Front Med (Lausanne). 2026 Jul 29;13:1871179. doi: 10.3389/fmed.2026.1871179. eCollection 2026.
ABSTRACT
BACKGROUND: Sarcopenia and frailty are common issues faced by individuals suffering from liver cirrhosis. These ailments greatly diminish life quality and increase the likelihood of death. Engaging in physical activity is a popular method to improve sarcopenia. Consequently, this systematic review and meta-analysis seeks to assess the effectiveness of exercise programs for addressing sarcopenia in those with liver cirrhosis.
PURPOSE: This study evaluated the efficacy of exercise interventions on sarcopenia in patients with liver cirrhosis through a meta-analysis of randomized controlled trials (RCTs).
METHODS: A comprehensive literature search was conducted across five databases: PubMed, Embase, CINAHL, CNKI, and the Cochrane Library, up to March 2026. Manually search for references in review articles that may meet the requirements. Two researchers independently carried out the literature search and review, data extraction and assessment of risk of bias. The analysis of results includes 6-min walk distance (6MWD), thigh circumference, knee extensor strength, gait speed, thigh muscle thickness, Chronic Liver Disease Questionnaire (CLDQ), Model for End-Stage Liver Disease (MELD) scores and handgrip strength. Statistical analyses were performed using Rev Man 5.3 and STATA 14.0.
RESULTS: This meta-analysis included 16 studies involving a total of 942 patients. The results demonstrated that exercise significantly enhanced various physical and clinical metrics in patients suffering from liver cirrhosis and sarcopenia. Notably, significant improvements were recorded in the 6MWD (MD = 54.35, 95% CI = 34.56-74.14, P < 0.001), thigh circumference (MD = 1.83, 95% CI = 0.92-3.38, P = 0.020), knee extensor strength (MD = 8.06, 95% CI = 2.59-13.53, P = 0.004), thigh muscle thickness (MD = 0.09, 95% CI = 0.05-0.14, P < 0.001), and scores on the CLDQ (MD = 0.75, 95% CI = 0.51-0.99, P < 0.001). Additionally, gait speed exhibited a significant increase (MD = 1.17, 95% CI = 0.09-2.26, P = 0.030). However, no significant changes were observed in grip strength, or MELD scores. Subgroup analysis indicates that aerobic exercise, or Resistance exercise, appear to improve physical activity levels in patients with cirrhosis.
CONCLUSION: Exercise may improve selected indicators of muscle mass and physical performance in patients with cirrhosis. Exercise improves thigh muscle thickness, thigh circumference, and knee extension strength in patients with sarcopenia and cirrhosis, while also enhancing their physical activity capacity and quality of life. In terms of exercise type, both aerobic and resistance training appear to improve physical activity levels in patients with cirrhosis. However, further research is needed to confirm this.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420261326379.
PMID:42591090 | PMC:PMC13461329 | DOI:10.3389/fmed.2026.1871179
