LIFE Study: Liver transplant recipient Initiative: Feasibility study to Enhance cardio-metabolic health

The study will assess the feasibility of implementing a telehealth model of care for delivering nutrition and exercise advice for the prevention and treatment of obesity and metabolic dysfunction after liver transplantation. There will be two groups; intervention group and a wait list control group randomised in a 2:1 ratio. Intervention: - Participants will undergo education for increasing physical activity in line with Australian National Guidelines (30minutes daily, up to 150minutes per week of aerobic and resistance activity) and aligning dietary patterns with Mediterranean Eating style. The Mediterranean diet education will focus on increasing use of extra virgin olive oil, increasing vegetables, fruits and legumes and nuts, increasing fish and seafood and decreasing dairy products and red meat. The dietary intervention will not include recommendations to include red wine as alcohol abstinence is expected to be maintained in this target group. Education is focused on food choice and dietary pattern with no specific education around weight reduction even though weight loss may occur as a result of dietary change. The exercise intervention will consist of x1 per week for 12 weeks supervised (via QHealth Portal) exercising involving a 10minute warm up, 20 minutes of a variety of aerobic and resistance exercises, followed by stretches 10min. The physical activity performed during these face to face sessions will vary across the course of the study to educate the participants on a variety of different exercises that they can choose to undertake to reach their daily 30min or weekly 150mins physical activity. Participants can freely choose what exercise to undertake outside of the supervised sessions, and can use the sessions to ask questions, discuss goal setting and receive any individualised modifications to exercises to suit their needs. Workbooks, cookbooks and exercise equipment including stepper, mat and thera-bands will be provided and used in the education sessions so that the participants can freely choose recipes and exercises that match with their personal preferences. A Dietitian will provide the education and support for Mediterranean Eating with fortnightly group appointments. An Exercise Physiologist will provide education and support for weekly exercise training sessions. Both health professionals will assist in goal setting and tracking of activities. Fidelity of the service delivery will be assessed by regular supervision of the intervention appointments by principal investigators and professional support and case discussions at weekly team meetings. The intervention will be delivered via the Queensland Health Portal whereby participants will log in online from their home device (computer/laptop/ipad) with the health professional located centrally at the Princess Alexandra Hospital and multiple participants logging in to each appointment for a group session. The first session will be one-on-one for the health professional to determine any individual specific needs, but all remaining appointments will be group based. The intervention will continue for 12 weeks with x5 1 hr sessions with the Dietitian and x12 1hr sessions with Exercise Physiologist. Adherence and compliance with the model of care will be assessed at each session by the health professional. Log books to record exercise sessions and diet tracking checklists will assist in recording adherence to recommendations for diet and exercise. Heart rate monitors will be used to monitor intensity of exercise reached.