Eight weeks of exercise training increases aerobic capacity and muscle mass and reduces fatigue in patients with cirrhosis.
OBJECTIVE
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.
Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB.
Laura
L
Zenith
Faculty of Rehabilitation Medicine, University of Alberta, Alberta Cardiovascular and Stroke Research Centre (ABACUS), Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Neha
N
Meena
Faculty of Rehabilitation Medicine, University of Alberta, Alberta Cardiovascular and Stroke Research Centre (ABACUS), Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Ailar
A
Ramadi
Faculty of Rehabilitation Medicine, University of Alberta, Alberta Cardiovascular and Stroke Research Centre (ABACUS), Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Milad
M
Yavari
Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB.
Andrea
A
Harvey
Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB.
Michelle
M
Carbonneau
Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB.
Mang
M
Ma
Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB.
Juan G
JG
Abraldes
Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB.
Ian
I
Paterson
Faculty of Rehabilitation Medicine, University of Alberta, Alberta Cardiovascular and Stroke Research Centre (ABACUS), Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Mark J
MJ
Haykowsky
Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB. Electronic address: ptandon@ualberta.ca.
Puneeta
P
Tandon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000416:Alberta; D002170:Canada; D015444:Exercise; D005221:Fatigue / Q000628:therapy*; D005260:Female; D005355:Fibrosis / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000033:anatomy & histology* / Q000502:physiology*; D010101:Oxygen Consumption; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
Cardiovascular; Clinical Trial; Fibrosis; Liver Disease