Use of a mobile-assisted telehealth regimen to increase exercise (MATRIX) in transplant candidates – A home-based prehabilitation pilot and feasibility trial

Abstract

Introduction. Physical fitness assessed by the liver frailty index (LFI) and 6-minute walk test (6MWT) informs the prognosis of liver transplant (LT) candidates although there is limited data on its reversibility following a prehabilitation. On a home-based exercise trial, we aimed to improve LFI and 6MWT and to investigate trial feasibility and intervention adherence. Methods. LT candidates with cirrhosis wore a personal activity tracker (PAT) and used EL-FIT (Exercise & Liver FITness app) for 14 weeks, including a 2-week technology acclimation run-in. The 12-week intervention consisted of EL-FIT plus PAT and 15-/30-min weekly calls with a physical activity coach aiming to complete ≥2 video-training sessions/week, or ≥500 step/day baseline increase for ≥8 weeks. We defined feasibility as ≥66% of subjects engaging in the intervention phase and adherence as ≥50% subjects meeting training endpoint. Results. 31 patients (61±7 years, 71% female, MELD 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 (3508 vs. baseline:1260) 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.

Home exercise, branched-chain amino acids, and probiotics improve frailty in cirrhosis: A randomized clinical trial

“…Such measures could consist of more frequent presential visits, where the particular benefits of the programme could be more discussed in person with each patient, and the use of smartphone applications. 39 …”

Emerging digital technologies to help patients with cirrhosis

“…In a 3-month study, the intervention led to improved frailty measures (liver frailty index, 6-minute walk test), including a third of patients transitioning from the frail to nonfrail state. [9] BIOMETRIC DATA…”

Editorial: Enhancing frailty assessment in liver transplantation candidates—The role of the Duke Activity Status Index in predicting mortality and guiding prehabilitation

“…Numerous predictive models exist for individuals with advCLD, including the recently updated Model for End‐Stage Liver Disease 3.0 score 2 . However, most predictive models fail to accurately capture physical frailty, which is common in LT candidates, 3 strongly predictive of poor clinical outcomes, 4 and can be reversed with exercise‐based prehabilitation programmes 5 …”