Document resource
Empowering patients with a broad spectrum of chronic liver disease (CLD) using formulaic advice to adopt physical activity (PA) in the context of multimorbidity and chronic inactivity is a major challenge. A community-based physical activity programme (CBPAP) where experiences are shared alongside common goal setting may support adoption of PA. 1 Adults (>18y) with CLD in inner-city Nottingham were identified from records at Nottingham University Hospitals NHS Trust between March-June 2024 to participate in a CBPAP supported by local government. Patients selected at random were offered enrolment to a free structured CBPAP alongside standard care. Consenting patients were referred to a community provider (RideWise) who led structured walks catering for all abilities. Patients walked for 1.5-hours at a pace set by the group. Sessions ran fortnightly between May-September 2024, consisting of 10 walks in rotating community settings. Patients joined as many sessions as able.142 patients were randomly selected and contacted by telephone; 62 (44%; 34♀, x̄62y, 15% ethnic minorities) expressed interest and were invited to an information session led by a clinician. Aetiology included Metabolic dysfunction associated steatotic liver disease (MASLD) 30 (48%), Alcohol-related liver disease (ALD) 9 (15%), Primary biliary cholangitis (PBC) 7 (11%), Metabolic dysfunction and alcohol-related liver disease (MetALD) 5 (8%), Autoimmune hepatitis (AIH) 2 (3%), Viral hepatitis 2 (3%), Drug-induced liver injury (DILI) 1 (2%), Hereditary haemochromatosis (HH) 1 (2%) and other 5 (8%). Severity of CLD included Cirrhosis 22 (36%), Hepatocellular carcinoma (HCC) 1 (2%), Transplant 1 (2%). 28 (60%; 12♀, x̄61y) attended an information session, 15 (54%; 8♀, x̄60y) registered for the CBPAP and 10 (67%; 5♀, x̄58y) engaged with the CBPAP provider. Of these, 6 (60%; 3♀, x̄65y, 2 ethnic minorities) attended ≥1 PA session; aetiology included MASLD 3, AIH 1, HCC 1, HH 1. Of these, 5 (90%) attended 3 (30%) PA sessions with 4 (67%; 1♀, MASLD 1, AIH 1, HH 1, HCC 1) attending 7 (70%) PA sessions. 3 (30%) patients attended 9 (90%) PA sessions. No patient completed a full programme.In a varied cohort of CLD patients, enrolment to a free structured CBPAP alongside standard care demonstrated high (90%) attrition among those expressing initial interest. Despite this, we observed patients who attended 40% of the CBPAP achieved a high re-attendance, completing 70% of the CBPAP. Factors preventing attendance following initial interest in PA should be explored further to reduce attrition and develop a sustainable CBPAP in CLD.Reference Bock C, Jarczok MN, Litaker D. Community-based efforts to promote physical activity: a systematic review of interventions considering mode of delivery, study quality and population subgroups. J Sci Med Sport 2014 May;17(3):276–82. doi: 10.1016/j.jsams.2013.04.009. Epub 2013 May 19. PMID: 23693030.