Abstract
Cirrhosis patients have reduced peak aerobic power (peak VO2) that is associated with reduced survival. Supervised exercise training increases exercise tolerance. The effect of home-based exercise training (HET) in cirrhosis is unknown. The objective was to evaluate the safety and efficacy of 8 weeks of HET on peak VO2, 6-minute walk distance (6MWD), muscle mass, and quality of life in cirrhosis. Random assignment to 8 weeks of HET (moderate to high intensity cycling exercise, 3 days/week) or usual care. Exercise adherence defined as completing ≥80% training sessions. Paired t-tests and analysis of covariance used for comparisons. Forty patients enrolled: 58% male, mean age 57 y, 70% Child Pugh-A. Between group increases in peak VO2 (1.7, 95% CI: −0.33 to 3.7 ml/kg/min, p = 0.09) and 6MWD (33.7, 95% CI: 5.1 to 62.4 m, p = 0.02) were greater after HET versus usual care. Improvements even more marked in adherent subjects for peak VO2 (2.8, 95% CI: 0.5–5.2 mL/kg/min, p = 0.02) and 6MWD (46.4, 95% CI: 12.4–80.5 m, p = 0.009). No adverse events occurred during testing or HET. Eight weeks of HET is a safe and effective intervention to improve exercise capacity in cirrhosis, with maximal benefits occurring in those who complete ≥80% of the program.
Highlights
In addition to the well-known health complications that arise with liver dysfunction[1], it is increasingly recognized that many patients with cirrhosis have severe physical deconditioning, sarcopenia, and physical frailty[2,3,4,5]
Our group and others have confirmed that supervised exercise training significantly improves peak VO2, muscle mass, and fatigue, and reduces the hepatic venous pressure gradient in patients with Child-Pugh A or B cirrhosis[14,15,16]
We tested the hypothesis that Home-based exercise training (HET) would significantly improve peak VO2, aerobic endurance, 6-minute walk distance (6MWD), muscle mass, and quality of life without adverse events compared to a usual care (UC) group
Summary
In addition to the well-known health complications that arise with liver dysfunction[1], it is increasingly recognized that many patients with cirrhosis have severe physical deconditioning, sarcopenia, and physical frailty[2,3,4,5]. These prevalent, interwoven conditions limit normal daily activities, increase the risks for pre-transplant death and removal from liver transplant wait lists[2,3,6], and lengthen hospital stays post-transplantation[7,8,9,10,11]. Home-based exercise training (HET) is an alternative delivery modality that has several advantages It is less biased in its potential inclusion of highly motivated patients and simulates a program that can be continued in the long-term. There has been no data on the efficacy of home-based exercise interventions in cirrhosis
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