This study evaluated whether a remotely supervised exercise program delivered through real-time videoconferencing provides outcomes comparable to an established in-person program for adults with multiple sclerosis. The remote format was implemented as an adaptation of the on-site protocol during the COVID-19 pandemic. Using a quasi-experimental design, outcomes related to fatigue, pain, physical health, balance, mobility, functional strength, and grip strength were assessed at baseline, three months, and six months. The analysis included 456 participants enrolled in either the standard in-person program or the remotely supervised version. Participants were predominantly women with relapsing-remitting disease. Across patient-reported outcomes, the remotely supervised program did not achieve non-inferiority at either follow-up time point, indicating that perceived fatigue, pain, and physical health improved less than in the in-person format. In contrast, several performance-based measures demonstrated comparable improvements between groups, including balance, mobility, and grip strength, and functional strength met non-inferiority criteria at six months. These findings suggest that real-time remote supervision can effectively support objective physical performance improvements but may be less effective in achieving comparable self-reported symptom benefits. Differences between subjective and objective outcomes may reflect the broader context of pandemic-related stressors affecting symptom perception.

Background: Adults with disabilities living in low-resource communities experience persistent inequities in access to healthcare, mental health services, and community participation. However, qualitative data capturing lived experiences in the Deep South remain limited. This study aimed to identify priority needs among adults with mobility disabilities residing in economically distressed communities near Birmingham, Alabama, to inform future telehealth programming. Methods: Fifteen adults (mean age = 60 ± 10 years), predominantly African American and female, completed semi-structured phone interviews exploring basic needs, neighborhood accessibility, health priorities, and perceived supports. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s six-phase thematic analysis. Results: Five themes emerged: (1) seeking stability amid severe mental health strain and inadequate supports; (2) constrained food environments shaped by cost, location, and safety; (3) feeling forgotten: systemic neglect and restricted participation in community life; (4) physical health deprioritized by competing needs and structural barriers; and (5) remote support as a viable but unrealized option. Participants described how safety concerns, transportation barriers, and rising food costs constrained daily functioning, while unmet mental health needs compounded isolation. Despite widespread cardiometabolic disease, immediate needs related to mental health, food, and housing consistently superseded physical health. Mental health support was identified as the most feasible area for remote delivery, though poor awareness of available resources limited engagement with any service model. Conclusions: Findings demonstrate that disability-related disparities in low-resource communities are driven largely by structural and environmental factors rather than individual choice. Telehealth and mobile-based services may provide a feasible access strategy for mental health and supportive care in under-resourced settings, particularly when integrated with broader community supports. Addressing foundational needs is essential for advancing health equity among people with disabilities in the Southeast.

Background: Children with disabling conditions encounter numerous challenges in participating in physical activity within their community. Telehealth has emerged as an ideal method for promoting physical health and wellness, but there is a need to identify optimal implementation strategies. Objective: This study aimed to describe the telehealth physical activity preferences of active children and youth with disabling conditions to rapidly inform the development of a pilot telehealth program that could be delivered nationally. Methods: A cross-sectional survey was conducted among a convenience sample of pediatric members of a community-based wellness program. Questions probed preferences for delivery method; programming frequency, intensity, duration, and type; desired outcomes; technology access and proficiency; and additional needed supports. Of the initial 56 respondents, 4 (7.1%) over the age of 18 years were excluded, leaving 52 (92.9%) for analysis. Outcomes were summarized descriptively. Results: Of 392 wellness program members, 56 (14.3%) responses were gathered. The mean age of the 52 analyzed respondents was 10 (SD 3; range 5-16) years. The sample predominantly comprised male (32/52, 61.5%) and White (34/52, 65.4%) individuals, with autism spectrum disorder and developmental disorder as the most common disability types (22/52, 42.3% each). Social and psychological barriers were the most frequently reported challenges to physical activity participation (36/52, 69.2% and 27/52, 51.9%, respectively). Most respondents reported an ideal exercise dose of 1 to 2 sessions per week of 30 to 45 minutes at a novice or beginner difficulty level. Winter was the preferred season for participation. The 2 most desired delivery formats were live videoconferencing and prerecorded videos. Desired program outcomes included strength improvement, mental health, developing new hobbies and activities, and social connection. Over 90% of respondents (47/52, 90.4%) reported having adequate technology at home to support virtual participation. Conclusions: Optimal telehealth programs for this cohort should be brief and low intensity and offered seasonally, with both live and prerecorded delivery options. Although this preferred dose does not meet US physical activity guidelines, it may represent an appropriate starting point for many inactive children with disabilities. Future research should examine behavior change strategies that motivate children to enroll in these programs and support gradual increases in physical activity over time.

