The use of an augmented reality app to support an exercise intervention for children and young people with cancer: perspectives of users and exercise and healthcare professionals in the FORTEe trial

Hayley Marriott¹Alba Solera-Sanchez¹Stanley Windsor¹Kim Straun²Marie A. Neu³Elias Dreismickenbecker³Francesca Lanfranconi⁴Emanuele Villa⁴Joachim Wiskemann⁵Nikolai Bauer⁵Miriam Götte⁶Ronja Beller⁷Filippo Spreafico⁸William Zardo⁹Peter Wright¹Joerg Faber³Eila Watson^10*

• ¹School of Sport, Nutrition and Allied Health Professionals, Faculty of Health Science and Technology, Oxford Brookes University, Oxford, United Kingdom
• ²School for Policy Studies, University of Bristol, Bristol, United Kingdom
• ³University Medical Center of the Johannes Gutenberg-University Mainz, Childhood Cancer Center Mainz, Mainz, Germany
• ⁴Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
• ⁵Heidelberg University Hospital and National Center for Tumor Diseases, a partnership between DKFZ and University Medical Center Heidelberg, Germany, Department of Medical Oncology, Heidelberg, Germany
• ⁶University Hospital Essen, West German Cancer Center, Essen, Germany
• ⁷Clinics for Paediatrics III, Department of Paediatric Haematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
• ⁸Fondazione IRCCS Istituto Nazionale dei Tumori, Pediatric Oncology Unit, Milan, Italy
• ⁹Fondazione IRCCS Istituto Nazionale dei Tumori, Pediatric Oncology Unit, Milan, Germany
• ¹⁰Oxford Institute of Applied Health Research, Faculty of Health Science, and Technology, Oxford Brookes University, Oxford, United Kingdom

Background: Mobile health (mHealth) technologies are increasingly used in paediatric oncology to promote physical activity, with growing evidence supporting their feasibility and effectiveness. Augmented reality (AR) is emerging as a promising addition, offering interactive features that may enhance participation in exercise for young people. As mHealth tools evolve, understanding user experiences and implementation challenges is essential to inform wider adoption in healthcare. The FORTEe clinical trial evaluates an individualised exercise programme designed for children, adolescents and young adults with cancer (CAYA). This sub-study explores the perspectives of CAYA and exercise and healthcare professionals involved in delivering the exercise intervention (exercise professionals) on the use of a novel AR application (app), designed to facilitate home-based exercise as part of the broader intervention. Key app features include personalised exercise programmes, AR demonstrations using a child-like avatar, and an integrated exercise diary. Methods: CAYA (9-21 years), and exercise professionals from the FORTEe trial's technology sub-study (six centres) were eligible. To explore experiences and perceptions of the AR app, half-structured interviews were conducted with CAYA and an anonymous online survey administered to exercise professionals. Interview data and open-ended text from survey was analysed using inductive qualitative content analysis. Survey data was analysed using descriptive statistics. Results: A total of 46 CAYA (mean age 13.6 ± 2.7 years, 39% female) provided feedback on the AR app via interviews, and 31 exercise professionals completed the survey. CAYA and exercise professionals reported generally positive experiences, finding the AR demonstrations novel and engaging. The personalised workouts were valued by both groups. However, both groups reported some technical difficulties that impacted reliability, and that some features, such as the exercise diary, lacked usability. Exercise professionals emphasised the app should complement rather than replace face-to-face sessions. To enhance the app further, both groups suggested incorporating gamification and avatar customisation. Conclusion: This study emphasises the potential of AR technology to increase engagement in exercise among CAYA and highlights ways to optimise the technology. While AR shows promise in paediatric oncology care, it should complement in-person exercise interventions. Future development should prioritise user-friendly design, personalised approaches, and equal access for young patients.