Byron Lai, PhD – R03
Due to alarmingly low rates of exercise participation, youth with cerebral palsy (YwCP) are at substantially high
risk for cardiovascular disease (CVD), related conditions, and CVD mortality as they age into adulthood.
Regular participation in aerobic exercise is an effective non-pharmaceutical method for preventing
cardiovascular disease and metabolic syndrome, but effective modalities such as walking, running, and cycling
are often not suitable for the large demographic of YwCP who have reduced mobility. The growing availability
of internet access and acceptance of telehealth (due to the coronavirus pandemic) create an unprecedented
opportunity to engage large, underserved groups of YwCP in exercise behavior. When combined with recent
advances in consumer-available virtual reality (VR) video game technology, telehealth programs have the
potential to create accessible and fully immersive single- and multiplayer active video gaming experiences at
the home. This enjoyable modality of exercise may enhance the likelihood that YwCP maintain regular
participation over periods of time that are necessary to elicit changes in cardiometabolic health. This
application proposes a pilot project that builds upon our recent feasibility work. The intervention will utilize a
theory driven protocol for remotely delivering and objectively monitoring VR exergaming through telehealth.
The procedures will be purely telehealth driven and include remote screening, consent, data collection, and
intervention procedures. Participants will be recruited from a children’s hospital, adult rehabilitation clinic, and
network of community organizations. Thirty-four YwCP will be randomized to one of two groups: 1) 12 weeks of
VR exergaming plus behavioral tele-physical education coaching (VRT) or a 2) 12-week waitlist control (WC)
that undergoes habitual activity before receiving VRT. VRT participants will be prescribed to complete at least
150 min per week of moderate-intensity exercise. Using exploratory statistical procedures, this pilot study will
compare changes in high sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides,
cholesterol and pressure between the VRT and WC only groups. At 0, 6, and 12 weeks, cardiometabolic
outcomes will be measured at the home via tele-assessment. Additionally, the study will qualitatively explore
behavioral mechanisms that underly participation via semi-structured interviews with participants from both
groups at post-intervention or dropout. Using a Grounded Theory approach, participant feedback will be
constructed into a substantive theory that can maximize long-term engagement of YwCP in tele-exergaming.
Study findings will be used to inform the development of a telehealth efficacy trial that can be easily replicated
across various sites and settings.