Visual responses of patients with generalized anxiety disorder who cycling in the virtual sportscapes with different tree cover densities

The tree density of virtual sportscape is the main factor that determines the benefits that generalized anxiety disorder (GAD) patients can obtain when they exercise with virtual environment. By using pupil size, fixation count and time as metrics, this research aimed to clarify the relationship between tree cover density and stress in the virtual environment. Ninety GAD patients were randomly grouped into the 36–60% tree density (high tree density, HTDS), 20–35% tree density (medium tree density, MTDS), or control groups (n = 30). Researchers used eye-tracking technology to analyze fixation time, fixation count and changes in pupil size to evaluate the stress changes of participants after 20 min of aerobic exercise in a virtual environment. The results showed that pupil size expanded in GAD patients after exercising in the virtual environment. Furthermore, GAD patient cycling in the MTDS group can show smaller pupil size than those in HTDS. Those results suggest that GAD patient cycling 20 min in the MTDS group can perceived lower stress. The results of eye tracking analysis showed that GAD patients spend more time and counts observing tree elements in HTDS and MTDS sportscapes. Specifically, they spent more 48% and 27% time on tree and green plants in the HTDS condition and MTDS condition, respectively, than in non-natural sportsscapes. Although 36–60% tree density of virtual natural sportscape can get more visual attention from GAD patients, 20–35% tree density of virtual natural sportscape is more capable of reducing their stress.