The effectiveness of a telerehabilitation exercise program in people with chronic liver disease

Brief name: A telerehabilitation exercise program for people with chronic liver disease. Materials: Participants will be randomised to an intervention group (telerehabilitation group) or control group. The intervention participants will be provided with a hard and soft copy of a telerehabilitation exercise program. They will also receive a logbook to log compliance with the exercise program. Procedures: All participants will undertake outcome measure testing before and after the intervention period. This will involve assessment of: strength (1 repetition maximum chest press, leg press and hand dynamometry), endurance (Vo2 peak graded treadmill test), anthropometry (ISAK restricted profile), health related quality of life (SF-12 questionnaire) and liver health (Liver function blood test and Fibroscan) Who: The investigator will be an honours physiotherapy student. He will be supervised by a Curtin University Associate Professor (14 years) and Exercise Physiologist at Fiona Stanley Hospital/Royal Perth Hospital (25 years). Clinical Support will be provided by a practicing Gastroenterologist and Hepatologist at Fiona Stanley Hospital, Clinical Associate Professor and Research Fellow at The University of Western Australia, and Clinical Associate Professor at Curtin University. Mode of delivery: Once prescribed the exercise program, participants will complete it independently, however, participants will be provided with 3 sessions of telerehabilitation. Telerehabilitation is where the investigator will engage with small groups (3 participants) of intervention participants using MS Teams. Participants and the investigator will engage using a video call on their own personal smart phone, laptop or tablet. Devices will not be provided by the study investigators. Frequency of exercise: The exercise program will span 8 weeks. Participants will complete aerobic training 3x/week and strength training 2x/week. The telerehabilitation program will be supervised for 1 strength exercise session in week 3, 5 and 7. Aerobic training sessions will range from 15-30 minutes in length and the strength training sessions will be approximately 20 minutes long. The aerobic exercise program will involve a moderate intensity walking program. Participants will begin with a moderate intensity 15-minute walk every aerobic training session for the first week of the intervention. For the first 4 weeks (week 1-4), walking duration will increase by 5 minutes every week until the participants are walking 30 minutes per session (i.e. week 1 walks will be 15 minutes in duration, week 2 walks 20 minutes in duration, week 3 walks 25 minutes in duration and week 4 walks 30 minutes in duration). For the last 4 weeks of the program (week 5-8), high intensity walking intervals will be progressively added each week, until the participant is walking 30 minutes at a high intensity. Walking intensity will be relative to participants’ baseline aerobic fitness and will be prescribed based on heart rate and rating of perceived exertion. Participants will be loaned polar monitors® to check their heart rate when completing aerobic training to ensure they are exercising at a moderate or high intensity. Furthermore, they will be instructed to use the Borg Rating of Perceived Exertion (Borg RPE) 6-20 scale for subjective moderate and high intensity of exercise. Moderate intensity walking will be at a Borg RPE of 11-13. High intensity walking will be at a Borg RPE of 14-16. The strength training program will consist of a whole-body exercise program. Exercises will be completed using body weight and a resistance band/gymstick®. Participants will be loaned a gymstick® if they prefer or will be provided a resistance band for the exercises requiring a resistance band. For the first 4 weeks (week 1-4), moderate intensity exercises will be completed which include: standing up from a chair, resistance band rows in a long sitting position, mini squats, wall push ups, double leg calf raises, and leg raises with flexed knees in a supine position. The exercises will be completed in a circuit format with a 5-minute rest between sets. The participants should aim to exercise at a Borg RPE of 11-13. The 5-minute rest will be active recovery, where participants walk at low intensity (Borg RPE of 7-8). For the last 4 weeks (week 5-8), participants will partake in higher intensity exercises, which include standing up from a lower seat (or any other stable and lower surface), resistance band rows in a bent over standing position, lunges to ½ range, kneeling/ normal push-ups, single leg calf raises, and abdominal crunches. A circuit format and a 5-minute walking active recovery will be used again. Participant exercise intensity should be at a Borg RPE of 14-16. By increasing the intensity of the exercise program halfway through the intervention, it is anticipated that participants will have an improvement in strength due to progressive overload. Location: Participants will complete the exercise program from home or a convenient location of their choice (eg a park or uncluttered gym). Initial prescription of the exercise program and outcome measure assessment will be completed at Fiona Stanley Hospital. Personalisation: Participants will initially be prescribed an individualized exercise program at Fiona Stanley Hospital before undertaking the intervention. Intensity will be prescribed using the Borg RPE (6-20) scale and heart rate. During the 3 telerehabilitation sessions (in week 3,5 and 7) participants' exercise programs will be adapted to encourage training adaptations. Exercise intensity will be progressed or regressed by altering training volume, resistance, rest times and intensity of the exercise to maintain Borg RPE and heart rate in the target zones. If the participant's exercise program has been changed, they will be provided with a new soft copy of their exercise program. Adherence: Participant adherence will be monitored using an exercise logbook, where participants log their compliance with the aerobic and strength training program. The investigator will count number of sessions attended to assess compliance with the exercise program. Adherence will be improved by providing 3 telerehabilitation sessions and a Facebook messenger group which will help foster team comradery and improved motivation.