Feasibility of using telehealth to deliver an exercise and nutrition intervention to people with non-alcoholic fatty liver disease

INTERVENTION: This is a 12‐week pilot randomized controlled trial designed to investigate the feasibility of using telehealth as an approach to remotely deliver an exercise and dietary program for middle‐aged and older adults (aged 45 years and over) with diagnosed non‐alcoholic fatty liver disease (NAFLD). Specifically, the program will focus on lifestyle strategies aimed to promote regular muscle strengthening training, increased dietary protein intake (predominantly from plant‐based sources) and promote healthy eating behaviours to optimise body composition, muscle strength and function. Following baseline assessments, participants will be randomised (1:1 ratio) to receive either usual care or the telehealth lifestyle intervention. Those participants allocated to the telehealth intervention will be prescribed a 12‐week muscle strengthening program by a qualified accredited exercise physiologists (EP) using a commercially available (and free) web‐based exercise prescription platform and app (TeleHab) accessible via a smart device (phone or tablet). TeleHab is a digital platform specifically designed for health professionals to prescribe exercise programs to participants remotely that can also track and monitor progress, provide regular feedback and assess particpant adherence via app analytics. Selecting from a library of >5,000 exercises, the EP will design an individualised program for each participant including the training dose (frequency, sets, repetitions) for each exercise. The participant can set reminders for exercise times, record exercise completion (sets, repetitions) and rate their perceived exertion and any pain for each exercise. Exercise prescription will be personalised based on the participant’s baseline assessment, medical and physical activity history, a CONDITION: Diet and Nutrition ‐ Other diet and nutrition disorders Metabolic and Endocrine ‐ Other metabolic disorders Musculoskeletal ‐ Other muscular and skeletal disorders Non alcoholic fatty liver disease; ; Non alcoholic fatty liver disease PRIMARY OUTCOME: Adherence (>80% of serves to protein rich foods/week): as assessed via protein check lists[At completion of the 12 week intervention] Adherence (66% or two out of threee sessions/week) to the exercise (muscle strengthening program): assessed via Telehab App[At completion of the 12 week intervention] SECONDARY OUTCOME: Acceptability of exercise intervention as assessed via questionnaire (Likert scale) and qualitative interview data (thematic analysis)[At completion of the 12 week intervention] Acceptability of nutrition intervention as assessed via questionnaire (Likert scale) and qualitative interview data (thematic analysis) ; INCLUSION CRITERIA: Participants must be adults aged 45 years and over with a diagnosis of NAFLD determined by routine ultrasound or biopsy; and at least one elevated serum ALT level (>20 U/L female, >30 U/L male) during the past 6 months. Eligible participants must have no evidence of another form of liver disease and have consent from their consulting physician. To be included in this study participants must also have access to a smart phone ipad/tablet or computer with text message functioning and be able and willing to use it during course of study to receive messages and push notifications, have a home internet connection and own or have access to (e.g., chemists, GP) electronic scales suitable for self‐reported weighing. ; [At completion of the 12 week intervention] Adverse events (eg. muscle sprain, exacerbation of existing injury) for exercise (muscle strengthening) program: collected via Telehab App and video consultations conducted with accredited exercise physiologist. [Collected weekly (Telehab app) and at weeks 2 and 6 after commencing intervention (video consults): reported at completion of the 12 week intervention] Lower limb muscle strength/function: assessed via sit to stand test[Baseline, 6 and 12 weeks after commencing the intervention] Perceptions of safety for exercise (muscle strengthening) program assessed via a 5‐point Likert scale [At completion of the 12 week intervention] Physical activity (sedentary, light intensity and moderate‐vigorous physical activity): assessed via accelerometer[Baseline, 6 and 12 weeks after commencing the intervention] Protein Intake (g/kg/day): as assessed via 24‐hour diet record[Baseline, 6 and 12 weeks after commencing the intervention] Retention to the exercise and nutrition intervention as assessed via audit of study records (REDCap)[At completion of the 12 week intervention] Satisfaction of exercise intervention as assessed via questionnaire (Likert scale) and qualitative interview data (thematic analysis)[At completion of the 12 week intervention] Satisfaction of nutrtion intervention as assessed via questionnaire (Likert scale) and qualitative interview data (thematic analysis)[At completion of the 12 week intervention] Usability as assessed via the System Usability Scale questionnaire[At completion of the 12 week intervention]