*Purpose: Physical activity is key to liver transplant (LT) prehabilitation, and leveraging technologies to monitor physical performance and to generalize training may be advantageous. EL-FIT is a novel app linked to personal activity trackers (PAT), which continuously monitor steps and heart rate, and delivers educational/exercising videos (5 sections, 4-7 videos per section). Through a proprietary algorithm, EL-FIT can allocate training intensity and it includes multiple motivational features to incentivize its users to become more physically active. We aimed to determine the usability of EL-FIT in 25 LT candidates over 4 to 6 weeks.

*Methods: We compared the EL-FIT stratification algorithm to that of our LT physical therapist (LT-PT) across 3 intensities: strength & mobility, low and moderate intensity; and determined whether patients exercised with EL-FIT videos and interacted with EL-FIT features. PAT-collected step count and heart rate was reviewed, along with achievements, including rate of perceived exertion (RPE) following exercising with a video, and delivered heart (moderate exercise 28-min/day), silver-foot and gold-foot badges (surpassing step goal for 5 days/week during 1 or 2 weeks, respectively).

*Results: Age was 59±7 years (56% male, BMI 33±6), MELD-Na 19±4, with Child C in 52%. No patient had overt hepatic encephalopathy (HE), but 95% had minimal HE. Agreement between EL-FIT and LT-PT allocation was 92% (2 patients allocated to a lower intensity level by EL-FIT). Frailty was present in 16% by liver frailty index (LFI) and in 29% by 6-min walk test (6MWT). Video interaction was documented for 22 participants (92%), each watching 3 to 109 videos, with 21 reporting intensity of exercise via emoji-RPE. A video section was completed by 18 participants, and 10 [42%] executed the whole section of corresponding intensity. EL-FIT database successfully collected step counts and heart rate for an average of 36 days/patient. Based on step count performance, 9 patients received heart badges (from 2 to 71 each), and 13 and 9 received silver/gold-foot badges (from 1 to 12 each). Frail patients did not receive less badges when frailty was defined by LFI, although they did receive less silver/gold-foot badges when defined by 6MWT (p=0.02).

*Conclusions: A technology such as EL-FIT can be used to successfully educate LT candidates on physical function and facilitate training, in spite of a high prevalence of decompensation and minimal HE. This type of technology appears to safely allocate exercise intensity, compared to what would be allocated with LT-PT. Thus, EL-FIT provides a promising technology that can be applied to LT candidates to monitor, and potentially enhance physical activity, within the context of LT prehabilitation.

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