Leveraging Extended Reality Exergaming and Telehealth to Improve Physical Activity and Health in Children with Disabilities

Byron Lai, PhD – R01 Project Summary/Abstract Children with physical disabilities face significantly higher risks for cardiovascular disease (CVD) and physical deconditioning as they age, primarily due to alarmingly low rates of exercise participation. Aerobic exercise is a proven non-pharmaceutical method for preventing CVD and maintaining health and fitness, yet common modalities like walking, running, and cycling are often inaccessible for children with mobility impairments. Disappointingly, children with disabilities often fail to engage in exercise at sufficient durations or health- enhancing intensities to elicit meaningful improvements in their health, particularly when the exercise is self- regulated and unsupervised by specialists. The rise of telehealth and widespread internet access offers a unique opportunity to deliver scalable, accessible, and age-appropriate exercise programs for underserved children with disabilities. This project aims to address this gap by conducting a 2-arm, parallel group, phase II randomized controlled trial (RCT) to evaluate the efficacy of a telehealth-delivered extended reality (XR) exergaming intervention on the health of children with cerebral palsy (CwCP). This innovative program leverages commercially available immersive gaming technology adapted for CwCP, behavioral tele-coaching, and caregiver involvement to help participants meet the recommended adult exercise guidelines of 150 minutes per week of moderate-intensity aerobic activity. The intervention is multi-level, targeting both the child and caregiver with behavioral strategies to enhance adherence. The intervention is based on our pilot work and integrates enjoyable, age-appropriate XR fitness games with adaptive gameplay to accommodate diverse levels of mobility and functional ability. The trial will enroll 130 physically inactive children with CP, aged 10–17 years, who will be randomized to either a 12-week XR exergaming intervention or a non-intervention control group. Outcomes will be assessed remotely using telehealth platforms and include measures of physical activity levels, cardiometabolic health indicators (e.g., blood pressure, cholesterol, hemoglobin A1c), and physical health and fitness (e.g., grip strength, cardiorespiratory capacity, functional mobility, and self-reported global health). A 24-week follow-up phase will evaluate the sustainability of both physical activity and health outcomes after the intervention, resulting in a 36-week study duration. If successful, this study will provide a transformative, scalable solution for increasing physical activity and improving health outcomes in children with disabilities, demonstrating the feasibility of meeting established exercise guidelines and building a robust foundation for understanding their effects on health in this underserved population. Project Number: 1R01HD120345-01 | Fiscal Year: 2026 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Byron Lai | Institution: UNIVERSITY OF ALABAMA AT BIRMINGHAM, BIRMINGHAM, AL | Award Amount: $640,699 | Activity Code: R01 | Study Section: Lifestyle Change and Behavioral Health Study Section[LCBH] View on NIH RePORTER: https://reporter.nih.gov/project-details/11266764