Exercise Training Improves Physical Function in Liver Cirrhosis
A systematic review of randomised controlled trials has found that structured exercise programmes can improve physical function and muscle strength in adults with liver cirrhosis, with no major safety concerns reported.
The review examined the benefits and safety of physical exercise in adults with pre-transplant liver cirrhosis, particularly its effects on muscle mass, strength and functional performance. Researchers searched six databases and identified four randomised controlled trials involving 135 patients with cirrhosis. The studies were evaluated for potential bias using the Risk of Bias 2 tool, while the strength of the evidence was assessed using the GRADE system.
Supervised Exercise Shows Greater Benefits
Patients who participated in supervised exercise programmes experienced better functional capacity and muscle strength than those receiving usual care. Their performance on the six-minute walk test improved by as much as 69 m, while cardiopulmonary effort time increased by 2.0 min.
Supervised training was also associated with gains in muscle strength. Isokinetic knee torque increased by 11 N.m, and handgrip strength improved by 2.6 kgf. Measurements obtained through magnetic resonance imaging or dual-energy X-ray absorptiometry indicated modest increases in muscle mass. However, assessments of total lean mass using bioelectrical impedance did not demonstrate a significant improvement.
In contrast, exercise programmes carried out at home without supervision resulted in improvements that were not statistically significant.
Supervised Training Considered Safe and Effective
The trials reported no exercise-related cases of variceal bleeding, acute decompensation or severe adverse events. Some concerns about study bias remained, largely because it was not possible to blind participants or assessors during performance-based testing.
The certainty of evidence was rated as moderate for functional capacity and muscle mass, but low for muscle strength. Overall, the findings indicate that structured, supervised exercise can be a safe and effective strategy for improving functional capacity and muscle strength in stable patients with liver cirrhosis.
According to the authors, supervision may be particularly important because it helps patients reach the level of exercise stimulus needed to address sarcopenia. However, larger randomised controlled trials are required to determine whether these short-term improvements result in meaningful long-term benefits for patients awaiting liver transplantation.
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