A PILOT TRIAL OF TELEHEALTH ACTIVE VIDEO GAMING USING IMMERSIVE VIRTUAL REALITY ON CARDIOMETABOLIC HEALTH AMONG YOUTH WITH CEREBRAL PALSY

Byron Lai，PhD - R03 项目总结/摘要 由于运动参与率低得惊人，患有脑瘫的青少年（YwCP） 随着年龄的增长，他们患心血管疾病（CVD）、相关疾病的风险以及CVD死亡率。 经常参加有氧运动是预防糖尿病的有效非药物方法。 心血管疾病和代谢综合征，但有效的方式，如步行，跑步和骑自行车 通常不适合行动不便的YwCP的大量人口。不断增长的可用性 互联网接入和远程医疗的接受（由于冠状病毒大流行）创造了前所未有的 有机会让大型的、服务不足的YwCP团体参与锻炼行为。当与最近的 随着消费者可用的虚拟现实（VR）视频游戏技术的进步，远程医疗计划 创造可访问和完全沉浸式的单人和多人活动视频游戏体验的潜力， 家中这种令人愉快的运动方式可以提高YwCP保持规律的可能性。 参与一段时间，这是必要的，以引起心脏代谢健康的变化。这 应用程序提出了一个试点项目，建立在我们最近的可行性工作。干预措施将利用 理论驱动的协议，用于通过远程医疗远程提供和客观监测VR exergaming。 这些程序将纯粹由远程医疗驱动，包括远程筛查、同意、数据收集和 干预程序。参与者将从儿童医院、成人康复诊所和 社区组织网络。34名YwCP将随机分为两组：1）12周的 VR exergaming加上行为远程体育教练（VRT）或2）12周的等待名单控制（WC） 在接受VRT之前进行习惯性活动。将规定VRT参与者至少完成 每周进行150分钟的中等强度运动。使用探索性统计程序，这项试点研究将 比较高敏C反应蛋白和血胰岛素、血红蛋白A1 c、甘油三酯 胆固醇和压力之间的VRT和WC只有组。在0、6和12周时，心脏代谢 将通过远程评估在家中衡量成果。此外，该研究将定性探讨 行为机制，通过半结构化的访谈参与者从两个 干预后或辍学的群体。使用扎根理论方法，参与者的反馈将 构建成一个实质性的理论，可以最大限度地长期参与YwCP在远程exergaming。 研究结果将用于为远程医疗疗效试验的开发提供信息，该试验可以很容易地复制 在不同的地点和环境中。

Byron Lai, PhD – R03 Project Summary/Abstract 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.