# Feasibility of Vigorous Extended Reality Tele-Exergaming for Cardiometabolic Health in Youth With Mobility Disabilities: Protocol for a Case Series Study

## TL;DR

This study explores whether intense virtual reality gaming at home can improve heart and metabolic health in young people with mobility disabilities.

## Contribution

The study introduces a home-based, telemonitored exergaming protocol for youth with cerebral palsy to improve cardiometabolic health.

## Key findings

- The study will assess changes in body composition and blood markers before and after the intervention.
- Feasibility will be evaluated through quantitative metrics and qualitative participant feedback.
- Results will guide future trials on the efficacy of exergaming for this population.

## Abstract

Young people with mobility disabilities have limited options to maintain their cardiometabolic health and cardiorespiratory fitness. Active video gaming using extended reality head-mounted displays is becoming increasingly common for promoting serious exergaming. However, there is a need to identify dosing protocols that can potentially lead to meaningful improvements in cardiometabolic health and cardiorespiratory fitness.

This feasibility study aims to explore potential benefits of vigorous-intensity extended reality exergaming, conducted at home with telemonitoring for body composition and cardiometabolic health, in 4 young people with cerebral palsy and overweight or obesity. The secondary aim is to assess the effects of the program on cardiorespiratory fitness. The tertiary aim is to describe the safety and acceptability of the intervention.

This case study is a phase 1 feasibility trial with a pretest-to-posttest design including 4 participants. Young people with cerebral palsy and overweight or obesity (aged 13-24 years) will be purposively selected to participate based on 2 mobility categories (ambulatory: n=2; nonambulatory: n=2). The intervention prescription will include 240 minutes per week of vigorous-intensity exercise at home for a total of 6 weeks, with telemonitoring of exercise data that will be supplemented with weekly coaching calls. Participants will exercise using a head-mounted display to control an immersive exergame. Caregivers will agree to manage a play schedule and assess their children’s safety during play. Body composition will be measured using dual-energy x-ray absorptiometry at the pre- and postintervention time points (weeks 0 and 7, respectively). Blood-related health (fasting insulin, lipids, high-sensitivity C-reactive protein, and glycated hemoglobin) will be measured via a blood spot test, and blood pressure will be measured via a sphygmomanometer. Cardiorespiratory fitness (peak oxygen consumption) will be measured using a portable metabolic cart (COSMED K5) during a graded exercise test on an arm ergometer at the pre- and postintervention time points. Quantitative process metrics and qualitative feedback will be used to assess feasibility. Changes in outcomes over time will be descriptively analyzed.

Recruitment began in October 2025. All data are anticipated to be collected by December 2025. Full results are anticipated to be analyzed and submitted for publication by April 2026.

This feasibility study tests an accessible and intensive program, which leverages high-intensity exercise gaming with telehealth procedures for children with cerebral palsy. Study findings will inform a pilot efficacy trial to improve cardiometabolic health and fitness among young people with mobility disabilities.