Effects of an Exercise Programme on Functional Capacity, Body Composition and Risk of Falls in Patients with Cirrhosis: A Randomized Clinical Trial

Román, Eva; García-Galcerán, Cristina; Torrades, Teresa; Herrera, Silvia; Marı́n, A.; Doñate, Maite; Alvarado‐Tapias, Edilmar; Malouf, Jorge; Nácher, Laura; Serra-Grima, Ricard; Guarner, Carlos; Córdoba, Juan; Soriano, Germán

doi:10.1371/journal.pone.0151652

Cited by 133 publications

(155 citation statements)

References 35 publications

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“…Prior studies, consisting of 6‐60 participants, have mainly focused on face‐to‐face, supervised exercise interventions in the hospital setting and in patients without significant liver failure warranting LT . In agreement with our findings, the safety, acceptability, and adherence of variable exercise programs in patients with MELD scores of 9‐13 was considered satisfactory . Similar to our patient demographic, a recent French study of 13 patients on the LT waiting list (average age, 51 years; MELD, 13) reported that 12 weeks of exercise intervention increased aerobic capacity, as assessed by cardiopulmonary exercise testing (oxygen consumption [VO 2 ] peak) and the 6‐minute walk test .…”

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

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Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

et al. 2019

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Frailty is associated with increased mortality both before and after liver transplantation (LT). There are no standardized exercise programs, in particular home‐based exercise programs (HBEPs), for patients awaiting LT. The aim was to investigate the feasibility of such a program in patients awaiting LT. Patients were randomly selected from the Birmingham LT waiting list and provided with a 12‐week HBEP, including average daily step (ADS) targets and twice‐weekly resistance exercises. Feasibility was based on patient eligibility (≥66% of waiting list), target recruitment (≥90% of n = 20), safety (no related serious adverse events), and adherence (≥66% adherence to 6‐week HBEP). Measures of aerobic (incremental shuttle walk test [ISWT], ADS), functional capacity (short physical performance battery test [SPPBT]), and health‐related quality of life (EuroQol 5‐Dimension 5‐Level (EQ‐5D‐5L) and hospital anxiety and depression score [HADS]) were taken at baseline and at 6 and 12 weeks. 18 patients (50% male; median age, 55 years) were recruited. All domains of the study feasibility criteria were met. ISWT improved after 6 weeks (50 m; P ≤ 0.01) and 12 weeks (210 m; P ≤ 0.01), despite withdrawal of the telephone health calls. Similarly, improvements were seen in ADS (2700/day; P ≤ 0.01) and the SPPBT (2.5; P = 0.02) after 12 weeks. There was no difference in HADS (median difference [MD] –3; P = 0.69), but EQ‐5D‐5L after 12 weeks (17.5%; P = 0.04). In conclusion, a 12‐week HBEP, incorporating both easy‐to‐apply resistance and aerobic exercises, is safe and feasible in patients awaiting LT. Measures of aerobic and functional capacity demonstrate trends toward improvement that warrant further investigation in a randomized controlled trial.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

et al. 2019

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“…Consistent with the broader chronic disease literature, the experimental and clinical evidence for a benefit of exercise in cirrhosis is promising. Several small clinical trials have demonstrated significant improvements in muscle health (mass, strength, functional capacity), quality of life, fatigue, cardiopulmonary fitness and reductions in the hepatic venous pressure gradient, without adverse events . Unfortunately, most patients (63%‐92%) included in these trials were cirrhosis CP‐A, while patients at the lower end of physical deconditioning (CP‐B/C) have not been evaluated systematically so far .…”

