Facilitating the Virtual Exercise Games for Youth with T1D (ExerT1D) Peer Intervention: Protocol Development and Feasibility

AimsAdolescents with type 1 diabetes (T1D) face several unique challenges to engaging in moderate-to-vigorous physical activity (MVPA), including uncertainty with diabetes self-management, risk of hypoglycemia, limited access to safe or supportive environments, and diabetes-specific stigma. Opportunities for T1D peer activities with T1D role model support are limited. To address this need, we tested iterative refinements of pilot Virtual Exercise Games for Youth with T1D (ExerT1D) for feasibility and acceptability. Materials and MethodsYouth with T1D (ages 14-19) were recruited at a pediatric diabetes clinic and through social media. The program included 6 versions: study #1 (versions 1.1-1.4) included an active videogame, while study #2 (versions 2.1-2.2) included a virtual reality active videogame. All versions of the program included education about managing T1D with MVPA and objective habitual MVPA goal-setting guided by clinicians and young adult coaches living with T1D. ResultsSeventeen adolescents (median age 15.4 [IQR 14.6 - 16.4] years, 7 non-Hispanic white, 8 male, median HbA1c 8.1% [IQR 7.4%-11.1%]) enrolled. In total there were 260 person-sessions offered over 130 person-weeks. 15 participants attended 83% of sessions. Sessions began with pre-MVPA safety briefing with glucose checks, followed by the MVPA session, and ended with debriefing, goal-setting, and role-playing skits involving educational points related to T1D management. Participants rated the program, comfort, clinicians, coaches, and group cohesion high/very high (4.2{+/-}0.5 to 4.8{+/-}0.3 out of 5). They also rated motivation for the videogame high (4.1{+/-}0.4 out of 5). Building T1D and MVPA self-management skills achieved an excellent rating at a majority of sessions in both versions (76%), as did peer interactions (69%) and enriched communication (56%) after the addition of immersive virtual reality in version #2. Transitions between virtual reality apps forced group delays of 19{+/-}6min per session and some individuals to exercise separately. Compared to baseline, glycemic metrics appeared to decrease over time (d= -1.12, 90% CI [-1.78, -0.48]). No participants experienced diabetic ketoacidosis, severe hypoglycemia, or injuries during the study period. ConclusionsOverall, ExerT1D facilitated excellent peer support by engaging diverse youth with T1D in an MVPA program led by role models living with T1D.