Delivery of a telehealth supported home exercise program with dietary advice to increase plant-based protein intake in people with non-alcoholic fatty liver disease: A 12-week randomised controlled feasibility trial

ABSTRACT This study evaluated the feasibility and safety of a telehealth delivered home exercise plus plant-based protein diet in adults with non-alcoholic fatty liver disease (NAFLD). Secondary aims were to assess changes in macronutrient intake, weight, physical activity and physical function. This was a 12-week, randomised controlled feasibility trial including 28 adults aged >45 years with NAFLD randomised to a home muscle strengthening program (3 days/week) with increased protein intake (target ∼1.2-1.5 g/kg/day) from predominately plant-based sources and behavioural change support (3-4 text messages/week) (Pro-Ex n=14) or usual care (UC, n=14). Feasibility was assessed via retention (≤10% attrition), adherence (exercise ≥66%; recommended daily protein serves ≥80%) and safety (adverse events). Secondary outcomes included macronutrient intake (3x24-hour records), weight, moderate-to-vigorous physical activity (MVPA), and 30-second sit-to-stand (STS) performance. Study retention was 89%. Mean exercise adherence (Pro-Ex) was 52% with one adverse event from 241 sessions. In Pro-Ex, mean daily plant protein serves increased (0.9-1.4/day) and animal protein decreased (1.5-1.2/day) after 12-weeks, but overall adherence to the recommended serves/day was 32% (plant) and 42% (animal). Relative to UC, Pro-Ex experienced a mean 2.7 (95%CI: 0.9,4.4) increase in 30-sec STS number, 46-minute (95%CI: -153, 245) increase in MVPA, 1.7kg (95%CI: -3.5, 0.2) decrease in weight, 35.2g (95%CI: 11.0, 59.3) increase in protein. A telehealth, home muscle strengthening and plant-based dietary protein intervention in adults with NAFLD was safe and did improve habitual plant and animal protein intake, but overall adherence was relatively modest suggesting more intensive healthcare support may be required.