Utilization of a Directly Supervised Telehealth-Based Exercise Training Program in Patients With Nonalcoholic Steatohepatitis: Feasibility Study

Abstract

Background Most patients with nonalcoholic fatty liver disease (NAFLD) are physically inactive despite the well-known benefits of physical activity. Telehealth offers promise as a novel way to deliver an exercise training program and increase physical activity. However, the feasibility, safety, and efficacy of telehealth-based exercise programs is unknown in patients with NAFLD. Objective The aim of this study was to determine the feasibility of a directly supervised exercise training program delivered exclusively with telehealth to patients with nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD. Methods In response to COVID-19 research restrictions, we adapted an existing clinical trial and delivered 20 weeks of moderate-intensity aerobic training 5 days a week under real-time direct supervision using an audio–visual telehealth platform. Aerobic training was completed by walking outdoors or using a home treadmill. Fitness activity trackers with heart rate monitors ensured exercise was completed at the prescribed intensity with real-time feedback from an exercise physiologist. Results Three female patients with biopsy-proven NASH were enrolled with a mean age of 52 (SD 14) years. The mean body mass index was 31.9 (SD 5.1) kg/m2. All patients had metabolic syndrome. All patients completed over 80% of exercise sessions (mean 84% [SD 3%]) and no adverse events occurred. Body weight (mean –5.1% [SD 3.7%]), body fat (mean –4.4% [SD 2.3%]), and waist circumference (mean –1.3 in. [SD 1.6 in.]) all improved with exercise. The mean relative reduction in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was 35.1% (SD 8.8%). Mean reductions in hemoglobin A1c and Homeostatic Model Assessment for Insulin Resistance were also observed (–0.5% [SD 0.2%] and –4.0 [SD 1.2], respectively). The mean peak oxygen consumption (VO2peak) improved by 9.9 (SD 6.6) mL/kg/min. Conclusions This proof-of-concept study found that supervised exercise training delivered via telehealth is feasible and safe in patients with NASH. Telehealth-based exercise training also appears to be highly efficacious in patients with NASH, but this will need to be confirmed by future large-scale trials. Trial Registration ClinicalTrials.gov NCT03518294; https://clinicaltrials.gov/ct2/show/NCT03518294

Using Telehealth for Diagnosis and Management of Non‐Alcoholic Fatty Liver Disease

“…Studies to determine role of telehealth specifically for NAFLD/NASH patients remain few and far between 16,17 . But opportunities abound for the use of telehealth to improve diagnosis and management of fatty liver disease.…”

“…Using wearable devices can help monitor simple measures such as step count, daily weights and even diet. Motz et al demonstrated improvements in physical, laboratory, and imaging findings of 3 NASH patients by applying telemonitoring and supervised exercise training 17 …”

“…There are only few reports on successful utilization of telehealth in lifestyle modification for NAFLD. 16,17 In this review, we will highlight the potential for using telehealth in diagnosis and management of fatty liver disease and review the feasibility in reducing disparities in care. review on March 3, 2021] and expanded its use to urban populations.…”

“…Telemedicine has been used successfully in the field of hepatology around the world, 10,12‐15 but data on fatty liver disease is limited. There are only few reports on successful utilization of telehealth in lifestyle modification for NAFLD 16,17 . In this review, we will highlight the potential for using telehealth in diagnosis and management of fatty liver disease and review the feasibility in reducing disparities in care.…”

“…19 Studies to determine role of telehealth specifically for NAFLD/NASH patients remain few and far between. 16,17 But opportunities abound for the use of telehealth to improve diagnosis and management of fatty liver disease. There is a significant unmet need to guide and educate PCPs in rural areas or during a pandemic at community hospitals without access to gastroenterologists/ hepatologists, in diagnosis and management of NAFLD/ NASH.…”