Research Objectives (1) To qualitatively explore the preferences and needs of adults with spinal cord injury (SCI) regarding participation in physical activity interventions; (2) To develop a discrete choice experiment (DCE) survey to quantify the most valued features of such interventions, with the goal of informing the design of more tailored and effective programs. Design Qualitative interview study using a content analysis approach Setting One-on-one, semi-structured interviews were conducted remotely via Zoom or phone. Participants A convenience sample of 30 adults with traumatic SCI participated in the study. The mean age was 45 years (range: 25–71 years). Gender distribution was balanced (47% male, 53% female). Most participants identified as African American (64%) and had paraplegia (83%) and incomplete injuries (63%). Injury levels included cervical (n=8), thoracic (n=10), lumbar (n=10), and sacral (n=2). Interventions N/A Main Outcome Measures Content analysis of interview transcripts identified key preferences and needs related to physical activity program design, including the "what, when, where, and who" elements of intervention delivery. Results Findings from the interviews informed the development of a preliminary discrete choice experiment (DCE) survey that captured the diverse preferences of adults with SCI regarding physical activity programs. The survey includes questions designed to elicit priorities across multiple domains, such as participants’ primary physical goals and additional benefits they hope to achieve beyond physical outcomes. It also explores preferences for exercise modality and their prior experience with the selected modality. Key structural elements of the program—such as its overall duration, frequency per week, and session length—are included, along with preferences for delivery format and convenient locations. The role of the trainer, including the desired level and frequency of support, was also addressed, as was interest in behavioral coaching. Additionally, participants expressed views on ideal group size, preferred intensity levels, and how progress should be monitored and communicated. Finally, the survey seeks to understand what type of knowledge or educational content participants hope to gain from the program experience. Conclusions Insights from this phase will inform the development of a structured DCE survey to quantify exercise program preferences among adults with SCI. The finalized survey, enhanced with expert input and literature review, will be administered to a larger cohort to explore variations by age, functional level, and motivation. This preference-based approach offers a scalable model for designing tailored, inclusive exercise interventions across disability groups.

Purpose: Recent studies have shown that high-intensity interval training (HIIT) can improve cardiometabolic health in individuals with spinal cord injury (SCI); however, many barriers remain for individuals with spinal cord injury to participate in exercise such as lack of time, accessible equipment and facilities, and transportation. The use of telehealth interventions may be a form of exercise delivery that can ease the burden on the participant and lead to greater exercise participation. Thus, the purpose of this study was to determine the feasibility and efficacy of a home-based telehealth HIIT arm crank exercise training program for individuals with spinal cord injury. Methods: Participants were randomly assigned to 16 weeks of telehealth HIIT arm crank exercise training or a no-exercise control group. Body composition, resting energy expenditure (REE), blood lipids, insulin sensitivity, blood pressure, aerobic capacity (VO2 max), and a qualitative interview were assessed at baseline and at 16 weeks post intervention. Results: Six individuals (four male and two female, mean age 52.7 +/- 10.2 years) with spinal cord injury were recruited for this study. Four out of five HIIT participants showed improvements in aerobic capacity, insulin sensitivity, and resting energy expenditure. Three qualitative themes emerged: (1) convenience and perceived benefits were critical elements of engagement; (2) high-intensity exercise elicited time-sensitive responses; and (3) trainers played a key role in promoting strong program adherence. Conclusions: Overall, we found that this program could be easily implemented and per-formed at home in individuals with spinal cord injury. We also found that participants enjoyed the 1:1 training sessions with a telecoach and that the intervention was easy to adhere to, as demonstrated by participant attendance. There is a need for future randomized controlled trials to determine the efficacy of telehealth exercise training for improving cardiometabolic health in spinal cord injury.

