Outcomes of exercise interventions in patients with advanced liver disease: a systematic review of randomized clinical trials
Abstract
INTRODUCTION: Frailty and sarcopenia are common complications of advanced liver disease. Owing 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 (RCTs) 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 November 18, 2021. A third independent arbitrator adjudicated all disagreements. We qualitatively summarized these outcomes as follows: (i) muscular fitness (maximal inspiratory/expiratory pressures, muscle size, muscle strength, and bioimpedance testing), (ii) cardiorespiratory fitness (cardiopulmonary exercise testing and 6-minute walk distance), (iii) quality of life, and (iv) others (safety or frailty indices). RESULTS: There were 11 RCTs (4 home-based interventions) with 358 participants. Interventions ranged from 8 to 14 weeks and included cycling, walking, resistance exercises, balance and coordination training, and respiratory exercises. All described outcomes compared preintervention with postintervention measurements. Nine studies showed statistically significant improvements in at least 1 physical fitness variable. Ten studies showed statistically significant improvements in at least 1 muscular fitness variable. Six studies showed statistically significant improvements in at least 1 quality-of-life variable. Attrition rates ranged from 5% to 36%, and adherence rates ranged very widely from 14% to 100%. Only 1 study reported frailty indices. Notably, no complications of portal hypertension were seen in intervention groups in the 9 studies that reported these data. DISCUSSION: A review of 11 RCTs with 358 participants with advanced liver disease demonstrates that exercise interventions can have favorable outcomes on muscular/cardiorespiratory fitness and quality of life. Although attrition and adherence varied, these interventions seem to be safe in patients with cirrhosis and are well tolerated.
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Consistent benefits of exercise demonstrated in RCTs include reversal of sarcopenia and improvements in aerobic capacity, muscle mass and strength, performance measures, health-related quality of life and hepatic venous pressure gradient.
“Consistent bene fi ts of exercise demonstrated in RCTs include reversal of sarcopenia and improvements in aerobic capacity, muscle mass and strength, performance measures, health-related quality of life and hepatic venous pressure gradient.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [459]
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- Authors
- Jamali, T., Raasikh, T., Bustamante, G., Sisson, A., Tandon, P., Duarte-Rojo, A., & Hernaez, R.
- Affiliations
- Baylor College of Medicine (US)
- Texas Medical Center Library (US)
- University of Alberta (CA)
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Section of Gastroenterology. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX Center, Houston, Texas, USA;
- Corresponding author
- Jamali, Taher
- Raasikh, Taaj
- Venue
- American Journal of Gastroenterology
- Published
- 2022-08-12
- Volume
- 117
- Issue
- 10
- Pages
- 1614-1620
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W4283269533
- Cited by
- 47
- References
- 26
- Citations by year
- 2026: 15 · 2025: 7 · 2024: 19 · 2023: 6
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons-TMC (Texas Medical Center) (submittedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- exercise intervention, advanced liver disease, liver cirrhosis, sarcopenia, frailty, muscular fitness, cardiorespiratory fitness, quality of life, home-based exercise, resistance training, exercise safety, portal hypertension complications
- MeSH terms
- Frailty, Exercise Therapy, Humans, Liver Diseases, Physical Fitness, Quality of Life, Randomized Controlled Trials as Topic
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