@Article{info:doi/10.2196/30239,
author="Motz, Victoria
and Faust, Alison
and Dahmus, Jessica
and Stern, Benjamin
and Soriano, Christopher
and Stine, Jonathan G",
title="Utilization of a Directly Supervised Telehealth-Based Exercise Training Program in Patients With Nonalcoholic Steatohepatitis: Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="17",
volume="5",
number="8",
pages="e30239",
keywords="physical activity; fatty liver; telemedicine; liver; nonalcoholic fatty liver disease; liver disease; fatty liver disease; aerobic training; telehealth; fitness; feasibility; steatohepatitis",
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 ",
issn="2561-326X",
doi="10.2196/30239",
url="https://formative.jmir.org/2021/8/e30239",
url="https://doi.org/10.2196/30239",
url="http://www.ncbi.nlm.nih.gov/pubmed/34402795"
}