Background People with chronic pain can develop a more sedentary lifestyle. Activity-based virtual reality (AVR) interventions may help increase activity and improve outcomes for people with chronic pain. Aim This study explored the acceptability and feasibility of AVR for improving activity levels and other pain relevant outcome measures among people with chronic pain. Participants Thirteen people with chronic musculoskeletal pain were recruited and randomised into a physiotherapy treatment as usual group (TAU) or AVR group. Design Randomised, non-blinded, pilot study involving within subject testing pre- and post-intervention. In addition, the TAU group underwent a pre-intervention waiting time to act as a control. Methods Each treatment arm (AVR, TAU or wait-time) lasted six weeks. Outcome measures were collected at the start and end of each six-week period and included self-report questionnaires, activity monitoring and physical function measures. Effect sizes were calculated and minimal clinical important differences in activity levels and pain relevant outcomes were documented where available. Feasibility was determined through recruitment and retention rates and acceptability through participant’s evaluation of sessions, perceived benefit and adherence to data collection processes. Results Recruitment was low and indicated a need for change in the exclusion criteria and recruitment sourcing when conducting a larger study. Retention rates, however, were reasonable and participants enjoyed the sessions and perceived to gain benefit from the AVR. Preliminary analysis of activity levels and other outcomes indicated that AVR was somewhat less effective than TAU, but effect sizes across the groups were small, though several limitations to the study protocol demand further research to quantify this. Conclusion The study confirmed that AVR was acceptable for a chronic pain population, but the study protocol as it stands would not be feasible for a large randomised controlled trial. Revisions may improve standardisation, and changes to the recruitment process are needed to increase participant numbers. Initial findings indicate that AVR is an enjoyable intervention for people with chronic pain, but pain relevant outcome measures did not indicate substantial differences in outcomes compared to standard physiotherapy or a waiting list control.