The study procedures were approved by the Jefferson Institutional Review Board (IRB) in December 2017. Beginning in January 2018, participants were selected from patients enrolled in CR at the Jefferson Health Methodist CR program on a rolling basis. Sample size calculations indicated that 68 patients were required to achieve a target power of 90%. Patients were randomized via the Google random number generator, limited to a range of 1-2—1 signifying the control group and 2 signifying the intervention group. To prevent patient bias, the consenting process did not include VR terminology or any reference to VR walking trails.

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