AIM:To examine the feasibility of a seated virtual reality exercise telehealth intervention on physical activity and cardiometabolic health in young people with cerebral palsy (CP). METHOD:This was a randomized two-arm parallel group study: an immediate start group versus a waitlist control that continued usual activities of daily living. The home-based intervention targeted 150 minutes per week of moderate-intensity exergaming for 12 weeks, using Meta Quest virtual reality headsets and games, adapted for seated exercise. Data were collected remotely in weeks 0, 7, and 13. RESULTS:Thirty-two young people with CP enrolled (mean age 16 years 8 months [SD 3 years 8 months], 19 females, 13 males), with a 9.4% dropout rate. Immediate start completers (n = 13) averaged 144 minutes per week (SD 73 minutes per week) of total exercise but fell short of the moderate-exercise target (150 minutes per week) at week 3 by 25%, week 6 by 31%, and week 12 by 48%. Immediate start surveys demonstrated that moderate-to-vigorous physical activity increased by 166% and 108% at weeks 7 and 13 respectively. Immediate start insulin levels improved by 45.2% and triglycerides by 20.2% from week 0 to 7. Waitlist control insulin and high-sensitivity C-reactive protein worsened from week 0 to 13 by 42.8% and 40% respectively. INTERPRETATION:Seated virtual reality exercise is a feasible and safe intervention that significantly increases physical activity participation. It shows potential for favorably influencing certain cardiometabolic markers, although further research is needed to establish sustained benefits.

Telehealth pulmonary rehabilitation (PR) expands access to rehabilitation services for individuals with COPD by addressing barriers to participation in center-based programs. However, it remains important to assess whether these programs follow an intervention framework that effectively enhances the well-being of individuals with COPD. This scoping review analyzed current literature on telehealth PR to identify trends and gaps in program components, delivery methods, remote monitoring, use of telehealth technology, program effectiveness, participants' subjective perceptions, and recommendations. A systematic search of databases such as PubMed, Web of Science, and Embase identified relevant studies published between January 2010 and June 2024. Eligible studies included adults (≥18 years) with COPD and used randomized controlled trials, quasi-experimental, observational, qualitative, or mixed-method designs. This review highlighted considerable heterogeneity in reporting of the baseline sociodemographic and clinical characteristics. About 50% of studies employed hybrid models combining asynchronous and synchronous interventions. Remote monitoring with Bluetooth-enabled devices was included in 46% of studies to track vital signs and activity levels. Common interventions included aerobic and resistance training (94%), aerobic training alone (34%), self-management education (70%), and health coaching (43%). Theoretically grounded health coaching showed promise in supporting self-management of symptoms and health behaviors. Despite these advances, significant gaps remain in remote assessment of functional outcomes and tailored interventions that account for diverse sociodemographic and clinical profiles. Overall, telehealth PR demonstrated noninferiority to center-based PR. The programs using a multimodal approach including exercise training, self-management education, health coaching, health care professionals, and peer support were effective in improving program adherence, health outcomes and reducing health care burden. The qualitative findings emphasized the importance of baseline technical training, tailoring programs to disease severity, and continuous support from health care providers and peers to sustain positive health behaviors.

Background: 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. Objective: 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. Methods: 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's 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. Results: 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. Conclusions: 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.

While half of individuals with Rett syndrome exceed 50 years of age, research shows that they have low levels of physical activity, especially for those of advanced age and poor ambulation. Despite this evidence, recent studies underscore the potential of leisure-time physical activity interventions to improve health outcomes and quality of life for individuals with Rett syndrome. This scoping review aimed to summarize the state of the science regarding physical interventions for individuals with Rett syndrome and their families across the lifespan, map the extent, range and nature of research activity in telehealth, and to describe outcomes targeted by interventions with a focus on health-related fitness. Systematic searches were performed within MEDLINE, SCOPUS, Google Scholar and CINAHL Plus. The data charted from eligible studies included specific details about the participants, study design, setting, intervention characteristics, outcomes, and relevant key findings. Inclusion criteria: (1) original, peer-reviewed research, (2) full text articles in English, (3) study reported a leisure-time physical activity intervention, (4) had a sample of individuals with RTT and or a caregiver. Twenty-three studies enrolled a total of 200 participants (mean age of 13±7, range 2 to 48 years of age). Participants were all females and studies included mostly ambulatory individuals. Rett syndrome severity was reported in less than half of the studies; however, the participants with mild to severe scores were represented. Most of the studies used a case study design or single group repeated measures and only three randomized trials were identified. The focus was primarily on gross motor function, walking ability, and physical activity outcomes. Nine interventions implemented telehealth into their design primarily using remote video call between a physical therapist and the participant’s parent. The findings of this review provide a foundation for designing evidence-based, scalable physical activity programs tailored to the unique needs of individuals with RTT. The integration of telehealth strategies offers a promising avenue for enhancing accessibility and caregiver engagement.

