title: Exercise manual for liver disease patients.
abstract: OBJECTIVE
  To increase inspiratory muscle strength and improve the quality of life of candidates for liver transplantation.
  
  
  METHODS
  Twenty-three candidates for liver transplantation participated in the control group and 14 made up the intervention group. The control group consisted of 18 men and 5 women, body mass index (BMI) 27.3 ± 4.5 kg/m(2) and Model for End-Stage Liver Disease (MELD) 18.2 ± 6.1. The intervention group consisted of 11 men and 3 women, BMI 28.6 ± 5.4 kg/m(2) and MELD 18 ± 4.5. The presence or absence of ascites was identified in the first patient evaluation and after three months. We evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure, spirometry, root mean square (RMS) of diaphragm and rectus abdominis, and the quality of life. The exercises were performed daily by patients at home for three months and were supervised at distance monthly. The manual consisted of diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT(®), lifting upper limbs with a bat and strengthening the abdomen.
  
  
  RESULTS
  There was significant difference (P = 0.01) between the first (initial) and the third month (final) MIP in the control group and in the intervention group, but there was no difference (P = 0.45) between the groups. The RMS of the diaphragm was lower (P = 0.001) and the functional capacity was higher (P = 0.006) in the intervention group compared to the control. The general health and mental health domains received higher scores after three months in the control group (P = 0.01) and the intervention group (P = 0.004), but there was no significant difference between them. The comparison between the presence of initial ascites with the presence of ascites was performed after three months in the control group (P = 0.083) and intervention group (P = 0.31). There was no significant difference, in relation to the presence of ascites after three months between groups (P = 0.21). In the intervention group, patients with ascites at the end of the time period had decreased scores on the social aspects SF-36 domain (P = 0.023) compared to those who had no ascites.
  
  
  CONCLUSIONS
  The proposed exercises provide an increase in the inspiratory muscle strength and improve functional capacity, consequently bettering the quality of life of liver disease patients.
authors.affiliation: Vivian Limongi, Daniele Costa dos Santos, Aurea Maria de Oliveira da Silva, Ilka de Fátima Santana Ferreira Boin, Raquel Silveira Bello Stucchi, Unit of Liver Transplantation, Hospital de Clinicas, State University of Campinas (Unicamp), Campinas 13020-060, Brazil.
authors.forename: Vivian
authors.initials: V
authors.lastname: Limongi
authors.affiliation: Vivian Limongi, Daniele Costa dos Santos, Aurea Maria de Oliveira da Silva, Ilka de Fátima Santana Ferreira Boin, Raquel Silveira Bello Stucchi, Unit of Liver Transplantation, Hospital de Clinicas, State University of Campinas (Unicamp), Campinas 13020-060, Brazil.
authors.forename: Daniele Costa
authors.initials: DC
authors.lastname: Dos Santos
authors.affiliation: Vivian Limongi, Daniele Costa dos Santos, Aurea Maria de Oliveira da Silva, Ilka de Fátima Santana Ferreira Boin, Raquel Silveira Bello Stucchi, Unit of Liver Transplantation, Hospital de Clinicas, State University of Campinas (Unicamp), Campinas 13020-060, Brazil.
authors.forename: Aurea Maria
authors.initials: AM
authors.lastname: de Oliveira da Silva
authors.affiliation: Vivian Limongi, Daniele Costa dos Santos, Aurea Maria de Oliveira da Silva, Ilka de Fátima Santana Ferreira Boin, Raquel Silveira Bello Stucchi, Unit of Liver Transplantation, Hospital de Clinicas, State University of Campinas (Unicamp), Campinas 13020-060, Brazil.
authors.forename: Ilka de Fátima Santana Ferreira
authors.initials: Ide F
authors.lastname: Boin
authors.affiliation: Vivian Limongi, Daniele Costa dos Santos, Aurea Maria de Oliveira da Silva, Ilka de Fátima Santana Ferreira Boin, Raquel Silveira Bello Stucchi, Unit of Liver Transplantation, Hospital de Clinicas, State University of Campinas (Unicamp), Campinas 13020-060, Brazil.
authors.forename: Raquel Silveira Bello
authors.initials: RS
authors.lastname: Stucchi
keywords: Breathing exercises; Electromyography; Muscle strength; Pre-operative period; Respiratory muscles