Exercise improves quality of life of patients with advanced liver disease

Exercise interventions may result in positive outcomes on muscular or cardiorespiratory fitness and quality of life in patients with advanced liver disease, suggest the results of a systematic review.

“Frailty and sarcopenia are common complications of advanced liver disease,” the authors said. “Owing to associated morbidity/mortality, there have been targeted efforts to prevent and/or improve both by enrolling these patients in focused exercise programs.”

Trials were independently searched on the databases PubMed and Embase from inception up to 18 November 2021. An independent arbitrator adjudicated all disagreements.

The authors described the outcomes as follows: muscular fitness (maximal inspiratory/expiratory pressures, muscle size, muscle strength, and bioimpedance testing), cardiorespiratory fitness (cardiopulmonary exercise testing and 6-minute walk distance), quality of life, and others (safety or frailty indices).

Eleven randomized controlled trials involving four home-based interventions, with a total of 358 participants, met the eligibility criteria. Interventions ranged from 8 to 14 weeks and included walking, cycling, resistance exercises, balance and coordinating training, and respiratory exercises. All outcomes compared pre- with postintervention measurements.

Statistically significant improvements in at least one physical fitness, muscular fitness, and quality of life variable were observed in nine, 10, and six studies, respectively. Only one study reported frailty indices.

Attrition rates ranged from 5 percent to 36 percent, while adherence rates were wide at a range of 14 percent to 100 percent. Of note, complications of portal hypertension were not observed in intervention groups in the nine studies reporting these outcomes.

“Although attrition and adherence varied, these interventions seem to be safe in patients with cirrhosis and are well tolerated,” the authors said.