A feasibility study of a monitored home program to increase walking and decrease frailty in cirrhotic patients

BACKGROUND: Frailty is a predictor of disease progression in cirrhotic patients. Prehabilitation programs are helpful interventions to reduce frailty and worsening sarcopenia. METHODS: This was a single-group, pre-post feasibility study of a 6-week home pedometer-monitored program with the goal of achieving a weekly compound 5%-10% step increase and thereby decreasing frailty in cirrhotic patients. A review of patients was performed 3 years after the intervention to assess clinical status and walking levels. RESULTS: Sixty-three cirrhotic patients were recruited and 71% completed the study. At the end of week 6, mean steps per day had increased by 37% from 3,394 at baseline to 4,500 (p < 0.001), with a mean weekly compound increase of 6.4%. For study completers, the mean Fried frailty index (FFI) score improved from 2.64 at baseline to 2.24 at the end of the intervention (p = 0.007). Patients with Model of End-Stage Liver Disease-Sodium (MELD-Na) scores <15 had significantly improved mean FFI scores, from 2.74 to 2.26 (p = 0.007); those with scores ≥15 did not have significant improvement. At the 3-year follow-up, 18% of patients had died, 13% had undergone liver transplantation, and 37% self-reported that they were walking more than before the intervention. CONCLUSIONS: These findings suggest the 6-week home pedometer-monitored program is feasible but is best suited for cirrhotic patients whose disease has not advanced to levels where they are considered for transplantation, as indicated by MELD-Na scores ≥15.