Exercise capacity and muscle strength in patients with cirrhosis

Abstract

Exercise capacity and muscle strength are predictors of outcome in a number of clinical populations. Advanced liver disease is a catabolic state, and patients often have muscle wasting. However, the relationships between exercise capacity, strength, and outcomes for patients undergoing liver transplantation are poorly understood. Thirteen studies have examined the association between these parameters in patients with cirrhosis, and they have found a significant reduction in the exercise capacity and muscle strength of patients with cirrhosis versus healthy controls. These impairments appear to be independent of the etiology of cirrhosis, but the data are equivocal with respect to their association with disease severity. Two studies reported a significant and independent association between pretransplant exercise capacity and posttransplant survival. Another 2 studies found that exercise training was well tolerated in patients with cirrhosis and resulted in improvements in exercise capacity (both studies) and muscle mass (1 study). These data are provocative and suggest that measuring and improving the exercise capacity and muscle strength of patients with cirrhosis who are awaiting liver transplantation could potentially improve outcomes. Liver Transpl 18:146-151,

Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Liver Transplantation

“…Recent studies showed that they develop impairment of exercise capacity and fitness [37,38] . Also reduced peak V O 2 can help identify patients at risk for mor- bidity and mortality after LT [7,39,40] .…”

Alterações Do Sistema Cardiopulmonar De Pacientes Cirróticos

“…Jones et al 15 M/F -masculino/feminino; Kg -kilograma; cm -centímetros; Kg\cm2 -quilograma por centímetro quadrado; dados descritos em média e desvio padrão; proporção e porcentagem e mediana e intervalo interquartil (P 25 -P 75 ); p -nível de significância (≤ 0,05). A força do aperto de mão e a composição corporal não foram diferentes estatisticamente entre os grupos (Tabela 3).…”

Editorial: the burden of chronic liver disease – an ecological method sees the wood for the trees. Authors’ reply

“…7 Experimental models demonstrate that the mitochondrial oxidation of fatty acids is enhanced in non-alcoholic fatty liver disease, such that increased flux through the mitochondrial tricarboxylic cycle leads to an increase in reactive oxygen species (ROS) and induction of proinflammatory mediators; furthermore, the inhibition of this flux mitigates hepatic insulin resistance, ROS and inflammation. 8 Therefore, inhibition of ROS signalling presents an attractive therapeutic opportunity. 2 In this single blind, cross-over trial, 19 NASH subjects and 19 age, gender and body mass index matched controls were randomised to 20 g dark chocolate or milk chocolate twice a day for 2 weeks, with a 1 week washout period in between.…”

“…Physical activity, for example, has been demonstrated to improve QoL and outcomes in a wide range of diseases, even in cirrhotic patients. 8 In summary, while hepatitis C is a relevant (co-) factor for chronic liver disease, other measures that aim to reduce the burden of liver disease should not be overlooked.…”