Is home-based, virtually delivered, group exercise feasible and acceptable for older patients with hepatocellular carcinoma? A non-randomised feasibility study (TELEX-Liver Cancer)

BMJ Open. 2024 Jun 12;14(6):e082155. doi: 10.1136/bmjopen-2023-082155.

ABSTRACT

OBJECTIVES: The study aimed to assess the feasibility, acceptability and safety of delivering a home-based telehealth exercise intervention to older patients with hepatocellular carcinoma (HCC).

DESIGN: Non-randomised feasibility study.

SETTING: Patients were recruited from UK outpatient liver cancer clinics.

PARTICIPANTS: Patients were aged ≥60 years with HCC, with post-treatment imaging reporting a complete response, partial response or stable disease.

INTERVENTION AND DATA COLLECTION: Patients were invited to attend synchronous online exercise sessions, twice weekly for 10 weeks. Physical function and patient-reported outcomes were assessed pre-intervention and post-intervention. Qualitative data were collected via semistructured interviews after intervention completion.

PRIMARY OUTCOME MEASURES: Recruitment, retention, exercise adherence and safety.

RESULTS: 40 patients were invited to participate and 19 (mean age 74 years) provided consent (recruitment rate 48%). Patients completed 76% of planned exercise sessions and 79% returned to the clinic for follow-up. Hand grip strength (95% CI 1.0 to 5.6), Liver Frailty Index (95% CI -0.46 to -0.23) and time taken to perform five sit-to-stands (95% CI -3.2 to -1.2) improved from pre-intervention to post-intervention. Patients reported that concerns they had relating to their cancer had improved following the intervention (95% CI 0.30 to 5.85). No adverse events occurred during exercise sessions.Qualitative data highlighted the importance of an instructor in real time to ensure that the sessions were achievable, tailored and well balanced, which helped to foster motivation and commitment within the group. Patients reported enjoying the exercise intervention, including the benefits of peer support and highlighted perceived benefits to both their physical and mental health. Patients felt that the online sessions overcame some of the barriers to exercise participation and preferred attending virtual sessions over face-to-face classes.

CONCLUSIONS: It is feasible, acceptable and safe to deliver supervised group exercise via videoconferencing to patients with HCC in their own homes. These findings will inform the design of a future, adequately powered randomised controlled trial to evaluate the efficacy of the intervention.

TRIAL REGISTRATION NUMBER: ISRCTN14411809.

PMID:38866571 | DOI:10.1136/bmjopen-2023-082155