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

Abstract

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.

Deficits in Muscle Strength and Physical Performance Influence Physical Activity in Sarcopenic Children After Liver Transplantation

“…This has important implications for the development of effective rehabilitation strategies to treat sarcopenia in children after LT. Recent evidence in adults with cirrhosis and sarcopenia indicate that the utilization of resistance exercise to treat sarcopenia is a safe, feasible, and effective method to elicit improvements in muscle strength . Evaluation of this approach as a potential rehabilitation strategy is warranted in children with sarcopenia.…”

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

“…Within the 11 exercise studies reported in CLD, several generic (SF‐36, EQ‐VAS) and disease‐specific (Chronic Liver Disease questionnaire, CLDQ) questionnaires have been utilised with variable findings (Tables and ). Improvements in vitality ( P = .01 (SF‐36)), perceived general health status ( P = .03 (SF‐36)), physical activity (+1.24 points (CLDQ)) and fatigue (+0.80 points (CLDQ)) were reported with exercise interventions, but interestingly in the two home‐based exercise intervention study from Canada and the UK, no improvements were seen in either generic HRQoL or anxiety and depression scores . This may be due to the lack of regular, supervised medical professional interactions or due to the fact that participants included in these studies were dealing with the ongoing burden of more advanced, decompensated cirrhosis whilst on the transplant‐waiting list.…”

“…Whether the changes in 6MWT in the Williams study are due to the intervention or to a “learning effect” is difficult to discern, as the study lacked repeat baseline assessments of the 6MWT . In support, further studies undertaken at home have found significant improvements in average daily steps and incremental shuttle walk test (ISWT) ( P < .01 for both outcomes) following a 12‐week exercise intervention consisting of walking and body‐weight resistance exercises (2‐3‐times weekly). These findings demonstrate that costly equipment may not be required to produce positive improvements in aerobic capacity and function for patients with CLD.…”

“…Only one UK study investigated change in function following a 12‐week home‐based combined aerobic (walking) and body‐weight resistance exercise intervention in patients listed for liver transplantation . Williams et al reported significant improvements in short physical performance battery scores (SPPB; +2.5 points) as well as 44% increase in patients reporting no problems with mobility (Euroquol‐5 dimension‐5 levels quality of life questionnaire) after the home‐based intervention. This degree of functional improvement may have a considerable positive impact on social care requirements as well as patient and their carer's quality of life.…”

The Gain Is Worth the Pain: Home‐Based Exercise in Liver Transplantation

“…As with efforts to enhance muscle mass in other wasting conditions, empiric interventions to improve physical performance through exercise, nutrition, pharmacotherapy, and behavioral support have been used . Williams et al in the current issue of Liver Transplantation assess the value of a home‐based exercise program (HBEP) …”