Background:Children have busy daily schedules, making school an ideal setting for promoting health-enhancing exercise behavior. However, children with mobility disabilities have limited exercise options to improve their cardiorespiratory fitness and cardiometabolic health. Objective:This study aims to test the feasibility of implementing a virtual reality (VR) exercise program for children with mobility disabilities in a high school setting. Methods:A pre- to posttrial single-group design with a 6-week exercise intervention was conducted at a high school. The study aimed to enroll up to 12 students with a disability. Participants were given the option of exercising at home or school. The exercise prescription was three 25-minute sessions per week at a moderate intensity, using a head-mounted VR display. School exercise sessions were supervised by research staff. Home exercise sessions were performed autonomously. Several implementation metrics of feasibility were recorded, including exercise attendance, volume, adverse events or problems, and benefits related to health-related fitness (walking endurance and hand-grip strength). The study also included a qualitative evaluation of critical implementation factors and potential benefits for participants that were not included in the study measures. Outcomes were descriptively analyzed, and 2-tailed t tests were used as appropriate. Results:In total, 10 students enrolled in the program and 9 completed the study (mean age 17, SD 0.6 y). In total, 5 (56%) participants exercised at school, and 4 (44%) exercised at home; 1 participant dropped out prior to exercise. The mean attendance for all 9 completers was 61.1% (11/18 sessions). The mean exercise minutes per week was 35.5 (SD 22) minutes. The mean move minutes per session was 17.7 (SD 11) minutes. The mean minutes per session was 18 (SD 1.4) minutes for school exercisers and 17 (SD 18) minutes for home exercisers, indicating variable responses from home exercisers. The mean rating of perceived exertion per exercise session was 4.3 (SD 2), indicating a moderate intensity that ranged from low to hard intensity. No adverse events or problems were identified. No improvements in walking endurance or hand-grip strength were observed. School exercisers achieved a higher attendance rate (83%) than home exercisers (27%; P<.001) and seemingly had a 2-fold increase in the volume of exercise achieved (school: mean 279, SD 55 min; 95% CI 212-347; home: mean 131, SD 170 min; 95% CI -140 to 401; P=.10). Qualitative themes relating to implementation factors and benefits to participant well-being were identified. Conclusions:This study identified factors to inform an optimal protocol for implementing a high school-based VR exercise program for children with disabilities. Study findings demonstrated that moderate exercise at school is feasible in VR, but simply providing children with VR exergaming technology at home, without coaching, will not successfully engage them in exercise.

OBJECTIVE:To examine the effects of a 12-week online movement-to-music (eM2M) intervention on health outcomes in people with mobility disabilities. DESIGN:Two-arm randomized controlled trial. SETTING:Synchronous, online delivery over Zoom. PARTICIPANTS:Adults (N=97) aged 18-70 and diagnosed with traumatic brain injury, stroke, multiple sclerosis, spinal cord injury, spina bifida, Parkinson, or cerebral palsy were randomized either to eM2M (n=48) or control (n=49). INTERVENTIONS:eM2M participants completed three 60-minute sessions weekly for 12 weeks, whereas controls maintained usual activities. MAIN OUTCOME MEASURES:Primary measures included resting heart rate, heart rate recovery, and grip strength. Secondary measures included Short Physical Performance Battery (SPPB), timed Up and Go, PROMIS 10 Global Health Items, Ability to Participate in Social Roles and Activities Short Form 8a, and Godin Leisure Time Exercise Questionnaire. Participants were assessed at baseline and postintervention, with intent-to-treat mixed-model analysis of covariance as primary analyses. RESULTS:After adjusting for baseline and mobility groups, there was no significant between-group difference in resting heart rate postintervention, though eM2M had a greater reduction in heart rate at minute-1 recovery (LSM=33.7%, P=.04). No difference was observed in dominant hand grip strength, whereas controls showed a significantly greater increase in nondominant grip strength compared to eM2M (LSM=-1.76kg, P=.03). In contrast, eM2M demonstrated significant improvements in overall SPPB (LSM=0.52, P=.048), gait speed (LSM=0.32, P=.02), and both physical (LSM difference=2.08, P=.04) and mental (LSM=2.22, P=.02) health compared to controls. No group differences were observed in social participation. After removing outliers, eM2M showed a significant increase in physical activity compared to controls (LSM=11.55, P=.02). CONCLUSIONS:Movement-to-music delivered online may improve cardiorespiratory fitness, mobility, quality of life, and physical activity in people with mobility disabilities.

