VR Fitness for the chronically ill: Hitstream virtual reality game review

As someone with multiple chronic illnesses, I assumed virtual reality games and fitness apps would be too difficult for me to use. But I finally gave it a try this year. I wish I had tried it years ago. Of all the exercise I’ve done over the years (skiing, volleyball, swimming, yoga, and ballet), this is the only one that makes me want to exercise daily—and often multiple times a day.

So I thought I’d share tips and tricks and an easier entry point into virtual reality for people who may be on the fence about whether they can handle VR due to health issues.

I’m reviewing the VR Fitness app, Hitstream on the MetaQuest 3S VR headset, but this game is also available on Steam PCVR as well as Pico Neo, Pimax, iQIYI, and Nolo VR headsets.

Hitstream features

The great thing about Hitstream is it doesn’t require a subscription, it’s fun, it’s energetic, it’s game-like, it’s customizable, and it’s immensely satisfying to punch stuff timed to music.

There’s a fantastic variety of movements and a wide range of rock/pop/electronic songs and outdoor/otherworldly backdrops with three different intensity levels. The exercise routines flow well in 10, 20, or 30-minute sets, with multiple short breaks in between songs.

This game offers mixed reality (you can see the game world and the real world environments at the same time) or full virtual viewing options. There’s even a multiplayer mode (which I haven’t tried yet).

According to the developer, “Moves are designed to be intuitive—they're carefully crafted so that they're easy to pick up, but they can take a while to master. The structure of the routines allows progression and improvement over time.”

I’ve found this to be true for me. I’ve gotten better over time with many of the routines to the point where I occasionally get a perfect score. That revs up my motivation to keep improving. I also like to add more of a challenge with quick squats any time I’m supposed to strike a lower hexagon. Another thing I do is hit harder or with less force depending on how I’m feeling on a given day.

Settings Adjustments for Health Issues

Before you begin your first routine, I recommend checking out the settings options and adjust anything you think you might find difficult. You can always toggle on the more challenging elements later when you’ve built up stamina and familiarity with the game.

Headset and controllers

If you’re having trouble keeping the headset from sliding around on your head, you can find after-market head straps that may offer a better fit. The one I decided to get was the BOBOVR E3 Head Strap for Meta Quest 3S on Amazon. It works way better because it has an adjustment counterweight toward the back of the head.

If you have skin sensitivity...

For folks with MCAS (mast cell activation syndrome), rosacea, or other skin sensitivities, the headset might be irritating. You can wash the headset parts that touch your face with mild liquid detergent. Just be sure to never submerge the parts underwater or under running water as that could damage them. Here is more information from Meta on that.

If the small straps on the controllers bother your wrists, you can switch out the straps with better ones, twist them around so they don't move around as you play, or remove the straps altogether. To remove or switch them out, you'll need to open up the battery compartments on the controllers first.

If you have POTS or knee pain...

You can toggle off squats  or choose the half-squat option to shorten the time you are in the squat position.

In addition you can switch off walls, which means you won't need to move swiftly to avoid running into the walls. I recommend turning these off initially until you get used to the gameplay, if you need to play seated, or if you have a small area in which to play. Full disclosure, the walls tend to make me run into furniture so I turned those off indefinitely.

I should note that I have to take a medication that reduces my POTsy tachycardia, so I couldn't play this game without it.

If you have POTS or dysautonomia in general, you are likely already aware that mild to moderate exercise is best. For my part, I know I have to be both relaxed  and keep my punching strength to about 75% of my maximum power and intensity. This keeps me from overdoing it.

If you suffer from lightheadedness, pre-syncope or syncope (meaning you almost or fully pass out), VR games where you are mostly standing in one place will likely work best, at least initially. VR headsets can cause what's known as virtual reality sickness (i.e., motion sickness). You can also reduce potentially nausea-inducing elements of the game, such as toggling off particle effects, switching on extended platform glow, or turning on scenic view (which omits the glowing portals in the distance).

I'm thankful Hitstream has never caused me to feel nauseous or dizzy, but many other VR games have. I think this is due to the fact that in Hitstream you stand in the center of the game environment and either face a single direction or turn in a circle from time to time (this is a setting you can change). I also made sure to choose a completely virtual environment, as opposed to mixed reality, which has a tendency to worsen nausea.

If you have nerve pain...

Initially I found that I had a lot of nerve pain in my hands and fingers after playing Hitstream. My nerve pain gets worse when I grip things for too long. But I figured out that I could hold onto the controllers with just my middle and ring fingers and also avoid pressing the trigger buttons because they aren't needed to play Hitstream.

I've also found that if I stand too long in a given position I end up with my feet going numb. One thing I do to combat this is to move my feet often and switch positions throughout the gameplay.

If you have hEDS...

For those with hypermobility or similar connective tissue or musculoskeletal disorders, shadowboxing (or running into furniture!) has the potential to cause subluxations or even broken bones.

Some ways to protect your joints, bones, and muscles are to wear KT tape, arm braces, or torso braces when you play. You can even play Hitstream with a single hand! Definitely start with shorter sessions at first and build up your stamina and endurance slowly. I started out at the lowest intensity and worked my way to the standard intensity. I doubt I'll ever move up to the highest intensity.

Also learning more about the proper stance and the safest ways to throw various punches can protect your joints as well.

Final Thoughts

All of the usual wisdom applies here: pace yourself; check with your doctor before starting any new exercise or health routines; and stop if you feel you feel pain or you get dizzy. And if you’re new to Hitstream or VR exercise in general, I highly recommend going through the initial tutorial and then start off with the "Now is Midnight" routine in the Scene 1 Collection. Enjoy!