Original article
Pancreas, biliary tract, and liver
Eight Weeks of Exercise Training Increases Aerobic Capacity and Muscle Mass and Reduces Fatigue in Patients With Cirrhosis

https://doi.org/10.1016/j.cgh.2014.04.016Get rights and content

Background & Aims

Patients with cirrhosis have reduced exercise tolerance, measured objectively as decreased peak exercise oxygen uptake (peak VO2). Reduced peak VO2 is associated with decreased survival time. The effect of aerobic exercise training on peak VO2 has not been well studied in patients with cirrhosis. We evaluated the safety and efficacy of 8 weeks of supervised exercise on peak VO2, quadriceps muscle thickness, and quality of life.

Methods

In a prospective pilot study, stable patients (79% male, 57.6 ± 6.7 years old) with Child–Pugh class A or B cirrhosis (mean Model for End-Stage Liver Disease score, 10 ± 2.2) were randomly assigned to groups that received exercise training (n = 9) or usual care (controls, n = 10) at the University of Alberta Hospital in Canada from February through June 2013. Supervised exercise was performed on a cycle ergometer 3 days/week for 8 weeks at 60%–80% of baseline peak VO2. Peak VO2, quadriceps muscle thickness (measured by ultrasound), thigh circumference, answers from Chronic Liver Disease Questionnaires, EQ-visual analogue scales, 6-minute walk distance, and Model for End-Stage Liver Disease scores were evaluated at baseline and at week 8. Analysis of covariance was used to compare variables.

Results

At week 8, peak VO2 was 5.3 mL/kg/min higher in the exercise group compared with controls (95% confidence interval, 2.9–7.8; P = .001). Thigh circumference (P = .001), thigh muscle thickness (P = .01), and EQ-visual analogue scale determined self-perceived health status (P = .01) was also significantly higher in the exercise group compared with controls at week 8; fatigue subscores of the Chronic Liver Disease Questionnaires were lower in the exercise group compared with controls (P = .01). No adverse events occurred during cardiopulmonary exercise testing or training.

Conclusions

In a controlled prospective pilot trial, 8 weeks of supervised aerobic exercise training increased peak VO2 and muscle mass and reduced fatigue in patients with cirrhosis. No relevant adverse effects were observed. Larger trials are needed to evaluate the effects of exercise in patients with cirrhosis. ClinicalTrials.gov number: NCT01799785.

Section snippets

Materials and Methods

This randomized controlled pilot study was conducted at the University of Alberta Hospital in Edmonton, Alberta, Canada, from February to June 2013. All potentially eligible patients were consecutively screened during clinic visits at the Cirrhosis Care Clinic, and all provided signed informed consent. Study approval was granted by our local Health Research Ethics Board, and the study was registered at ClinicalTrials.gov (study ID: NCT01799785). All co-authors had access to the study data and

Baseline Characteristics

Thirty-six consecutive patients were approached, of which 20 agreed to participate. The baseline characteristics of the patients who did not participate were similar to those who participated (mean age, 58 years; mean CP score, 7; mean MELD score, 11). One patient was excluded before initiating exercise because he met criteria for CP-C disease (Supplementary Figure 1). Data were analyzed for 19 patients (9 ET, 10 UC).

Baseline clinical characteristics are shown in Table 1. Seventy-nine percent

Discussion

The safety and efficacy of supervised ET in clinically stable cirrhosis patients have not been well-studied. Our pilot study is a randomized controlled trial to evaluate whether peak VO2 can be improved after 8 weeks of supervised ET. In this predominantly compensated group of patients (74% CP-A), aerobic ET significantly improved peak VO2, thigh circumference, quadriceps muscle thickness, and patient-perceived health status. Importantly, symptoms of fatigue were also significantly lower with

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    Conflicts of interest The authors disclose no conflicts.

    Funding Funded by the University of Alberta Hospital Foundation. L. Zenith is funded by a Canadian Liver Foundation Graduate Studentship Award.

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    Authors share co-senior authorship.

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