# Feasibility of a tele-game-based exercise (Tele-exergame) program to prevent deconditioning in hospitalized COVID-19 patients

> **NIH VA I21** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2022 · —

## Abstract

Conventional face-to-face in-hospital mobility program (MP) is impractical for COVID-19 patients because of its
associated risk of infection to hospital staff as well as other hospitalized patients. To address the gap, we
propose a novel game-based virtually supervised (contactless) foot and ankle exercise, called Tele-Exergame,
as an alternative and practical option. The primary goal of this SPiRE application is to test feasibility,
acceptability, and proof of concept effectiveness of Exergame in COVID-19 patients as an alternative to
conventional in-hospital MP to reduce the loss of mobility during hospitalization and decline in mental health.
 Exergames are digital or web-based games that use body movement to promote physical activity and
generally involve strength, balance, and flexibility exercises. The tele-exergame MP, developed by our team,
uses a remotely supervised and game-based approach, which helps to increase patient motivation and
engagement in a cognitively demanding exercise program. For example, the Tele-Exergame MP includes foot
and ankle exercise tasks with explicit augmented visual feedback (i.e., the patient's movement controls an
object on the screen, thus providing real-time visual and audio feedback that is critical for motor learning).
Monitoring and feedback are achieved by using wearable sensors worn on feet. Our game-based exercise
includes a wide range of safe non-weight bearing exercise tasks, suitable for bedbound patients, and is
inspired by an evidence-based exercise program. A popular game (flight shooter game) that could be played
either while sitting or lying in bed by rapid, alternating ankle dorsiflexion and plantarflexion will be used. The
motion of foot is translated into the movement of an avatar to play the game; for example, to “shoot” targets on
a screen. The sensor on the foot can quantify motor and cognitive performance (e.g., slowness, weakness,
exhaustion, and working memory), defined as cognitive frailty, using a validated algorithm developed by our
team. Exercises are demonstrated remotely using a tele-medicine tablet, and the movement of subjects is
monitored in real-time by research staff.
 To demonstrate the feasibility of Tele-Exergame MP, COVID-19 or PUI (persons under investigation)
participants admitted to the MEDVAMC (n=60), with an anticipated length of stay at least 3 days will be
recruited. Participants will be randomized (n=1:1) to either intervention (IG) or control (CG) groups. Both
groups will receive standard of care. IG will additionally receive Tele-Exergame MP therapy. Tele-Exergame
sessions will range from 3-10 minutes based on patient ability and completed twice daily. Primary outcomes
include acceptability, deconditioning (cognitive-frailty), and mental health (e.g., depression and anxiety)
assessed at baseline, at discharge, and at 1-month post-discharge. Secondary outcomes include adverse
events (e.g., venous thromboembolism (VTE), falls, etc), instrumental activities of d...

## Key facts

- **NIH application ID:** 10451604
- **Project number:** 5I21RX003731-02
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Sarvari Yellapragada
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10451604

## Citation

> US National Institutes of Health, RePORTER application 10451604, Feasibility of a tele-game-based exercise (Tele-exergame) program to prevent deconditioning in hospitalized COVID-19 patients (5I21RX003731-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10451604. Licensed CC0.

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