Diabetes mellitus is a chronic and non-communicable disease, with approximately five to seven percent of diagnosed cases classified as type-1 diabetes (T1DM). T1DM can develop due to immunodeficiency factors that lead to the destruction of pancreatic cells and subsequent reliance on exogenous insulin [1], [2]. Over the years, elevated blood glucose levels can worsen the lipid profile, characterised by high levels of low-density lipoprotein (LDL) cholesterol and low levels of high-density lipoprotein (HDL) cholesterol. Additionally, the inflammatory profile may be affected, as evidenced by increased levels of c-reactive protein [1], [2], [3], [4], [5]. The current guidelines emphasise on insulin therapy, a balanced diet, minimising sedentary habits (such as sedentary screen time) and engaging in exercise [1], [2].

The guidelines recommend traditional aerobic activities such as running (RUN), jogging and cycling, as well as strength activities like gym or functional exercises. In both human and animal models, across both healthy and diabetic patients, engaging in a single session of these activities has been shown to enhance glucose uptake by muscle cells and aid in controlling circulating glucose levels, ultimately improving the overall metabolic profile over time [[1], [2], [6], [7], [8]]. In recent years, exergames, also known as active video games (AVG), have also been proposed as an alternative for both healthy and diabetic individuals, offering exercise-like movements such as jumping, squats, punching, kicking and deflecting [[2], [9]]. These games have been shown to enhance metabolism, including blood glucose levels, heart rate, and oxygen consumption, similar to traditional aerobic sessions, thereby providing potential cardiovascular health benefits [[2], [9], [10]].

The maintenance of cardiovascular and metabolic health parameters in T1DM patients is influenced by other factors, including lipid profile, inflammation, and immune system responses [2]. These parameters could be affected by single- and multi-session protocols, involving aerobic, strength, or combined exercise [[6], [11], [12]]. Different effects on lipid profiles (such as LDL and HDL), inflammation (such as c-reactive protein), and immune system responses (including leukocytes) have been observed. These differences could be attributed to variations in the volume and intensity of exercise sessions, as well as differences in age cohorts [[3], [6], [11], [12]]. To ensure accurate comparison, it is important to verify intensity- and duration-matched sessions. It is worth noting that while some studies examined these changes for up to 30 mins, the acute changes in biochemical variables may persist for up to 24 hours after the aerobic exercise session [[11], [13], [14]].

A meta-analysis of longitudinal studies has shown inconsistent effects of exercise on lipid profiles (triglycerides, HDL or LDL) for T1DM patients [6]. While some cross-sectional research suggests positive impacts on related markers like inflammation in animal and human models [[11], [12], [13]], the duration of direct lipid changes in humans is poorly understood, with limited evidence beyond short-term effects [3]. Considering that aerobic sessions may be less motivating for T1DM individuals, exploring alternative exercise options and their effects becomes important [[2], [9], [10]]. Therefore, we aim to compare the 24-hour biochemical blood responses following aerobic and exergame sessions in T1DM patients. We hypothesise that both sessions will yield similar blood responses after 24 hours.