Changes in Hepatic Venous Pressure Gradient Induced by Physical Exercise in Cirrhosis: Results of a Pilot Randomized Open Clinical Trial
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OBJECTIVES: Exercise has been scarcely studied in patients with cirrhosis, and prior evidence showed hepatic venous pressure gradient (HVPG) to be increased in response to exercise. The aim of this study was to investigate the effects of a supervised physical exercise program (PEP) in patients with cirrhosis. METHODS: In an open-label, pilot clinical trial, patients with cirrhosis were randomized to PEP (cycloergometry/kinesiotherapy plus nutritional therapy, n=14) or control (nutritional therapy, n=15); for 14 weeks. Primary outcomes were: the effect of PEP in HVPG, and quality of life (chronic liver disease questionnaire, CLDQ). As secondary outcomes we investigated changes in physical fitness (cardiopulmonary exercise testing), nutritional status (phase angle-bioelectrical impedance), ammonia levels, and safety. RESULTS: Twenty-two patients completed the study (11 each). HVPG decreased in subjects allocated to PEP (-2.5 mm Hg (interquartile range: -5.25 to 2); P=0.05), and increased in controls (4 mm Hg (0-5); P=0.039), with a significant between-groups difference (P=0.009). No major changes were noted in CLDQ in both groups. There was significant improvement in ventilatory efficiency (VE/VCO2) in PEP group (-1.9 (-3.12 to -0.1); P=0.033), but not in controls (-0.4 (-5.7 to 1.4); P=0.467). Phase angle improvement and a less-pronounced exercise-induced hyperammonemia were noted only in PEP group. No episodes of variceal bleeding or hepatic encephalopathy were observed. CONCLUSIONS: A supervised PEP in patients with cirrhosis decreases the HVPG and improves nutritional status with no changes in quality of life. Further studies evaluating physical training in cirrhosis are eagerly awaited in order to better define the benefits of sustained exercise. ClinicalTrials.gov:NCT00517738.
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In patients with advanced chronic liver disease (cirrhosis), mild-to-moderate exercise is safe, reduces the degree of portal hypertension, and is not associated with an increased risk for variceal bleeding or other hepatic decompensation.
“also in patients with advanced chronic liver disease (i.e. cirrhosis) mild‐to‐moderate exercise is safe, reduces the degree of portal hypertension and was not associated with an increased risk for variceal bleeding or other hepatic decompensation [31].”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [31]
The Results report a reduction in hepatic venous pressure gradient with the exercise program, and the Safety section reports no variceal bleeding or hepatic encephalopathy during the study. The claim is broader than the evidence: the Discussion says the findings do not apply to more advanced disease, and Methods notes that patients with high-risk varices were excluded and all participants received propranolol. The small trial therefore supports safety observations in its selected participants, not a general absence of increased risk for other hepatic decompensation. (LLM, conf=0.86)
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- Authors
- Macías-Rodríguez, R. U., Ilarraza-Lomelí, H., Ruiz-Margáin, A., Ponce-de-León-Rosales, S., Vargas-Vorácková, F., García-Flores, O., Torre, A., & Duarte-Rojo, A.
- Affiliations
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (MX)
- ORCID
- Torre, Aldo
- Venue
- Clinical and Translational Gastroenterology
- Published
- 2016-07
- Volume
- 7
- Issue
- 7
- Pages
- e180
- ISSN
- 2155-384X (ISSN-L)
- PMC
- PMC5543482
- OpenAlex
- W2470168770
- Cited by
- 142
- References
- 41
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 17 · 2023: 19 · 2022: 12 · 2021: 25 · 2020: 14 · 2019: 16 · 2018: 11 · 2017: 7 · 2015: 1
- FWCI
- 8.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- www.springer.com/tdm (unspecified)
- Locations
- Clinical and Translational Gastroenterology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- liver cirrhosis, hepatic venous pressure gradient, physical activity, supervised exercise, kinesiotherapy, nutritional therapy, quality of life, ventilatory efficiency, phase angle, nutritional status, ammonia, variceal bleeding, hepatic encephalopathy
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