Objective:(1) To examine the experiences and perceptions of people with multiple sclerosis (MS) who previously completed a 3-month tele-exercise program; (2) to identify modifiable factors regarding the program components and implementation procedures that could be used to develop an adaptive tele-exercise intervention. Design:A qualitative study using a semistructured interview guide. Setting:An extension of a comparative effectiveness trial delivered for 761 people with MS between 2016 and 2021. Interviews were conducted over Zoom or phone. Participants:Twenty-two adults with MS who completed the 3-month program (age range, 24-67y, 86% women, 73% Caucasian, 68% relapsing-remitting MS). Participants presented a wide range of mobility disabilities, ranging from no mobility limitation to wheelchair or scooter (n=22). Interventions:Not applicable. Main Outcome Measures:Thematic analysis of the transcribed interview led to the identification of desirable components and delivery mechanisms of the tele-exercise program. Results:Our analysis indicated the importance of individualized and ongoing modification of exercise program content to accommodate changes in participants' functional abilities and health status. Participants reported an ideal timepoint of human support, preferably every 3 weeks, via phone or videoconference calls to capture the intervention modification needs (eg, exercise position, intensity, and clarification of exercise instruction). We further identified desirable components for behavioral modifications, such as inclusion of an exercise companion and self-monitoring tool and postintervention resources for sustaining exercise participation during follow-up periods. Conclusions:The findings of this study offer insights into tailoring future adaptive tele-exercise intervention designs aimed at promoting engaging and sustainable exercise participation in people with MS.

Background Wheelchair users live predominantly sedentary lifestyles and have a substantially higher risk for cardiometabolic disease and mortality compared to people without disabilities. Exercise training has been found to be effective in improving cardiometabolic health (CMH) outcomes among people without disabilities, but research on wheelchair users is limited and of poor quality. Objective The primary aim of this study is to examine the immediate and sustained effects of a 24-week, telehealth, movement-to-music cardiovascular (M2M-C) exercise program on core indicators of CMH among adult wheelchair users compared to an active control group. The secondary aim is to explore the beneficial effects of M2M-C exercises on cardiovascular capacity, physical activity, and quality of life. Intervention components include tailored exercises and remote performance monitoring, delivered via live videoconference training by a telecoach and asynchronous videos. Methods This study’s design is a parallel-arm randomized controlled trial enrolling 132 physically inactive adult wheelchair users with poor cardiometabolic profiles. The M2M-C intervention group involves 24 weeks of virtual live and monitored home exercise training (3×/wk, 15-40 min/session), followed by a 12-week maintenance period where participants have access to an online media library of exercise videos. The control group involves 36 weeks of self-guided exercise through access to a media library of exercise videos, including videos for range of motion, muscle strength, and balance. The primary outcomes are cardiometabolic indicators of health, and assessors are blinded. Results Recruitment procedures started in January 2024 with the first participant enrolled on March 18, 2024. All data are anticipated to be collected by November 2027, and the main results of the trial are anticipated to be published by February 2028. Secondary analyses of data will be subsequently published. A total of 16 participants have been recruited as of paper submission. Conclusions The knowledge obtained from this trial will provide evidence to inform exercise prescriptions aimed at improving CMH among adult wheelchair users. Trial Registration ClinicalTrials.gov NCT05606432; https://clinicaltrials.gov/study/NCT05606432 International Registered Report Identifier (IRRID) DERR1-10.2196/57423

Background:There are limited options for aerobic exercise options that improve cardiorespiratory fitness and manage cardiometabolic health that are also age-appropriate and suitable for children with mobility disabilities. Children with disabilities require exercise programs that incorporate adapted movements to meet various functional needs, which offer brief training durations to accommodate busy schedules and use remote training methods at home to bypass logistical transportation barriers. Objective:The aim of this study is to test the potential effects and safety of a sprint-intensity arm-exercise interval training program, combined with music and telehealth, on cardiorespiratory fitness and cardiometabolic health in a child with cerebral palsy. Methods:This study was a 12-week exercise intervention from pretrial to posttrial for a single child with cerebral palsy (male, age 17 y). The intervention was conducted at the participant's homes. The participant exercised 3 times per week while following along with YouTube exercise videos. Videos included 4-second maximal sprint bouts followed by periods of rest, which were repeated 30 times during a single exercise session (total of ~2 minutes of maximal exercise). Exercise sessions were supervised by research staff using videoconferencing. Cardiorespiratory fitness was indicated by peak oxygen consumption (pVO2), which was measured by a portable metabolic cart during a graded exercise test. Cardiometabolic health outcomes included body composition by dual-energy x-ray absorptiometry scan and a cardiometabolic blood profile by a dried blood spot test. Outcomes were descriptively analyzed. Results:The participant achieved a 33.6% increase in pVO2 (14.6 to 19.5 mL/kg-1/min-1), a 37.8% improvement in blood triglycerides (82 to 51 mg/dL), and a 15.4% improvement in the total cholesterol to high-density lipoprotein ratio (6.5 to 5.5). Additionally, he had a 5.9% reduction in body weight (171 to 161 lbs) and a 9.6% reduction in total body fat (61.35 to 55.48 lbs) from the arms, legs, and trunk. The participant experienced no adverse events or problems during the intervention. After completing the program, the participant elicited a maximal intensity of exercise using armbands, as demonstrated through pVO2. Conclusions:Sprint-intensity interval training that uses the arms may be safe and potentially effective for enhancing cardiorespiratory fitness and cardiometabolic health in children with physical disabilities. Further research is needed to verify the outcomes of this case report.

