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Testing Multiple Delivery Methods of the Virtual Exercise Games for Youth with T1D Peer Intervention: Protocol
Garrett I Ash1,2, Soohyun Nam3, Selene S Mak4
1Department of Internal Medicine and Department of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut, USA, garrett.ash@yale.edu.
Hormone Research in Paediatrics
|February 16, 2026
Summary
The ExerT1D program, using virtual reality games and T1D coaches, showed feasibility and acceptability for adolescents with type 1 diabetes (T1D) to improve physical activity and self-management skills.
Area of Science:
- Pediatric Endocrinology
- Digital Health Interventions
- Adolescent Health
Background:
- Adolescents with type 1 diabetes (T1D) face significant barriers to moderate-to-vigorous physical activity (MVPA), including self-management challenges, lack of supportive environments, and diabetes-related stigma.
- Limited opportunities exist for peer engagement and role model support among youth with T1D, hindering participation in physical activities.
- The Virtual Exercise Games for Youth with T1D (ExerT1D) program was developed to address these needs through iterative refinements for feasibility and acceptability.
Purpose of the Study:
- To test the feasibility and acceptability of iterative refinements of the ExerT1D program.
- To evaluate the program's potential to support T1D self-management and MVPA engagement in adolescents.
- To explore the impact of virtual reality integration on participant experience and outcomes.
Main Methods:
- A pilot program involving 6 versions of ExerT1D, incorporating active videogames and virtual reality (VR) active videogames.
- All program versions included T1D exercise management education delivered by clinicians and goal-setting support from young adult coaches with T1D.
- Seventeen adolescents (median age 15.4 years) with T1D participated, with iterative design changes based on feedback.
Main Results:
- Participants reported high satisfaction with the program, clinicians, coaches, and group cohesion.
- Motivation for videogame engagement was high, and T1D/MVPA self-management skills were rated as excellent.
- Exploratory analysis indicated a decrease in HbA1c/Glucose Management Indicator (GMI) over time (d=-1.12).
Conclusions:
- The ExerT1D program successfully created a supportive environment for adolescents with T1D to engage in MVPA, guided by peers with T1D.
- The integration of VR enhanced communication and peer interactions, although technical delays were noted.
- Larger studies are warranted to confirm the intervention's impact on physical activity, glycemic control, and quality of life.
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