Virtual exercise therapy is considered a useful method by which to encourage patients with generalized anxiety disorder (GAD) to engage in aerobic exercise in order to reduce stress . This study was intended to explore the psychological and physiological responses of patients with GAD after cycling in a virtual environment containing natural images . Seventy-seven participants with GAD were recruited in the present study and randomly assigned to a virtual nature (VN) or a virtual abstract painting (VAP) group . Their electroencephalogram alpha activity, perceived stress, and levels of restorative quality and satisfaction were assessed at baseline and after an acute bout of 20 min of moderate-intensity aerobic exercise . The results showed that both the VN and VAP groups showed significantly higher alpha activity post-exercise as compared to pre-exercise . The VN group relative to the VAP group exhibited higher levels of stress-relief, restorative quality, and personal satisfaction . These findings imply that a virtual exercise environment is an effective way to induce a relaxing effect in patients with GAD. However, they exhibited more positive psychological responses when exercising in such an environment with natural landscapes.