INTRODUCTION Physical fitness assessed by the Liver Frailty Index (LFI) and 6-minute walk test (6MWT) informs the prognosis of liver transplant candidates, although there are limited data on its reversibility after prehabilitation. On a home-based exercise trial, we aimed to improve LFI and 6MWT and to investigate trial feasibility and intervention adherence. METHODS Liver transplant candidates with cirrhosis wore a personal activity tracker and used Exercise and Liver FITness app for 14 weeks, including a 2-week technology acclimation run-in. The 12-week intervention consisted of Exercise and Liver FITness app plus personal activity tracker and 15-/30-minute weekly calls with a physical activity coach aiming to complete ≥2 video-training sessions/week, or ≥500 step/d baseline increase for ≥8 weeks. We defined feasibility as ≥66% of subjects engaging in the intervention phase and adherence as ≥50% subjects meeting training end point. RESULTS Thirty-one patients (61 ± 7 years, 71% female, model for end-stage liver disease 17 ± 5, ∼33% frail) consented and 21 (68%) started the intervention. In the 15 subjects who completed the study, LFI improved from 3.84 ± 0.71 to 3.47 ± 0.90 ( P = 0.03) and 6MWT from 318 ± 73 to 358 ± 64 m ( P = 0.005). Attrition reasons included death (n = 4) and surgery (n = 2). There was 57% adherence, better for videos than for walking, although daily steps significantly increased (3,508 vs baseline: 1,260) during best performance week. One adverse event was attributed to the intervention. DISCUSSION Our clinical trial meaningfully improved LFI by 0.4 and 6MWT by 41 m and met feasibility/adherence goals. In-training daily step increase supported physical self-efficacy and intervention uptake, but maintenance remained a challenge despite counseling.

中文翻译：

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使用移动辅助远程医疗方案来增加移植候选者的锻炼：家庭预康复试点和可行性试验。

简介 通过肝脏衰弱指数 (LFI) 和 6 分钟步行测试 (6MWT) 评估的体能可以告知肝移植候选者的预后，尽管关于预康复后其可逆性的数据有限。在一项家庭运动试验中，我们的目标是改善 LFI 和 6MWT，并调查试验的可行性和干预依从性。方法 患有肝硬化的肝移植候选人佩戴个人活动追踪器并使用“运动和肝脏健身”应用程序 14 周，其中包括为期 2 周的技术适应磨合。为期 12 周的干预包括锻炼和肝脏健身应用程序加上个人活动追踪器以及每周 15/30 分钟与体育活动教练的通话，旨在每周完成 ≥2 次视频训练课程，或每天基线增加 ≥500 步持续≥8周。我们将可行性定义为 ≥66% 的受试者参与干预阶段，将坚持性定义为 ≥50% 的受试者达到训练终点。结果 31 名患者（61 ± 7 岁，71% 女性，终末期肝病模型 17 ± 5，∼33% 虚弱）同意，21 名患者（68%）开始干预。在完成研究的 15 名受试者中，LFI 从 3.84 ± 0.71 改善至 3.47 ± 0.90 ( P = 0.03)，6MWT 从 318 ± 73 改善至 358 ± 64 m ( P = 0.005)。自然减员原因包括死亡 (n = 4) 和手术 (n = 2)。尽管在最佳表现周期间每日步数显着增加（3,508 步与基线：1,260），但视频的坚持率为 57%，比步行更好。一项不良事件归因于干预。讨论 我们的临床试验有意义地将 LFI 提高了 0.4，将 6MWT 提高了 41 m，并达到了可行性/依从性目标。训练中每日增加步数支持身体自我效能和干预措施的吸收，但尽管有咨询，维持仍然是一个挑战。