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

The study targets young people with cerebral palsy and overweight or obesity aged 13-24 years, purposively selected across two mobility categories.

• Total sample size is 4 participants.
• Participants are divided into ambulatory (n=2) and nonambulatory (n=2) categories.
• Inclusion criteria specify both cerebral palsy diagnosis and overweight or obesity.
• Purposive selection is used rather than random sampling.

The intervention prescribes 240 minutes per week of vigorous-intensity extended reality exergaming at home over 6 weeks.

• Exercise is performed using a head-mounted display to control an immersive exergame.
• Total intervention duration is 6 weeks.
• Telemonitoring of exercise data is supplemented with weekly coaching calls.
• Caregivers are required to manage the play schedule and assess children's safety during play.

Body composition is measured using dual-energy x-ray absorptiometry (DXA) at pre- and post-intervention time points.

• Measurements occur at weeks 0 and 7.
• DXA is used as the primary body composition measurement tool.
• Body composition is listed as a primary outcome measure for cardiometabolic health.

Blood-related cardiometabolic health markers are assessed via a blood spot test at pre- and post-intervention.

• Markers include fasting insulin, lipids, high-sensitivity C-reactive protein, and glycated hemoglobin.
• Blood pressure is measured via a sphygmomanometer.
• These measures constitute the blood-related component of the cardiometabolic health primary outcome.

Cardiorespiratory fitness (peak oxygen consumption) is measured using a portable metabolic cart during a graded exercise test on an arm ergometer.

• The COSMED K5 portable metabolic cart is used for measurement.
• Testing occurs at pre- and post-intervention time points (weeks 0 and 7).
• An arm ergometer is used to accommodate participants with mobility disabilities.
• Cardiorespiratory fitness is identified as a secondary outcome.

Safety and acceptability of the intervention are assessed as tertiary aims using both quantitative and qualitative methods.

• Quantitative process metrics and qualitative feedback are both used to assess feasibility.
• Changes in outcomes over time will be descriptively analyzed.
• The study is designated a phase 1 feasibility trial with a pretest-to-posttest design.

Recruitment began in October 2025 with data collection anticipated to be completed by December 2025 and results submitted for publication by April 2026.

• Full results are anticipated to be analyzed and submitted for publication by April 2026.
• All data collection is anticipated to conclude by December 2025.
• Study findings are intended to inform a subsequent pilot efficacy trial.