANOVA showed there were significant main effects of condition (F = 13.458, df =1.579, 66.334, p