Feasibility of an App-based Nutrition & Exercise Program in Cirrhosis

Patients living with chronic disease are at-risk for frailty because of their potentially sedentary lifestyle and/or symptoms. Supervised exercise programs are useful for improving or maintaining physical capacity as measured by common physical function measures. However, accessibility is limited due to scheduling, transportation, employment, and residential location. Unsupervised, self-directed home-based programs have had limited success due to absence of peer support and accountability.

An alternative is an app-based program that offers interactive engagement with study staff and accountability. Further, follow-along videos and tracking for both nutrition and exercise can be completed at the patient's convenience.

A 12-week pilot study with patients living with cirrhosis will assess the acceptability of the programming. The hypothesis is that study participants will find the customization of the app and interaction with the study staff acceptable as measured by completion rates (primary study endpoint). Secondary outcomes include change in measures (0-12 weeks) for the 6-minute walk test (6MWT), thigh muscle thickness, and chair sit-to-stands. At the end of the study, participants will also complete a program satisfaction survey (developed in-house).

Interviews with participants, caregivers, and study staff, conducted via videoconference at 4-6 weeks and end of study, will be descriptively analysed to identify feasibility, acceptability, and perceived utility of the program. Analyses will also identify areas for program improvement.

Inclusion criteria

• adult (aged 18 years and older)
• diagnosis of cirrhosis (MELD<25) according to biopsy, imaging, elastography, or other
• fulfill the guideline-based prophylaxis in place for high risk gastroesophageal varices
• able to communicate (e.g., speak, read, and write) in English
• provide informed written consent for self

Exclusion criteria

• hepatocellular carcinoma (HCC) outside of the Edmonton liver transplant criteria
• previous myocardial infarction
• EF <50%
• ischemia on stress testing
• oxygen saturation <95%
• non-HCC malignancy
• end-stage renal disease.
• at the discretion of the healthcare team if a participant can participate in the pilot study