Therapeutic Physical Exercise Programs in the Context of NASH Cirrhosis and Liver Transplantation: A Systematic Review

Abstract

In recent years, various physical exercise interventions have been developed with a view to reducing comorbidity and morbidity rates among patients with chronic diseases. Regular physical exercise has been shown to reduce hypertension and mortality in patients with type 2 diabetes. Diabetes and obesity are often associated with the development of nonalcoholic fatty liver disease, which can lead to liver fibrosis and then (in some cases) nonalcoholic steatohepatitis cirrhosis. We searched the literature for publications on personalized physical exercise programs in cirrhotic patients before and after liver transplantation. Eleven studies in cirrhotic patients and one study in liver transplant recipients were included in the systematic review, the results of which were reported in compliance with the preferred reporting items for systematic reviews and meta-analyses guidelines. The personalized physical exercise programs lasted for 6 to 16 weeks. Our review evidenced improvements in peak oxygen consumption and six-minute walk test performance and a reduction in the hepatic venous pressure gradient. In cirrhotic patients, personalized physical exercise programs improve quality of life, are not associated with adverse effects, and (for transplant recipients) might reduce the 90-day hospital readmission rate. However, none of the literature data evidenced reductions in the mortality rates before and after transplantation. Further prospective studies are needed to evaluate the benefit of long-term physical exercise programs in cirrhotic patients before and after liver transplantation.

Innovative Therapeutic Approaches in Non-Alcoholic Fatty Liver Disease: When Knowing Your Patient Is Key

“…On the other hand, a recent expert meeting has gathered strong evidence that regular physical activity plays an important role in preventing NAFLD and improving intermediate clinical outcomes [ 193 ]. Various studies have demonstrated an improvement in NAFLD with personalized physical exercise programs [ 194 ], even in the absence of significant weight loss [ 195 , 196 ], and a reduction of the hepatic venous pressure gradient in cirrhotic patients [ 197 ].…”

Frailty in end-stage liver disease: Understanding pathophysiology, tools for assessment, and strategies for management

“…In fact, low moderate-vigorous activity has been associated with increased mortality among liver transplant wait-listed patients[ 157 ]. Conversely, exercise interventions have the potential to safely improve exercise capacity, peak oxygen consumption, muscle mass and function, and quality of life, while decreasing the hepatic venous pressure gradient in individuals with cirrhosis[ 158 , 159 ]. This can even reverse the process of frailty in cirrhotic patients.…”

Sarcopenia and malnutrition in patients with liver diseases

“…Также для коррекции саркопении, слабости в программу реабилитации включают регулярные физические упражнения. В ряде исследований показана польза регулярных аэробных тренировок средней интенсивности [53][54][55]. Физическая активность позволяет увеличить мышечную массу и силу, снизить утомляемость, обеспечивает лучшее качество жизни [56].…”