Objectives To investigate the preliminary efficacy of a maximal-intensity arm exercise program on cardiorespiratory fitness and cardiometabolic health among children with cerebral palsy and to evaluate the feasibility of the program via safety and adherence. Design Randomized controlled trial with a 2-armed parallel-group design, which aims to recruit 50 children with cerebral palsy (aged 6-17y of age). Participants are randomized to either an immediate start (IS) 12-week sprint-intensity exercise program or a waitlist control group that continues habitual activity for 12 weeks. Setting Home exercise and recruitment from the Division of Pediatric Rehabilitation Medicine clinics at the Children's Hospital of Alabama. Participants A total of 25 participants (N=25) were enrolled: 3 participants dropped out, 7 are ongoing, and 12 completed. Interventions The program included 3 supervised exercise sessions conducted at home, monitored through a web-based platform with videoconference and heart rate monitoring features. Exercises included adapted movements with music and child-appropriate themes (eg, superheroes, pop culture), guided by prerecorded videos on YouTube. Main Outcome Measures Outcomes were measured before and after intervention (weeks 0 and 13, respectively). Peak oxygen consumption (pVo2; primary outcome) was measured by portable metabolic cart during a graded exercise test. Secondary outcomes included body composition (measured by dual x-ray absorptiometry) and cardiometabolic profile (measured by blood spot test). Feasibility was evaluated by several process metrics. Results From completers or those in the IS group (n=12), exercise session attendance was 92% (n=238/258 sessions; n=12), and the exercise intensity achieved was a score of 6.7 (hard to very hard intensity) on the 0-10 Borg rating of perceived exertion scale. No adverse events or problems were identified or reported. Repeated-measures analysis of variance demonstrated a statistically significant group difference in the rate of change in pVo2 measured at pre and post, in favor of the IS group (df=12; F=11.9; P=.005). Mean change in pVo2 for the IS group was 1.7±1.9 mL/min/kg (95% confidence interval, 0-3.4mL/min/kg; n=7) and −0.52±3.2 mL/min/kg (95% confidence interval, −3.5 to 2.5mL/min/kg; n=7). No statistically significant changes were observed among other variables. Conclusions Preliminary analysis of this ongoing trial suggests improvements in cardiorespiratory capacity following a telehealth sprint-intensity arm exercise program. Findings demonstrate that the program is safe and well attended by children with cerebral palsy. Further analysis upon completion of the trial is necessary to enhance the strength of the presented findings. Disclosures none.

Background: There is a critical need for feasible, non-equipment based, safe, and cost-effective exercise interventions to promote muscle strength, dynamic postural balance, and independent mobility in adolescents with cerebral palsy (CP) or spina bifida (SB). Objectives: This study aimed to examine the feasibility and preliminary response of a novel exercise program: Functionally Loaded High-Intensity Circuit Training (FUNHIT) and conventional High-Intensity Circuit Training (HIT) in adolescents with CP/SB. Methods: Enrolled participants were allocated to FUNHIT or HIT or Controls in our randomized control trial. The interventions were delivered 2×/week × 4 weeks. Feasibility was assessed through process, operational, and scientific metrics. Outcome measures included maximum walking speed, Four Square Step Test (FSST), Timed Up and Go (TUG) and its dual-task variants, Lateral Step-Up Test (LSUT), Fear of Falling (FoF) and physical activity (PA) questionnaires. Results: We tested 5 participants (1 CP, 4 SB) in our study. Recruitment and retention rates were acceptable (63% enrollment, 100% retention and adherence). FUNHIT (n = 2) participants showed improvements in maximum walking speed (8–12%), FSST (15–29%), LSUT (22–33%), and TUG (4%). The HIT participant (n = 1) demonstrated improved TUG dual-task performance (40%) and FSST (30%) only. Control participants (n = 2) had varied changes (from 0–24%) in mobility, strength, balance. No adverse events were reported. Participants successfully followed (100%) the prescribed exercise dosage over the four-week period. Conclusions: FUNHIT and HIT are feasible and safe interventions for adolescents with ambulatory CP and SB who retain motor function, showing promising preliminary improvements in muscle strength, dynamic balance, and independent mobility. Our findings need to be validated in larger samples.

