# MITO-VATION: Feasibility of a technology-supported structured home exercise program in Mitochondrial Disease

## TL;DR

This study tested if digital health tools can help people with mitochondrial disease safely do home exercise, finding it feasible but challenging for some.

## Contribution

The study demonstrates the feasibility of using digital health technology to support home exercise in mitochondrial disease patients.

## Key findings

- Digital health tools were acceptable and safe for monitoring and supporting home exercise in PMD patients.
- Participants who already exercised achieved more program targets than those who did not.
- Adherence to strength training was low, highlighting the need for tailored and flexible programs.

## Abstract

Exercise intolerance, combined with low levels of physical activity, are commonly observed in individuals with Primary Mitochondrial Disease (PMD). However, access to health professionals with expertise in prescribing exercise to this population is limited. The use of digital health technology (DHT) may be a feasible and acceptable approach for therapists to support people with PMD to increase levels of physical activity, including exercise. Ten participants with mild to moderate PMD were recruited. All were provided with an eight-week home exercise program via an online exercise prescription app and remotely monitored using a smart watch. Participants received telehealth supporting their home exercise regimen along with reminders to move from the smart watch. The primary outcomes were feasibility and acceptability. Secondary outcomes were physical performance measures and fatigue, measured pre- and post-intervention. Only 26% of eligible participants enrolled. There were no dropouts, and four minor adverse events reported. Most participants (80%) participated in 80% or more of the telehealth sessions and wore the smart watch on 80% or more days during the study. Daily step target achievement was poor and only one participant met their individualised target on ≥80% of days. Half the participants achieved their weekly target of 150 intensity minutes (heart rate >50% of their theoretical maximal heart rate) on 7 or more weeks. Home exercise program adherence was low with only 30% of participants completing 80% or more of the scheduled strength training sessions over 8 weeks. Post-hoc exploration found pre-intervention exercisers achieved 4 out of 5 intervention targets compared to 0 for non-exercisers. Acceptability outcomes extracted from post-program questionnaires were overall positive towards the smart watch and home exercise program. There were no meaningful changes in any physical outcome measures or fatigue post-test. The use of DHT may be feasible and acceptable for prescribing home exercise and monitoring activity levels in individuals with mild to moderate forms of PMD, particularly those with a history of exercise.

This study looked at whether using digital health technology can help adults with primary mitochondrial disease (PMD) take part in a safe, structured home exercise program. PMD is a rare, lifelong condition that causes fatigue, muscle weakness and exercise intolerance, making it hard for people to be active and to access specialist physiotherapy, especially outside major cities. We worked with 10 adults with mild to moderate PMD who could attend our Sydney centre. Each person completed an 8-week home program that included daily step goals, weekly “intensity minutes”, and strength exercises prescribed by a physiotherapist. Participants wore a Garmin Vivoactive 5 smart watch, used an exercise app (PhysiApp), and had weekly telehealth catch-ups for support and monitoring. We found that once enrolled, participants were willing and able to complete the program: no one dropped out, and there were only minor, manageable side effects such as temporary muscle soreness. Most people wore the watch as requested and valued the feedback and reminders it provided. However, keeping up with the more effortful parts of the program (especially strength training) was challenging over time, particularly for people who were not already exercising. Overall, remotely monitored exercise using consumer technologies appears safe, acceptable and potentially scalable for people with PMD, but programs must be flexible, individually tailored and supported over the longer term.