Combined resistance and endurance training at a moderate‐to‐high intensity improves physical condition and quality of life in liver transplant patients

Abstract

Although currently moderate and high intensity concurrent physical exercise is prescribed in populations with special needs due to its greater effect on physical condition and health-related quality of life (HRQOL), there are no data in the liver transplantation (LT) setting. The aim of this study is to evaluate changes in maximal strength, aerobic capacity, body composition, liver function, and HRQOL in LT patients after a moderate-to-high intensity combined resistance-endurance training. Six months after LT, 54 patients were randomized into 2 groups: intervention group (IG) and control group (CG). A total of 50 patients completed the study with repeat testing at 6 and 12 months after LT. The IG completed a 6-month exercise training program, consisting of exercising 2 days for 24 weeks in the hospital facilities, whereas the CG followed usual care recommendations. Patients completed a 5-multijoint exercise circuit with elastic bands involving the major muscle groups. The effects of the concurrent training program on maximal oxygen consumption, overall and regional maximal strength, body composition, liver function, and HRQOL were analyzed. The IG showed a significant improvement (P < 0.05) in outcome measurements compared with the CG in aerobic capacity, hip extension, elbow flexion, overall maximal strength, physical functioning, and vitality of HRQOL, whereas no changes were observed in body composition and liver function tests. In conclusion, this is the first study that combines supervised resistance and aerobic training performed at moderate-to-high intensity in LT recipients. It results in significant improvements in aerobic capacity, maximal strength, and HRQOL. Liver Transplantation 23 1273-1281 2017 AASLD.

Review article: impact of exercise on physical frailty in patients with chronic liver disease

“…To date, seven studies (four RCTs; three observational studies) have investigated the use of exercise after liver transplantation (Table ) in a total of five patient cohorts (n = 243), as two European populations were utilised twice . Participant numbers ranged from 15 to 119, with the latter being an American RCT from 2006 in which 41% received the exercise intervention; whilst the mean age was 39‐61 years with no gender predominance.…”

“…Time spent exercising per week ranged from 90‐150 minutes with each session lasting between 30 and 75 minutes. Participants were instructed to complete their aerobic exercise sessions at either a moderate (60% heart rate reserve) or high (70%‐85% heart rate reserve) level of intensity, while Beyer et al reported that the intensity of the session was “individualised according to the patient's work capacity”.…”

“…Although optimising HRQoL in patients with CLD is important for both the patient and carer, achieving high levels that are comparable to the general population is the ultimate goal after a definitive intervention like liver transplantation. Utilising the SF‐36 and the less commonly used RAND‐36 questionnaires, three studies highlighted significant improvements in patient‐reported general health status, physical function and vitality with exercise after liver transplantation. It is, however, difficult to understand the independent effect of exercise in these studies, as two of these studies incorporated counselling sessions into the intervention .…”

“…The design of the exercise intervention varied greatly across all seven studies, in which five studies used a combination of aerobic and resistance-based training 50,[53][54][55][56] and the other two focused on aerobic exercise only. 51,52 Aerobic training was reported as predominantly walking, with a solitary study utilising cycling 52 and the resistance element varied from elastic resistant band work 53,54 to weighted exercises. 55,56 Time spent exercising per week ranged from 90-150 minutes with each session lasting between 30 and 75 minutes.…”

“…55,56 Time spent exercising per week ranged from 90-150 minutes with each session lasting between 30 and 75 minutes. Participants were instructed to complete their aerobic exercise sessions at either a moderate (60% heart rate reserve) 55,56 or high (70%-85% heart rate reserve) 53 On the whole, exercise sessions were delivered in the form of supervised classes that participants attended as an out-patient. Only one study reported a home-based approach 52 and although the authors reported that it was feasible and effective (as measured by a significant increase in VO 2 peak), a substantial amount of healthcare support was required in the intervention arm (ie, 19 counselling sessions on average over 10 months).…”