{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:47:15Z","timestamp":1782841635351,"version":"3.54.5"},"reference-count":56,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2019s 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/85246","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:40:06Z","timestamp":1764945606000},"page":"e85246-e85246","source":"Crossref","is-referenced-by-count":1,"title":["Feasibility of Vigorous Extended Reality Tele-Exergaming for Cardiometabolic Health in Youth With Mobility Disabilities: Protocol for a Case Series Study"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5464-4720","authenticated-orcid":false,"given":"Byron","family":"Lai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1538-5834","authenticated-orcid":false,"given":"Maggie","family":"Logan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2879-3236","authenticated-orcid":false,"given":"Raven","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5466-0432","authenticated-orcid":false,"given":"Ashley","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4578-9127","authenticated-orcid":false,"given":"Jordyn","family":"Terrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9167-8663","authenticated-orcid":false,"given":"Larsen","family":"Bright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1860-7452","authenticated-orcid":false,"given":"Drew","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9116-2536","authenticated-orcid":false,"given":"Christen J","family":"Mendonca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"3","key":"R1","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.amepre.2024.11.013","article-title":"Cardiometabolic risk in pediatric patients with intellectual and developmental disabilities","volume":"68","author":"Nolan","journal-title":"Am J Prev Med"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","first-page":"200","DOI":"10.4239\/wjd.v6.i1.200","article-title":"Obesity and cardiometabolic disease risk factors among US adolescents with disabilities","volume":"6","author":"Messiah","journal-title":"World J Diabetes"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1186\/s12889-023-15796-4","article-title":"Cardiovascular risk profiles clusters among children and adolescents with disabilities","volume":"23","author":"Yehuda","journal-title":"BMC Public Health"},{"issue":"9","key":"R4","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1111\/j.1365-2788.2010.01305.x","article-title":"Obesity and obesity-related secondary conditions in adolescents with intellectual\/developmental disabilities","volume":"54","author":"Rimmer","journal-title":"J Intellect Disabil Res"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.ridd.2010.10.007","article-title":"Prevalence of obesity-related chronic health conditions in overweight adolescents with disabilities","volume":"32","author":"Yamaki","journal-title":"Res Dev Disabil"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1111\/dmcn.13777","article-title":"Age-related trends in cardiometabolic disease among adults with cerebral palsy","volume":"61","author":"Peterson","journal-title":"Dev Med Child Neurol"},{"issue":"4","key":"R7","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1111\/dmcn.14148","article-title":"Prevalence of metabolic syndrome and cardiovascular disease risk factors in adults with cerebral palsy","volume":"61","author":"Heyn","journal-title":"Dev Med Child Neurol"},{"issue":"9","key":"R8","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1016\/j.ridd.2014.03.051","article-title":"Habitual physical activity and cardiometabolic risk factors in adults with cerebral palsy","volume":"35","author":"Ryan","journal-title":"Res Dev Disabil"},{"issue":"8","key":"R9","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1111\/dmcn.13737","article-title":"The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review","volume":"60","author":"Ryan","journal-title":"Dev Med Child Neurol"},{"issue":"4","key":"R10","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1080\/17437199.2016.1198240","article-title":"A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities","volume":"10","author":"Martin Ginis","journal-title":"Health Psychol Rev"},{"issue":"10298","key":"R11","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/S0140-6736(21)01164-8","article-title":"Participation of people living with disabilities in physical activity: a global perspective","volume":"398","author":"Martin Ginis","journal-title":"Lancet"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/8080473","article-title":"Physical activity in adolescents and young adults with cerebral palsy","volume":"2017","author":"Waltersson","journal-title":"Biomed Res Int"},{"issue":"7","key":"R13","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1111\/dmcn.12394","article-title":"Duration and patterns of habitual physical activity in adolescents and young adults with cerebral palsy","volume":"56","author":"Shkedy Rabani","journal-title":"Dev Med Child Neurol"},{"issue":"8","key":"R14","doi-asserted-by":"publisher","first-page":"647","DOI":"10.3109\/09638288.2012.715721","article-title":"Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review","volume":"35","author":"Carlon","journal-title":"Disabil Rehabil"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"Haegele J Hodge S Shapiro D , editors. Routledge Handbook of Adapted Physical Education. Routledge; 2020. ISBN: 9780429052675","DOI":"10.4324\/9780429052675"},{"issue":"5","key":"R16","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1038\/s41366-021-00767-9","article-title":"Effect of