Section: Management Of Malnutrition and Sarcopenia In Cirrhosismentioning

confidence: 99%

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Bunchorntavakul

Reddy

2019

Aliment Pharmacol Ther

148

131

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Summary Background Malnutrition/sarcopenia and frailty are common in patients with cirrhosis and are associated with poor outcomes. Aim To provide an overview of data on the importance, assessment and management of malnutrition/sarcopenia and frailty in cirrhosis. Methods A literature search was conducted in PubMed and other sources, using the search terms “sarcopenia,” “muscle,” “malnutrition,” “cirrhosis,” “liver” and “frailty” from inception to April 2019, to identify the relevant studies and international guidelines. Results The prevalence of malnutrition/sarcopenia in cirrhosis is 23%‐60%. Frailty generally overlaps with malnutrition/sarcopenia in cirrhosis, leading to increased morbidity and mortality. Rapid nutritional screening assessment should be performed in all patients with cirrhosis, and more specific tests for sarcopenia should be performed in those at high risk. The pathogenesis of malnutrition/sarcopenia in cirrhosis is complex/multifactorial and not just reduction in protein/calorie intake. Hyperammonemia appears to be the main driver of sarcopenia in cirrhosis through several molecular signalling pathways. Nutritional management in malnourished patients with cirrhosis should be undertaken by a multidisciplinary team to achieve adequate protein/calorie intake. While the role of branched‐chained amino acids remains somewhat contentious in achieving a global benefit of decreasing mortality‐ and liver‐related events, they, and vitamin supplements, are recommended for those with advanced liver disease. Novel strategies to reverse sarcopenia such as hormone supplementation, long‐term ammonia‐lowering agents and myostatin antagonists, are currently under investigation. Conclusions Malnutrition/sarcopenia and frailty are unique, inter‐related and multi‐dimensional problems in cirrhosis which require special attention, prompt assessment and appropriate management as they significantly impact morbidity and mortality.

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“…In this study, patients performed aerobic exercise for 12 weeks at moderate intensity (heart rate, 60%‐70% of maximum) and received leucine supplementation . In a recent study, aerobic exercise performed for 12 weeks, without any nutritional supplementation, led to a significant decrease in body fat ( P = 0.003), an increase in lean mass ( P = 0.01), and an increase in functional capacity . Furthermore, aerobic exercise combined with caloric restriction attenuated loss of FFM from 25% to 11% .…”

Section: Management Issues In Sarcopeniamentioning

confidence: 99%

Sarcopenia in hiding: The risk and consequence of underestimating muscle dysfunction in nonalcoholic steatohepatitis

Bhanji¹,

Narayanan

Allen³

et al. 2017

Hepatology

220

212

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Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Up to one third of individuals with NAFLD will develop nonalcoholic steatohepatitis (NASH), which is associated with progression to cirrhosis and is rapidly becoming the leading indication for liver transplantation. Sarcopenia is defined as a progressive and generalized loss of skeletal muscle mass, strength, and function. It is observed in up to 60% of patients with end-stage liver disease and portends a poor prognosis. Recent studies have shown that sarcopenia is a novel risk factor for developing NAFLD. Pathophysiological mechanisms relating sarcopenia and NASH may include insulin resistance (IR) and increased inflammation. IR leads to accumulation of triglycerides in both muscle tissue and the liver. It also exacerbates proteolysis and leads to muscle depletion. Chronic inflammation leads to liver injury and progression of fibrosis. The inflammatory milieu also stimulates protein catabolism. Viewing skeletal muscle as an endocrine organ that secretes various salutary myokines may help us understand its role in the development of steatosis. A better understanding of the pathophysiology will aid in developing physical and pharmacological therapeutic interventions. In this review, we will explore the complex inter-relationships between sarcopenia and NASH. We will discuss the impact of sarcopenia in patients with NASH and therapeutic options for the management of sarcopenia. (Hepatology 2017;66:2055-2065).

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Effects of an Exercise Programme on Functional Capacity, Body Composition and Risk of Falls in Patients with Cirrhosis: A Randomized Clinical Trial

Cited by 133 publications

References 35 publications

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Sarcopenia in hiding: The risk and consequence of underestimating muscle dysfunction in nonalcoholic steatohepatitis

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