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Use of a Mobile-Assisted Telehealth Regimen to Increase Exercise in Transplant Candidates: A Home-Based Prehabilitation Pilot and Feasibility Trial
Duarte-Rojo, Andres Bloomer, Pamela M. Grubbs, Rachel K. Stine, Jonathan G. Ladner, Daniela Hughes, Christopher B. Dunn, Michael A. Jakicic, John M.
Duarte-Rojo, Andres
Bloomer, Pamela M.
Grubbs, Rachel K.
Stine, Jonathan G.
Ladner, Daniela
Hughes, Christopher B.
Dunn, Michael A.
Jakicic, John M.
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Abstract
INTRODUCTION:
Physical fitness assessed by the Liver Frailty Index (LFI) and 6-minute walk test (6MWT) informs the prognosis of liver transplant candidates, although there are limited data on its reversibility after prehabilitation. On a home-based exercise trial, we aimed to improve LFI and 6MWT and to investigate trial feasibility and intervention adherence.
METHODS:
Liver transplant candidates with cirrhosis wore a personal activity tracker and used Exercise and Liver FITness app for 14 weeks, including a 2-week technology acclimation run-in. The 12-week intervention consisted of Exercise and Liver FITness app plus personal activity tracker and 15-/30-minute weekly calls with a physical activity coach aiming to complete ≥2 video-training sessions/week, or ≥500 step/d baseline increase for ≥8 weeks. We defined feasibility as ≥66% of subjects engaging in the intervention phase and adherence as ≥50% subjects meeting training end point.
RESULTS:
Thirty-one patients (61 ± 7 years, 71% female, model for end-stage liver disease 17 ± 5, ∼33% frail) consented and 21 (68%) started the intervention. In the 15 subjects who completed the study, LFI improved from 3.84 ± 0.71 to 3.47 ± 0.90 (P = 0.03) and 6MWT from 318 ± 73 to 358 ± 64 m (P = 0.005). Attrition reasons included death (n = 4) and surgery (n = 2). There was 57% adherence, better for videos than for walking, although daily steps significantly increased (3,508 vs baseline: 1,260) during best performance week. One adverse event was attributed to the intervention.
DISCUSSION:
Our clinical trial meaningfully improved LFI by 0.4 and 6MWT by 41 m and met feasibility/adherence goals. In-training daily step increase supported physical self-efficacy and intervention uptake, but maintenance remained a challenge despite counseling.
Description
Date
2023-07-24
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Lippincott, Williams & Wilkins
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Keywords
Physical rehabilitation, Cirrhosis, Wearable, Frailty, Cardiorespiratory fitness
Citation
Duarte-Rojo A, Bloomer PM, Grubbs RK, Stine JG, Ladner D, Hughes CB, Dunn MA, Jakicic JM. Use of a Mobile-Assisted Telehealth Regimen to Increase Exercise in Transplant Candidates: A Home-Based Prehabilitation Pilot and Feasibility Trial. Clin Transl Gastroenterol. 2023 Nov 1;14(11):e00601. doi: 10.14309/ctg.0000000000000601. PMID: 37477616; PMCID: PMC10684184