exercise intervention dosage on reducing visceral adipose tissue: a systematic review and network meta-analysis of randomized controlled trials","volume":"45","author":"Chang","journal-title":"Int J Obes (Lond)"},{"issue":"7","key":"R17","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002014","article-title":"Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials","volume":"4","author":"Lin","journal-title":"J Am Heart Assoc"},{"issue":"s109","key":"R18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1469-8749.2007.00001.x","article-title":"The definition and classification of cerebral palsy","volume":"49","journal-title":"Dev Med Child Neurol"},{"issue":"8","key":"R19","doi-asserted-by":"publisher","first-page":"727","DOI":"10.3109\/09638288.2016.1161086","article-title":"Exergaming for individuals with neurological disability: a systematic review","volume":"39","author":"Mat Rosly","journal-title":"Disabil Rehabil"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1097\/PEP.0000000000000387","article-title":"Virtual reality and serious games in neurorehabilitation of children and adults: prevention, plasticity, and participation","volume":"29 Suppl 3","author":"Deutsch","journal-title":"Pediatr Phys Ther"},{"issue":"3","key":"R21","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1111\/j.1469-8749.2008.03184.x","article-title":"Interactive computer play in rehabilitation of children with sensorimotor disorders: a systematic review","volume":"51","author":"Sandlund","journal-title":"Dev Med Child Neurol"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2017.04.011","article-title":"The effect of active video games on cognitive functioning in clinical and non-clinical populations: a meta-analysis of randomized controlled trials","volume":"78","author":"Stanmore","journal-title":"Neurosci Biobehav Rev"},{"issue":"2","key":"R23","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1111\/dmcn.14751","article-title":"Leisure-time physical activity interventions for children and adults with cerebral palsy: a scoping review","volume":"63","author":"Lai","journal-title":"Dev Med Child Neurol"},{"issue":"10","key":"R24","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1097\/PHM.0000000000000743","article-title":"Current trends in exercise intervention research, technology, and behavioral change strategies for people with disabilities: a scoping review","volume":"96","author":"Lai","journal-title":"Am J Phys Med Rehabil"},{"issue":"2","key":"R25","doi-asserted-by":"publisher","DOI":"10.2196\/28210","article-title":"Examining the feasibility of early mobilization with virtual reality gaming using head-mounted display and adaptive software with adolescents in the pediatric intensive care unit: case report","volume":"8","author":"Lai","journal-title":"JMIR Rehabil Assist Technol"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1602","article-title":"Supportive accountability: a model for providing human support to enhance adherence to eHealth interventions","volume":"13","author":"Mohr","journal-title":"J Med Internet Res"},{"issue":"6","key":"R27","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1258\/135763303771005207","article-title":"The socio-economic impact of telehealth: a systematic review","volume":"9","author":"Jennett","journal-title":"J Telemed Telecare"},{"issue":"8","key":"R28","doi-asserted-by":"publisher","DOI":"10.2196\/40708","article-title":"The effects of virtual reality tele-exergaming on cardiometabolic indicators of health among youth with cerebral palsy: protocol for a pilot randomized controlled trial","volume":"11","author":"Lai","journal-title":"JMIR Res Protoc"},{"key":"R29","unstructured":"Borg G . Borg\u2019s Perceived Exertion And Pain Scales. Human Kinetics; 1998. ISBN: 0880116234"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","DOI":"10.2196\/rehab.5524","article-title":"Teleexercise for persons with spinal cord injury: a mixed-methods feasibility case series","volume":"3","author":"Lai","journal-title":"JMIR Rehabil Assist Technol"},{"key":"R31","unstructured":"Liguori G . ACSM\u2019s Guidelines for Exercise Testing and Prescription. Wolters Kluwer Health; 2020. ISBN: 9781975150211"},{"issue":"3","key":"R32","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1080\/02701367.2019.1615605","article-title":"Age-based prediction of maximal heart rate in children and adolescents: a systematic review and meta-analysis","volume":"90","author":"Cicone","journal-title":"Res Q Exerc Sport"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.2196\/56499","article-title":"Telehealth movement-to-music with arm-based sprint-intensity interval training to improve cardiometabolic health and cardiorespiratory fitness in children with cerebral palsy: protocol for a pilot randomized controlled trial","volume":"13","author":"Lai","journal-title":"JMIR Res Protoc"},{"issue":"2","key":"R34","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/dmcn.12624","article-title":"Factors associated with physical activity in children and adolescents with a physical disability: a systematic review","volume":"57","author":"Bloemen","journal-title":"Dev Med Child Neurol"},{"issue":"3","key":"R35","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1016\/j.jpeds.2012.02.042","article-title":"Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy","volume":"161","author":"Verschuren","journal-title":"J Pediatr"},{"issue":"11","key":"R36","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1001\/archpedi.161.11.1075","article-title":"Exercise training program in children and adolescents with cerebral palsy: a randomized