title: Exercise therapy in primary biliary cirrhosis: the importance of moving while sitting on a surgical waiting list-a case study.
abstract: BACKGROUND
  It is being increasingly recognised that reduced cardiorespiratory fitness is associated with poorer outcomes after major surgery. Exercise limitation and reduced aerobic capacity are common in people with end-stage liver disease. There is limited evidence about the role of exercise therapy in the management of primary biliary cirrhosis (PBC) and no studies have looked at the effect of exercise in people with PBC who are awaiting liver transplantation. This case study is the first to report that personalised exercise therapy improves cardiorespiratory fitness in a patient with PBC without worsening symptoms of severe fatigue.
  
  
  METHODS
  Cardiopulmonary exercise testing was used to assess cardiorespiratory fitness in a patient with end-stage PBC prior to listing for transplantation. A personalised exercise programme was designed to improve cardiorespiratory fitness while the patient was on the transplant waiting list.
  
  
  RESULTS
  Anaerobic threshold, VO2PEAKand maximum workload all improved with regular exercise. Fatigue levels remained unaltered.
  
  
  CONCLUSIONS
  This patient tolerated and adhered to a personalised exercise programme for a prolonged period of time while awaiting surgery despite significant fatigue and disease burden. Liver transplantation was successfully completed and this woman remains well over 2 years post-surgery.
authors.affiliation: Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne , UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Hallsworth
authors.affiliation: Institute ofCellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Liver Unit, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Jopson
authors.affiliation: Institute ofCellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Liver Unit, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Jones
authors.affiliation: Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne , UK.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Trenell
keywords: LIVER TRANSPLANTATION; PRIMARY BILIARY CIRRHOSIS