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

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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.