title: Effects of in-hospital exercise on liver function, physical ability, and muscle mass during treatment of hepatoma in patients with chronic liver disease.
abstract: OBJECTIVE
  Sarcopenia and physical disability assessed by a 6-min walking test (6MWT) are associated with poor prognosis of patients with chronic liver disease (CLD). However, CLD patients with hepatocellular carcinoma (HCC) mostly rest in bed during hospitalization. We aimed to investigate the effects of therapeutic exercise on liver function, 6MWT, and skeletal muscle mass during HCC treatment in patients with CLD.
  
  
  METHODS
  We enrolled 54 CLD patients with HCC (median age, 76 years). During hospitalization, patients performed a combination of stretching, strength training, balance practice, and endurance training (2.5-4 metabolic equivalents/20 min/day). Primary outcomes were changes from admission to discharge in Child-Pugh class, 6MWT, and skeletal muscle mass. Furthermore, factors associated with skeletal muscle atrophy were analyzed by a decision-tree analysis.
  
  
  RESULTS
  Exercise did not worsen the Child-Pugh class. On discharge, the 6MWT ambulation distance was maintained, and heart rate variability during the 6MWT was significantly improved compared to that on admission (area under the curve 50.3 vs. 39.0 arbitrary units; P = 0.0027). Although skeletal muscle mass was significantly reduced (20.6 kg vs. 20.0 kg, P = 0.0301), branched-chain amino acid (BCAA) treatment was identified as the most distinguishable factor for minimizing muscle mass atrophy (-1.1 kg vs. -0.5 kg/hospitalization).
  
  
  CONCLUSIONS
  Therapeutic exercise improved physical ability without worsening liver function during hospitalization for HCC treatment in CLD patients. Although exercise did not completely prevent skeletal muscle atrophy, BCAA treatment minimized the skeletal muscle atrophy. Thus, exercise with BCAA treatment may be important for the management of CLD patients with HCC.
authors.affiliation: Division of Rehabilitation, Kurume University Hospital, Kurume, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Koya
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Kawaguchi
authors.affiliation: Division of Rehabilitation, Kurume University Hospital, Kurume, Japan.|Department of Orthopedics, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Ryuki
authors.initials: R
authors.lastname: Hashida
authors.affiliation: Department of Nursing, Kurume University Hospital, Kurume, Japan.
authors.forename: Emiko
authors.initials: E
authors.lastname: Goto
authors.affiliation: Division of Rehabilitation, Kurume University Hospital, Kurume, Japan.|Department of Orthopedics, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Matsuse
authors.affiliation: Division of Rehabilitation, Kurume University Hospital, Kurume, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Saito
authors.affiliation: Division of Rehabilitation, Kurume University Hospital, Kurume, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirota
authors.affiliation: Division of Rehabilitation, Kurume University Hospital, Kurume, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Taira
authors.affiliation: Department of Nursing, Kurume University Hospital, Kurume, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Matsushita
authors.affiliation: Department of Nursing, Kurume University Hospital, Kurume, Japan.
authors.forename: Minami
authors.initials: M
authors.lastname: Imanaga
authors.affiliation: Department of Clinical Nutrition, Kurume University Hospital, Kurume, Japan.
authors.forename: Ayu
authors.initials: A
authors.lastname: Nagamatsu
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Tomotake
authors.initials: T
authors.lastname: Shirono
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Shimose
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Iwamoto
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Niizeki
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.|Ultrasonic Diagnosis Center, Kurume University Hospital, Kurume, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Kuromatsu
authors.affiliation: Department of Nursing, Kurume University Hospital, Kurume, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Miura
authors.affiliation: Division of Rehabilitation, Kurume University Hospital, Kurume, Japan.|Department of Orthopedics, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Shiba
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Torimura
keywords: hepatocellular carcinoma; kinesiotherapy; nutrition; physical function; sarcopenia