Home-based program with incentives, daily text reminders boosts activity in LT candidates
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A home-based, prehabilitation program for liver transplant candidates that included financial incentives and text reminders increased walking by one-third over baseline, according to data presented at EASL Congress.
“We wanted to test the feasibility and acceptability of a home-based, pragmatic patient-randomized program among liver transplant candidates at a single liver transplant center,” Marina Serper, MD, MS, assistant professor of gastroenterology and hepatology at the University of Pennsylvania, said during her presentation. “Our inclusion criteria was age of 21 or older and having a MELD score of less than or equal to 25. We did not want to take patients with very high MELD scores who would be too ill to exercise. Patients had to be on the active liver transplant waitlist or on the pre-waitlist list that we have at the University of Pennsylvania.”
To evaluate the efficacy of behavioral intervention to promote exercise before liver transplantation, Serper and colleagues randomly assigned 30 patients (mean age, 61 years; 47% women; median MELD-Na, 13) with at least one high-risk feature of frailty, impaired mobility or malnutrition to intervention (n = 20) or control (n = 10) arms.
Patients in the intervention arm were given a wearable personal fitness tracker (Nokia Go), which included financial incentives and text-based reminders to increase daily steps by 15% in 2-week intervals for a total of 12 weeks. Both arms were given personalized dietary and physical activity recommendations based on a nutrition assessment, short physical performance battery (SPPB) and frailty, and were incentivized to check in weekly with study staff.
Researchers studied feasibility and acceptability, as well as mean end-of-study step counts, SPPB, grip strength and body composition.
Of the 30 patients, one-third were frail by grip strength alone, 97% met criteria for prefrailty, 37% had impaired mobility by SPPB, 56% had low muscle mass and 23% had a history of falls. The mean liver frailty index was 4.
According to Serper, all of the patients in the intervention arm thought the exercises were easy and helpful compared with 67% of patients in the control arm, while 61% of participants in the intervention group thought the nutrition recommendations were helpful vs. 78% in the control arm.
Nearly 90% of participants reported the fitness trackers were easy to use and more than 80% were willing to extend the intervention after transplant. Further, 83% of patients in the intervention arm thought the step count goals were helpful, and 94% in this arm reported the weekly check-ins were helpful.
During the weekly-check ins, patients reported 51% adherence to step goals and 93% adherence to step measurement. The most commonly reported barriers to exercise were fatigue and weather, and pain was rarely reported.
Of note, Serper told attendees that end-of-study step counts were nearly 1,000 steps higher in the intervention arm vs. the control arm.
“Now this does not sound like a lot to a healthy individual,” Serper said. “However, if you look at the beginning, the control arm is actually walking about 2,600 steps only at baseline, and the intervention arm was walking 2,160 steps at baseline. So over time, and we see this in patients on the waitlist, the control group actually was walking less, potentially becoming a little bit more deconditioned, whereas the intervention arm actually gained steps.”
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Serper M, et al. Abstract OS-052: Prehabilitation intervention to maximize early recovery (PRIMER) in liver transplantation: a randomized, controlled trial. Presented at: EASL Congress; June 21-24, 2023; Vienna (hybrid meeting).
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