A therapeutic exercise program for adolescents engaged in gender diversity services: study protocol for a non-randomised clinical trial

Introduction:
Despite the well-documented benefits of exercise for adolescents’ physical and mental health, exercise remains an underutilized strategy for improving the health of trans adolescents. This is notable because, compared to their cisgender peers, trans adolescents experience greater health challenges and systemic barriers to being physically active. To date, no research has evaluated an evidence-based exercise service within specialist paediatric gender services in Australia.

Methods:
The study is a non-randomised type 2 effectiveness-implementation hybrid trial for adolescents engaged with Child and Adolescent Health Service Gender Diversity Service at Perth Children’s Hospital, Western Australia. The participant group will receive the intervention alongside standard care. The design of the program has incorporated input from the GENder idenTity Longitudinal Experience (GENTLE) Cohort Consumer Advisory group; trans young people, families, and health professionals; guidelines for common medical presentations within paediatric gender services and international physical activity guidelines for adolescents. Program implementation and feasibility (i.e., participant engagement, perceptions and experiences of the intervention), as well as preliminary effectiveness of the targeted exercise program on health outcomes (i.e., quality of life, wellbeing and markers of physical health), will be evaluated as part of a pilot trial.

Discussion:
This project addresses a significant gap in research and healthcare and aims to enhance service delivery by integrating exercise into standard care for specialist paediatric gender services in Australia. Anticipated impacts include shaping current and future practices by defining safe, effective exercise for trans adolescents while laying the groundwork for larger scale implementation and research on long-term health benefits.