controlled trial","volume":"161","author":"Verschuren","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1177\/1090198104263660","article-title":"Health promotion by social cognitive means","volume":"31","author":"Bandura","journal-title":"Health Educ Behav"},{"issue":"7","key":"R38","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1038\/sj.ejcn.1601371","article-title":"The Adolescent Food Habits Checklist: reliability and validity of a measure of healthy eating behaviour in adolescents","volume":"56","author":"Johnson","journal-title":"Eur J Clin Nutr"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-199706001-00009","article-title":"Godin Leisure-Time Exercise Questionnaire","volume":"29","author":"Godin","journal-title":"Med Sci Sports Exerc"},{"issue":"2","key":"R40","doi-asserted-by":"publisher","first-page":"604","DOI":"10.2466\/03.27.PMS.120v19x7","article-title":"The Godin-Shephard leisure-time physical activity questionnaire: validity evidence supporting its use for classifying healthy adults into active and insufficiently active categories","volume":"120","author":"Amireault","journal-title":"Percept Mot Skills"},{"issue":"11","key":"R41","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1080\/09638288.2018.1424956","article-title":"Use of the Godin Leisure-Time Exercise Questionnaire in multiple sclerosis research: a comprehensive narrative review","volume":"41","author":"Sikes","journal-title":"Disabil Rehabil"},{"issue":"5","key":"R42","doi-asserted-by":"crossref","first-page":"587","DOI":"10.70252\/FJPA7915","volume":"9","author":"Zelener","journal-title":"Int J Exerc Sci"},{"issue":"2","key":"R43","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1177\/193229680800200210","article-title":"Cardiometabolic risk factors assessed by a finger stick dried blood spot method","volume":"2","author":"Kapur","journal-title":"J Diabetes Sci Technol"},{"issue":"2","key":"R44","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1177\/193229681000400202","article-title":"Postprandial insulin and triglycerides after different breakfast meal challenges: use of finger stick capillary dried blood spots to study postprandial dysmetabolism","volume":"4","author":"Kapur","journal-title":"J Diabetes Sci Technol"},{"key":"R45","unstructured":"Tisdell EJ Merriam SB Stuckey-Peyrot HL . Qualitative Research: A Guide to Design and Implementation. Jossey-Bass; 2025."},{"key":"R46","unstructured":"Stake RE . The Art of Case Study Research. Sage Publications; 1995. URL: https:\/\/link.springer.com\/chapter\/10.1007\/978-3-030-85124-8_7"},{"issue":"2","key":"R47","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1080\/13645579.2016.1144401","article-title":"Applying critical realism in qualitative research: methodology meets method","volume":"20","author":"Fletcher","journal-title":"Int J Soc Res Methodol"},{"key":"R48","unstructured":"Willis JW . Foundations of Qualitative Research: Interpretive and Critical Approaches. SAGE Publications; 2007. ISBN: 9781452279008"},{"key":"R49","unstructured":"Braun V Clarke V . Thematic analysis. In: Cooper H Camic PM Long DL Panter AT Rindskopf D Sher KJ , editors. APA Handbook of Research Methods in Psychology. American Psychological Association; 2012:57-71."},{"key":"R50","unstructured":"Braun V Clarke V Weate P . Using thematic analysis in sport and exercise research. In: Routledge Handbook of Qualitative Research in Sport and Exercise. Routledge; 2016."},{"issue":"2","key":"R51","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1177\/1468794112446106","article-title":"\u2018Unsatisfactory saturation\u2019: a critical exploration of the notion of saturated sample sizes in qualitative research","volume":"13","author":"O\u2019Reilly","journal-title":"Qual Res"},{"issue":"2","key":"R52","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1123\/apaq.2019-0081","article-title":"Research trends and recommendations for physical activity interventions among children and youth with disabilities: a review of reviews","volume":"37","author":"Lai","journal-title":"Adapt Phys Activ Q"},{"issue":"4","key":"R53","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1123\/apaq.2017-0109","article-title":"Characteristics of adults with neurologic disability recruited for exercise trials: a secondary analysis","volume":"35","author":"Lai","journal-title":"Adapt Phys Activ Q"},{"issue":"12","key":"R54","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1111\/dmcn.15346","article-title":"Global prevalence of cerebral palsy: a systematic analysis","volume":"64","author":"McIntyre","journal-title":"Dev Med Child Neurol"},{"issue":"3","key":"R55","doi-asserted-by":"publisher","DOI":"10.2196\/20667","article-title":"Feasibility of a commercially available virtual reality system to achieve exercise guidelines in youth with spina bifida: mixed methods case study","volume":"8","author":"Lai","journal-title":"JMIR Serious Games"},{"issue":"14","key":"R56","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1136\/bjsports-2011-090236","article-title":"Perceived barriers and facilitators to physical activity for children with disability: a systematic review","volume":"46","author":"Shields","journal-title":"Br J Sports Med"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e85246","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:13:39Z","timestamp":1782839619000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e85246"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":56,"URL":"https:\/\/doi.org\/10.2196\/85246","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]},"article-number":"v15i3e85246"}}