Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study

Berzigotti, Annalisa; Albillos, Agustı́n; Villanueva, Càndid; Genescà, Joan; Ardèvol, Alba; Augustín, Salvador; Calleja, José Luís; Bañares, Rafael; García‐Pagán, Juan Carlos; Mesonero, Francisco; Bosch, Jaime

doi:10.1002/hep.28992

Cited by 254 publications

(234 citation statements)

References 27 publications

(58 reference statements)

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“…Prior studies, consisting of 6‐60 participants, have mainly focused on face‐to‐face, supervised exercise interventions in the hospital setting and in patients without significant liver failure warranting LT . In agreement with our findings, the safety, acceptability, and adherence of variable exercise programs in patients with MELD scores of 9‐13 was considered satisfactory .…”

Section: Discussionsupporting

confidence: 88%

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

et al. 2019

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Frailty is associated with increased mortality both before and after liver transplantation (LT). There are no standardized exercise programs, in particular home‐based exercise programs (HBEPs), for patients awaiting LT. The aim was to investigate the feasibility of such a program in patients awaiting LT. Patients were randomly selected from the Birmingham LT waiting list and provided with a 12‐week HBEP, including average daily step (ADS) targets and twice‐weekly resistance exercises. Feasibility was based on patient eligibility (≥66% of waiting list), target recruitment (≥90% of n = 20), safety (no related serious adverse events), and adherence (≥66% adherence to 6‐week HBEP). Measures of aerobic (incremental shuttle walk test [ISWT], ADS), functional capacity (short physical performance battery test [SPPBT]), and health‐related quality of life (EuroQol 5‐Dimension 5‐Level (EQ‐5D‐5L) and hospital anxiety and depression score [HADS]) were taken at baseline and at 6 and 12 weeks. 18 patients (50% male; median age, 55 years) were recruited. All domains of the study feasibility criteria were met. ISWT improved after 6 weeks (50 m; P ≤ 0.01) and 12 weeks (210 m; P ≤ 0.01), despite withdrawal of the telephone health calls. Similarly, improvements were seen in ADS (2700/day; P ≤ 0.01) and the SPPBT (2.5; P = 0.02) after 12 weeks. There was no difference in HADS (median difference [MD] –3; P = 0.69), but EQ‐5D‐5L after 12 weeks (17.5%; P = 0.04). In conclusion, a 12‐week HBEP, incorporating both easy‐to‐apply resistance and aerobic exercises, is safe and feasible in patients awaiting LT. Measures of aerobic and functional capacity demonstrate trends toward improvement that warrant further investigation in a randomized controlled trial.

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Section: Discussionsupporting

confidence: 88%

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

et al. 2019

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“…A small pilot study demonstrated that adapted physical activity may improve the index of fitness and the quality of life in cirrhotic patients listed for LT [132]. Additionally, weight loss may reduce portal hypertension as well [133]. However, if lifestyle changes alone can reverse severe cirrhotic NASH is still unproven.…”

Section: How To Optimize the Outcome Of Nafld Patients Undergoing Ltmentioning

confidence: 99%

NAFLD and liver transplantation: Current burden and expected challenges

Pais

Barritt

Calmus

et al. 2016

Journal of Hepatology

370

315

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Summary Because of global epidemics of obesity and type 2 diabetes, the prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing both in Europe and the United States, becoming one of the most frequent causes of chronic liver disease and predictably, one of the leading causes of liver transplantation both for end-stage liver disease and hepatocellular carcinoma. For most transplant teams around the world this will raise many challenges in terms of preand post-transplant management. Here we review the multifaceted impact of NAFLD on liver transplantation and will discuss: (1) NAFLD as a frequent cause of cryptogenic cirrhosis, end-stage chronic liver disease, and hepatocellular carcinoma; (2) prevalence of NAFLD as an indication for liver transplantation both in Europe and the United States; (3) the impact of NAFLD on the donor pool; (4) the access of NAFLD patients to liver transplantation and their management on the waiting list in regard to metabolic, renal and vascular comorbidities; (5) the prevalence and consequences of post-transplant metabolic syndrome, recurrent and de novo NAFLD; (6) the alternative management and therapeutic options to improve the long-term outcomes with particular emphasis on the correction and control of metabolic comorbidities.

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“…Insulin resistance, total cholesterol, and leptin levels improved as well. Because exercise was not intense and frequent enough to improve muscle mass, the demonstrated changes were likely related to weight loss …”

Section: Interventions Targeting Sarcopenia and Physical Fitnessmentioning

confidence: 99%

Exercise and physical activity for patients with end‐stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list

Duarte‐Rojo¹,

et al. 2017

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and physical deconditioning are frequent complications in patients with cirrhosis and end-stage liver disease (ESLD). They are the end result of impaired dietary intake, chronic inflammation, altered macronutrient and micronutrient metabolism, and low physical activity. Frailty is the end result of prolonged sarcopenia and physical deconditioning. It severely affects a patient's functional status and presents in approximately 1 in 5 patients on the liver transplantation waiting list. Sarcopenia, poor physical fitness/cardiopulmonary endurance (CPE), and frailty are all associated with increased mortality in ESLD. Clinical trials addressing the usefulness of exercise in patients with cirrhosis have shown that it improves the metabolic syndrome, sarcopenia, CPE, health-related quality of life, and hepatic venous pressure gradient. Although evidence on the benefits of exercise on clinical outcomes derived from large clinical trials is still missing, based on existing literature from multiple medical subspecialties, we believe that an exercise program coupled to a tailored nutritional intervention benefits both cardiopulmonary and musculoskeletal functions, ultimately translating into improved functional status, sense of well-being, and possibly less complications from portal hypertension. In conclusion, although supervised exercise training is the prevailing approach to manage ESLD patients, such intervention is not sustainable or feasible for most patients. Innovative home-based physical activity interventions may be able to effectively reach a larger number of patients.Liver Transplantation 24 122-139 2018 AASLD.

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Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study

Cited by 254 publications

References 27 publications

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

NAFLD and liver transplantation: Current burden and expected challenges

Exercise and physical activity for patients with end‐stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list

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