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

• Published in: Clinical and translational gastroenterology Vol. 14; no. 11; p. e00601
• Main Authors: Duarte-Rojo, Andres, Bloomer, Pamela M., Grubbs, Rachel K., Stine, Jonathan G., Ladner, Daniela, Hughes, Christopher B., Dunn, Michael A., Jakicic, John M.
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer 01.11.2023; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: End Stage Liver Disease; Exercise; Exercise Therapy; Feasibility; Feasibility Studies; Female; Frailty; Humans; Intervention; Liver; Liver cirrhosis; Liver diseases; Male; Physical fitness; Preoperative Exercise; Severity of Illness Index; Smartphones; Telemedicine; Walking
• ISSN: 2155-384X; 2155-384X
• DOI: 10.14309/ctg.0000000000000601

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. 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. 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. 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.