Am J Gastroenterol. 2022 Jun 17. doi: 10.14309/ajg.0000000000001883. Online ahead of print.
ABSTRACT
BACKGROUND AIMS: Frailty and sarcopenia are common complications of advanced liver disease. Due to associated morbidity/mortality, there have been targeted efforts to prevent and/or improve both by enrolling these patients in focused exercise programs. This review systematically analyzes the data of randomized clinical trials (RCT) on anthropometric, physical fitness, quality of life, and safety outcomes of exercise interventions in patients with advanced liver disease.
METHODS: Two authors independently searched trials on PubMed and EMBASE from inception up to 11/18/2021. A third independent arbitrator adjudicated all disagreements. We qualitatively summarized these outcomes: 1) muscular fitness (maximal inspiratory/expiratory pressures, muscle size, muscle strength, and bioimpedance testing); 2) cardiorespiratory fitness (cardiopulmonary exercise testing, 6-minute walk distance), 3) quality of life, and 4) others (safety or frailty indices).
RESULTS: There were eleven RCTs (4 home-based interventions) with 358 participants. Interventions ranged from 8-14 weeks and included cycling, walking, resistance exercises, balance and coordination training, and respiratory exercises. All described outcomes compared pre- to post-intervention measurements. Nine studies showed statistically significant improvements in at least one physical fitness variable. Ten studies showed statistically significant improvements in at least one muscular fitness variable. Six studies showed statistically significant improvements in at least one quality of life variable. Attrition rates ranged from 5-36% and adherence rates ranged very widely from 14-100%. Only one study reported frailty indices. Notably, no complications of portal hypertension were seen in intervention groups in the nine studies that reported this data.
CONCLUSIONS: A review of eleven randomized clinical trials with 358 participants with advanced liver disease demonstrates that exercise interventions can have favorable outcomes on muscular/cardiorespiratory fitness, and quality of life. While attrition and adherence varied, these interventions appear to be safe in patients with cirrhosis and are well tolerated.
PMID:35973182 | DOI:10.14309/ajg.0000000000001883