BackgroundVirtual reality (VR) can supplement exercise therapy for poststroke upper-arm hemiparesis, but treatments have been largely limited by specialized or costly equipment, hindering replicability and generalizability. ObjectiveThis study examined the feasibility of using a commercially available bundle of VR supplies to improve hemiparetic arm function before and after an exergaming program in an individual post stroke. MethodsWe conducted a pre-post case study (male, aged 72 years, chronic stroke) of a 20-day VR exergaming program (1-hour session per day) using a head-mounted display (Meta Quest 2), with adaptive software (WalkinVR) to boost and adjust in-game movements. Measures of upper-arm function were performed at preintervention (day 0), midintervention (day 10), and postintervention (day 21) and included the Wolf Motor Function Test (WMFT) and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). Data were descriptively analyzed. ResultsThe participant demonstrated improvement in the mean time to complete tasks of the WMFT by 70.5% (δ=11.73 s; preintervention mean time 16.63, SD 31 s; effect size=0.54) from preintervention to midintervention and 78% (δ=12.96 s; effect size=0.59) from preintervention to postintervention. WMFT mean functional ability score demonstrated an improvement of 18% (δ=0.46 points; preintervention mean score 2.67, SD 0.87 points; effect size=0.59) from preintervention to midintervention and 23% (δ=0.6 points; effect size=0.79) from preintervention to postintervention. Range of motion improved in all joints by an average of 35.64% (SD 20%) from preintervention to postintervention. DASH scores demonstrated minimal improvements across the intervention. ConclusionsVR exergaming with adaptive software could be an easy-to-adopt method for improving the functional ability of the hemiparetic arm among people post stroke. Improvements were potentially meaningful but warrant confirmation in more rigorous study designs.

Objectives (1) To assess whether current telerehabilitation programs for individuals with chronic obstructive pulmonary disease (COPD) incorporate a comprehensive multimodal approach to address dyspnea, exercise tolerance, psychosocial well-being, long-term adherence, and health-related quality of life. (2) To identify and summarize (a) baseline assessment and remote monitoring; (b) mode of delivery (synchronous, asynchronous, and combined); (c) program components and intervention characteristics; (d) remote monitoring including devices for automatic data transfer; (e) statistically significant outcomes; (f) subjective experience and perceived benefits, barriers, and facilitators; (g) theoretical foundations for behavior change interventions. Design This study is a scoping review of telerehabilitation programs in individuals with COPD. The review was conducted between April 2024-Aug 2024. Setting Studies included home-based rehabilitation or telehealth rural sites in individuals with COPD. Participants Inclusion and exclusion criteria were used to identify the relevant studies using 3 databases (PubMed, Embase, Web of Science). A search syntax including key words and their synonyms was used to retrieve studies. Interventions The studies included in the review used telerehabilitation for individuals with COPD. The telerehabilitation was delivered through the use of web-based software, mobile applications, or telephone. Main Outcome Measures The primary outcome measures included exercise capacity and health-related quality of life; the secondary outcome measures included physical activity, anxiety, depression, social isolation, loneliness, self-management, episodes of acute exacerbations, hospitalizations, and program adherence. Results This review included 30 studies on tele-ehabilitation program from a total of 302 studies after removal of duplicates, title and abstract screening and full-text screening. A total of 3340 participants with mean age of 66 years and moderate to severe COPD were included in 30 studies. Most interventions lasted 8 weeks, while 5 studies were long-term (6-24mo) and evaluated the benefits of long-term, home-based exercise intervention after standard outpatient-based rehabilitation. This review highlighted heterogeneity in reporting baseline characteristics such as COPD stage, supplemental oxygen, severity of comorbidities, use of assistive devices, and social support. Most interventions were conducted in a home-based setting, except 3 studies conducted in rural setting via Telehealth site. Twenty studies reported continuous monitoring for assessment of safety parameters and/or physical activity such as oxygen saturation, heart rate, rate of perceived exertion, and daily steps, while 12 studies used Bluetooth devices for automatic data transfer. Most studies used combined asynchronous and synchronous approaches for program delivery. Synchronous approaches used real-time videoconferencing and phone calls while asynchronous approaches used video-guided education and exercises at participants’ convenience. Most commonly reported interventions were exercise (aerobic and resistance training) in 94% studies, walking training in 34% studies, education in 60% studies, and health coaching in 43% studies. The less commonly reported interventions included mind–body exercises (ie, yoga and tai chi) and mindfulness-based intervention in 2 (7%) studies. Education was primarily delivered asynchronously and was comprised of topics such as COPD disease, inhaler technique, smoking cessation, energy conservation, breathing technique, nutrition, and physical activity. Health coaching was delivered synchronously in most studies and included collaborative goal setting for healthy behavior change. The average weekly duration of aerobic and strength training delivered asynchronously was reported as 176 minutes, while synchronous exercise intervention lasted longer, 215 min/wk. The average weekly duration of synchronous education sessions was longer (102 minutes) than that of asynchronous education (20-30 minutes). In 13 (43%) studies, behavior change interventions such as health coaching or health care professional sessions were based on theoretical foundations such as motivational interviewing, SMART goals, salutogenic theory, COM-B model, value clarification exercise, and promotion of self-efficacy. The review highlighted the benefits of combined (asynchronous and synchronous) approaches in improving long-term adherence, self-management abilities, self-efficacy, exercise tolerance, disease burden, and health-related quality of life. Two qualitative studies using the combined approach reported improvement in mood, physical function, peer support, motivation, and need for personalized consultations. Conclusion Telerehabilitation is a safe, feasible, and noninferior therapeutic approach for the COPD population. However, there is a lack of uniformity in baseline comprehensive assessments, which would be beneficial for a person-centered therapeutic approach. The current telerehabilitation programs include primary components such as exercise, education, and health coaching with lack of mind–body-based and nutritional interventions to improve overall well-being. A combined asynchronous and synchronous approach is more beneficial in improving health outcomes and perceived satisfaction. The behavioral change interventions such as health coaching based on theoretical foundations improve self-management ability and self-efficacy, reduced episodes of acute symptom exacerbation and emergency department visits, and promoted long-term adherence to healthy lifestyle behaviors. Disclosures none.

