An Outpatient Hospital-based Exercise Training Program for Patients With Cirrhotic Liver Disease Awaiting Transplantation: A Feasibility Trial

Morkane, Clare; Kearney, Orla; Bruce, Deborah; Melikian, Clare; Martin, Daniel

doi:10.1097/tp.0000000000002803

Cited by 48 publications

(109 citation statements)

References 28 publications

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“…This was also observed in an earlier Canadian pilot RCT [113]. A study from the UK showing the feasibility of a hospital-based training program offered structured nutritional advice in both arms based on the EASL recommendations [114]. Two studies have also demonstrated a beneficial effect of a combined nutritional and PE intervention on portal pressure [115•, 116].…”

Section: Combining Nutritional Interventions With Physical Exercisementioning

confidence: 61%

Dietary Interventions in Liver Diseases: Focus on MAFLD and Cirrhosis

Vuille‐Lessard

Lange

Riebensahm

et al. 2021

Curr Hepatology Rep

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Purpose of Review Dietary interventions (DI) aimed at improving overweight and metabolic abnormalities in metabolic dysfunction-associated fatty liver disease (MAFLD) and at reducing malnutrition and sarcopenia in cirrhosis should become part of routine care in hepatology. This review focuses on recent advances in this field. Recent Findings In patients with MAFLD, a gradual reduction, respectively, of 7–10% of body weight if overweight or of 3–5% if lean, obtained by moderately reducing caloric intake, is effective to improve liver disease. Intermittent energy restriction might be an alternative to continuous energy restriction with higher adherence. Qualitative dietary adjustments should include increased intake of unprocessed foods including fruits and vegetables, whole grains, fiber, and unsaturated fatty acids (FAs), for example, through a Mediterranean diet. Refined carbohydrates (CHOs), saturated FA (SFAs), red meat, and processed meat should be limited. DI studies in HIV-infected subjects with MAFLD are very limited, and this is a field for future research. In patients with cirrhosis, DI should aim at correcting malnutrition and improving skeletal muscle mass. Daily diet contents should aim at achieving 30–35 kcal/kg of body weight, including 1.2–1.5 g/kg proteins, and oral or enteral supplementation might be used in patients unable to achieve these targets. In some studies, branched-chain amino acids (BCAAs) proved to be effective in improving muscle mass and were associated with a lower risk of hepatic encephalopathy. Obesity requires adjustment of the above-mentioned targets, and its management is challenging. Studies looking at the efficacy of DI recommended by the existing guidelines on clinical endpoints are a field for future research. Summary Dietary interventions are able to improve MAFLD and show potential to reduce complications in liver disease. Despite its key importance, there are many barriers limiting the implementation of DI in patients with chronic liver disease. Patients’ empowerment is crucial and should be the focus of specific educational programs. In addition, liver clinics would benefit from multidisciplinary teams involving experts in nutrition, physical exercise, primary care physicians, and psychologists when needed.

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Section: Combining Nutritional Interventions With Physical Exercisementioning

confidence: 61%

Dietary Interventions in Liver Diseases: Focus on MAFLD and Cirrhosis

Vuille‐Lessard

Lange

Riebensahm

et al. 2021

Curr Hepatology Rep

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“…It remains unknown whether an improvement of 1.7ml/kg/min VO 2 peak is clinically meaningful in CLD. Morkane et al reported that, while the intervention group increased their VO 2 peak by +2.3 mL/kg/min following a 6 week thrice weekly cycle ergometry exercise, the control group decreased their VO 2 peak by 1.9 mL/kg/min. The latter deterioration is not surprising in light of the fact that all participants had progressive decompensated liver disease, requiring liver transplantation.…”

Section: Physical Exercise In Patients With Chronic Liver Diseasementioning

confidence: 99%

Review article: impact of exercise on physical frailty in patients with chronic liver disease

