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Individuals with intellectual and developmental disabilities (IDD) are in need of effective and motivating physical fitness training programs. The aim was to test the effectiveness of a virtual reality (VR)-based exercise program in improving the physical fitness of adults with severe IDD when implemented by on-site caregivers. A research group (N=20; mean age±standard deviation=47.9±8.6 years; severe IDD level) was matched for age, IDD level and functional abilities with a comparison group (N=24, mean age=46.2±9.3 years; severe IDD level). An 8-week fitness program consisting of 2–3 30-min sessions per week included game-like exercises provided by the IREX/GX video capture VR system. Changes in physical fitness were monitored by changes in heart rate at rest. A significant (P<0.005) reduction in heart rate was demonstrated for the research group. No change in heart rate was monitored in the …