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://ichgcp.net/clinical-trials-registry/NCT03518294.

Keywords: aerobic training; fatty liver; fatty liver disease; feasibility; fitness; liver; liver disease; nonalcoholic fatty liver disease; physical activity; steatohepatitis; telehealth; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Victoria Motz, Alison Faust, Jessica Dahmus, Benjamin Stern, Christopher Soriano, Jonathan G Stine. Originally published in JMIR Formative Research (https://formative.jmir.org), 17.08.2021.

Figures

Figure 1

Observed clinical benefits of a supervised 20-week telehealth-delivered exercise training program. (A) All patients reduced MRI-PDFF-measured liver fat with exercise training. (B) Exercise training reduced body weight in all patients. (C) Cardiorespiratory fitness improved in all patients (mean VO2 peak +9.9 [SD 6.6] mL/kg/min). (D) Waist circumference was reduced by a mean 1.3 (SD 1.6) in. MRI-PDFF: magnetic resonance imaging proton density fat fraction; VO2 peak: peak oxygen consumption.