title: Patient-perceived barriers to lifestyle interventions in cirrhosis.
abstract: OBJECTIVE
  Sarcopenia, muscle weakness, and physical frailty are independent predictors of mortality in cirrhosis. These adverse prognostic factors are potentially modifiable with lifestyle interventions, including adequate nutritional intake and physical activity. Our aim was to identify patient-perceived barriers and enablers to these interventions.
  
  
  METHODS
  Adult patients with cirrhosis were prospectively recruited from two tertiary care liver clinics. Patients were excluded if they had hepatocellular carcinoma beyond transplant criteria, other active malignancy, or advanced chronic disease.
  
  
  RESULTS
  A total of 127 patients (mean age: 60 ± 9 years, 58% males, and 48% with Child-Pugh-B/C (CP-B/C) disease) were included. Two-thirds of the patients had cirrhosis related to alcohol or hepatitis C. CP-B/C patients were more likely to take oral nutritional supplements (56% vs 29%) and less likely to consume animal protein daily (66% vs 85%) when compared to CP-A patients. Early satiety, altered taste, and difficulty in buying/preparing meals were more common in CP-B/C patients and even present in 20-30% of CP-A patients. Most patients reported adequate funds to purchase food. As quantified by the International Physical Activity Questionnaire-Short Form, 47% reported low activity levels, with no significant differences between groups. CP-B/C patients were more fatigued with exercise, however, overall Exercise Benefits/Barriers Scale scores were similar across groups.
  
  
  CONCLUSIONS
  Barriers to nutritional intake and physical activity are common in cirrhosis and should be evaluated and treated in all patients. Asking simple screening questions in clinic and referring at-risk patients to expert multidisciplinary providers is a reasonable strategy to address these barriers. Future research should evaluate techniques to overcome modifiable barriers and enhance enablers.
authors.affiliation: Department of Medicine; The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Ney
authors.affiliation: Department of Medicine; The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta; Department of Medicine, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
authors.forename: Leah
authors.initials: L
authors.lastname: Gramlich
authors.affiliation: The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta; Alberta Health Services; Cirrhosis Care Clinic (Liver Unit), University of Alberta Hospital, Alberta, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Mathiesen
authors.affiliation: Department of Medicine; The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta; Department of Medicine, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Bailey
authors.affiliation: Division of Gastroenterology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Haykowsky
authors.affiliation: Department of Medicine; The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Mang
authors.initials: M
authors.lastname: Ma
authors.affiliation: Department of Medicine; The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta; Cirrhosis Care Clinic (Liver Unit), University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.affiliation: Department of Medicine; The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta; Cirrhosis Care Clinic (Liver Unit), University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Puneeta
authors.initials: P
authors.lastname: Tandon
mesh_terms: D000368:Aged; D005260:Female; D006305:Health Status Indicators; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D008019:Life Style; D008103:Liver Cirrhosis / Q000523:psychology*; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors