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Background: Numerous barriers to moderate to vigorous physical activity exist for youths with type 1 diabetes (T1D). The virtual exercise games for youth with T1D (ExerT1D) intervention implement synchronous support of moderate to vigorous physical activity including T1D peers and role models. Objective: This study aims to understand the acceptability of this intervention to participants. Methods: We conducted postprogram, semistructured, televideo interviews with participating youths to elicit perspectives on the acceptability of the intervention and experience with the program. Two coders independently reviewed and analyzed each transcript using a coding scheme developed inductively by senior researchers. Discrepancies were resolved by team discussion, and multiple codes were grouped together to produce 4 main thematic areas. Results: All 15 participants provided interviews (aged 14-19 years; 2 nonbinary, 6 females; median hemoglobin A1c level of 7.8% (IQR 7.4%-11.2%), 5 with a hemoglobin A1c level of ≥10%). Qualitative data revealed four themes: (1) motivation to engage in physical activity (PA)—improving their physical capabilities and stabilizing glucose levels were cited as motivation for PA and challenges of living with T1D were cited as PA barriers; (2) experience with and motivation to manage diabetes while engaging in PA—participants provided details of accommodating the inherent uncertainty or limitations of PA with diabetes and sometimes preparing for PA involved psychological and motivational adjustments while some relayed feelings of avoidance; (3) peer support encouraged engagement with the intervention—participants appreciated the peer aspects of components of ExerT1D and participants’ reflections of the facilitated group experience highlight many benefits of a small-group virtual program; and (4) improvements in PA and diabetes self-management efficacy—all participants credited the program with improving or at least raising awareness of T1D management skills. Conclusions: Our virtual PA intervention using an active video game and discussion component provided adolescents with T1D the confidence and peer support to engage in PA, improved awareness of diabetes-specific tasks to prepare for exercise, and improved understanding of the effect of PA on glucose levels. Engaging youths with a virtual video game intervention is a viable approach to overcome barriers to PA for adolescents with T1D. Trial Registration: ClinicalTrials.gov NCT05163912; https://clinicaltrials.gov/ct2/show/NCT05163912

Background College students are vulnerable to setting long-term trajectories of low physical activity (PA) but are reachable via mobile health fitness tracking (eg, mobile health step counting) and interpersonal support tailored to the college community. However, no studies have statistically isolated the appeal and influence of these intra- and interpersonal components in college-based PA interventions. Objective This study retrospectively examined a college-based PA promotion program at a northeast US public university during the COVID-19 pandemic to (1) test the impact of student status on the use of intervention components and (2) determine whether such use was associated with successful retention and goal achievement in the program. Methods The university used a commercial platform for a 30-day PA promotion program during April 2021 with intrapersonal (step-tracker syncing, education, self-monitoring, and motivational messaging) and interpersonal (friend interactions and team games) components. App use was operationalized as intrapersonal (frequency of opening app, education, and self-monitoring) and interpersonal (friends made in-app and team affiliation and size). Results Campus-wide emails elicited sign-up by 156 undergraduate students, 57 graduate students, and 126 faculty and staff members. Objective 1 yielded the following results: undergraduates used the app less frequently (median 0.8, IQR 0.4-1.7 times per day) than other groups (graduate students: median 1.4, IQR 0.7-2.7 times per day; P=.01; faculty: median 1.3, IQR 0.7-2.7 times per day, H2=14.5; P=.001) but made the same number of friends (median 1-2) and teammates (median 8-9; P=.77 for friends and P=.93 for teammates). Objective 2 yielded the following results: most participants (313/335, 93.4%; 95% CI 90%-96%) were retained for the first 7 days, but by 30 days, retention dropped, most notably for undergraduate students (82/154, 53.2%; 95% CI 45%-61%), followed by graduate students (39/56, 70%; 95% CI 56%-81%) and faculty and staff (93/125, 74.4%; 95% CI 66%-82%; χ22=12.6; P<.001). Retention was associated with app engagement frequency (model hazard ratio 0.56, 95% CI 0.43-0.72; P<.001) and affiliation with a team having high median app engagement and a large size (intracluster correlation coefficient 0.064, 95% CI 0.001-0.164, P=.05). Meeting a daily step goal was associated with app engagement frequency (β=.72, SE=0.21; P=.001), number of friends (β=.40, SE 0.20; P=.04), and an initial motive of maintaining or increasing (rather than starting) PA (β=.99, SE=0.21; P<.001). Conclusions College students, compared with faculty and staff, used the app less frequently, used the app for a shorter duration before abandonment, and met the step goal on fewer days. Engagement with the program was associated with longer retention and better PA outcomes, which were critically modified by the interpersonal engagement. These findings suggest that college students using virtual PA support during times of physical isolation could benefit from more tailored implementation strategies (eg, timed prompts and team reassignments).

INTRODUCTION: Adolescents with type 1 diabetes (T1D) face barriers to moderate-to-vigorous physical activity (MVPA) such as uncertainty with self-management, limited access to supportive environments, and stigma related to living with diabetes. Opportunities for 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. METHODS: The program included 6 versions: study 1 (1.1-1.4) included an active video game, and study 2 (2.1-2.2) included a virtual reality (VR) active video game. All versions included T1D exercise management education by clinicians and goal-setting guided by young adult coaches with T1D. RESULTS: Seventeen 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%]) were enrolled. Participants rated the program, comfort, clinicians, coaches, and group cohesion high/very high. Motivation for the video game was high. Building T1D and MVPA self-management skills was rated excellent at most sessions, as were peer interactions and enriched communication after adding immersive VR in study 2. Transitions between VR apps caused delays of 19 ± 6 min per 60 min-90 min session. Compared to baseline, HbA1c or glucose management indicator decreased over time in an exploratory analysis (d = -1.12, 90% CI: [-1.78, -0.48]). CONCLUSIONS: In a small cohort, the ExerT1D program facilitated a supportive environment for engaging diverse youth with T1D in an MVPA program led by T1D coaches. Larger studies are needed to assess the intervention's impact on engagement with physical activity, glycemic outcomes, and quality of life.

Abstract – Introduction: Adolescents with type 1 diabetes (T1D) face barriers to moderate-to-vigorous physical activity (MVPA) such as uncertainty with self-management, limited access to supportive environments, and stigma related to living with diabetes. Opportunities for 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. Methods: The program included 6 versions: study 1 (1.1–1.4) included an active video game, and study 2 (2.1–2.2) included a virtual reality (VR) active video game. All versions included T1D exercise management education by clinicians and goal-setting guided by young adult coaches with T1D. Results: Seventeen 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%]) were enrolled. Participants rated the program, comfort, clinicians, coaches, and group cohesion high/very high. Motivation for the video game was high. Building T1D and MVPA self-management skills was rated excellent at most sessions, as were peer interactions and enriched communication after adding immersive VR in study 2. Transitions between VR apps caused delays of 19 ± 6 min per 60 min–90 min session. Compared to baseline, HbA1c or glucose management indicator decreased over time in an exploratory analysis (d = −1.12, 90% CI: [−1.78, −0.48]). Conclusions: In a small cohort, the ExerT1D program facilitated a supportive environment for engaging diverse youth with T1D in an MVPA program led by T1D coaches. Larger studies are needed to assess the intervention’s impact on engagement with physical activity, glycemic outcomes, and quality of life. © 2026 S. Karger AG, Basel