Williams

Berzigotti

Lord

et al. 2019

Aliment Pharmacol Ther

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Summary Background Physical frailty is common in chronic liver disease and the setting of liver transplantation. It is associated with poor quality of life, increased hospitalisation and mortality. Despite this, the impact of exercise in these patients remains poorly understood. Aim To summarise the impact of physical exercise on physical frailty in patients with chronic liver disease until after liver transplantation. Methods A MEDLINE and PubMed search was undertaken using the terms; “physical activity”, “functional capacity”, “exercise”, “prehabilitation”, “frailty”, “liver cirrhosis”, “liver failure”, “liver transplantation” “chronic liver disease” and “end‐stage liver disease” from January 1990 to June 2019. Results Eleven studies (five randomised controlled, five observational, one case study) demonstrated that exercise improves VO2 peak, anaerobic threshold, 6‐minute walk distance, muscle mass/function and quality of life in patients with compensated and decompensated cirrhosis. Improvements were most significant with a combination of aerobic and resistance exercises at moderate‐high intensity. The studies were small (n = 1‐50) and mainly focused on supervised, hospital‐based exercises, excluding patients with significant liver failure (MELD > 12). Seven studies (four randomised controlled and three observational) demonstrated that predominantly supervised (only one home‐based) aerobic exercise after liver transplantation improves aerobic capacity, muscle mass/strength and quality of life. There was marked heterogeneity in timing, intensity and type of exercises. Conclusion Exercise improves key components of physical frailty (functional/aerobic capacity, sarcopenia) and quality of life in chronic liver disease and after liver transplantation. Understanding the type, compliance, intensity and duration of exercise and its impact on hard clinical outcomes should be the focus of future large controlled clinical trials.

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“…Reassuringly, however the Italian SportDiet study of 50 patients with compensated cirrhosis highlighted that 16-weeks diet and exercise intervention was both safe and significantly reduced portal pressures [80•]. To date, eleven studies (5 RCT, 5 observational, 1 case report) have demonstrated that exercise improves anaerobic thresholds, peak VO 2 , 6MWD, muscle mass/function and to a certain extent quality of life in patients with compensated and decompensated cirrhosis [62,[81][82][83]. None of these studies investigated survival benefit and the majority were small (1-50 patients), focus on supervised, hospital-based aerobic exercise interventions (i.e.…”

Section: Exercisementioning

confidence: 99%

Sarcopenia in Liver Transplantation: an Update

Dhaliwal

Williams

El‐Sherif

et al. 2020

Curr Hepatology Rep

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Purpose of Review Patients undergoing liver transplantation (LT) are at high risk of sarcopenia and associated physical frailty. This review summarises advances in our knowledge of the definition, assessment, clinical implications and management of sarcopenia in LT. Recent Findings Sarcopenia is associated with increased mortality, morbidity, physical disability and poor quality of life both before and after LT. Assessment tools have evolved from solely relying on imaging (i.e. muscle area only) to reproducible measures of function and physical performance status (i.e. liver frailty index). The multi-faceted management of sarcopenia is heavily reliant on nutrition (protein > 1.5 g/kg/day) and exercise (combined aerobic and resistance) advice. Summary There is an increased awareness of the clinical implications, assessment tools and management for patients with sarcopenia awaiting LT. Future studies need to investigate the role of specific nutritional supplements, pharmaco-/ behavioural therapy and the long-term outcomes (e.g. survival) of reversing sarcopenia in this patient population.

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An Outpatient Hospital-based Exercise Training Program for Patients With Cirrhotic Liver Disease Awaiting Transplantation: A Feasibility Trial

Cited by 48 publications

References 28 publications

Dietary Interventions in Liver Diseases: Focus on MAFLD and Cirrhosis

Dietary Interventions in Liver Diseases: Focus on MAFLD and Cirrhosis

Review article: impact of exercise on physical frailty in patients with chronic liver disease

Sarcopenia in Liver Transplantation: an Update

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