Background Pediatric patients with cancer have limited options to self-manage their health while they are undergoing treatments in the hospital and after they are discharged to their homes. Extended reality (ER) using head-mounted displays has emerged as an immersive method of improving pain and mental health and promoting health-enhancing physical activity among a variety of clinical groups, but there is currently no established protocol for improving both physical and mental health in pediatric cancer rehabilitation. Objective This phase I, pilot, feasibility randomized controlled trial aims to investigate the potential effects of a 14-week ER program on physical activity participation and indicators of health among pediatric patients with cancer who undergo bone marrow transplantation. An ancillary aim is to evaluate the feasibility of the program through participant engagement. Methods This study includes a 2-arm parallel group design with a 1-group crossover (the control group will start the intervention after a waiting period). Overall, 16 pediatric patients with cancer undergoing rehabilitation (aged ≥8 years) at a children’s hospital will be randomly allocated into one of two groups: (1) an immediate start group that undergoes an ER program in the hospital until discharge and then for 8 weeks at home (total duration of approximately 14 weeks), and (2) a waitlist control group that undergoes usual care in the hospital and for 8 weeks at home, before receiving the 8-week home ER program. The program will include active video gaming with rhythmic music exercises as well as mindfulness-based practices using a high-quality app. Home-based programming will include behavioral coaching calls. Physical activity will be measured daily through step counts using a tri-axial accelerometer. Health outcomes will be measured across time and include global health, measured by the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health Scale Short Form 7+2, and lung function, measured by a forced expiratory volume using a peak flow meter. Feasibility will be evaluated through participant engagement metrics, such as enrollment, dropout, adverse events, and attendance rates. Descriptive statistics will be obtained for all study variables. Outcomes will be modeled using mixed modeling procedures, and changes in means will be estimated with CIs. Results The study was funded in February 2024. Recruitment procedures started on June 27, 2024. All data are anticipated to be collected by February 2026. Full trial results are anticipated to be analyzed and submitted for publication by March 2026. The study’s anticipated end date is March 31, 2026. Conclusions This trial tests an accessible remote program for improving both physical and mental health among pediatric patients with cancer. The knowledge obtained from this study will inform the development of a larger trial. Trial Registration ClinicalTrials.gov NCT06298357; https://clinicaltrials.gov/study/NCT06298357 International Registered Report Identifier (IRRID) DERR1-10.2196/64879