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Home-based exercise improves aerobic power in patients with cirrhosis

LAS VEGAS — Home-based endurance exercise improved peak aerobic power, suggesting it may improve overall survival in patients with cirrhosis, according to results of a pilot study presented at ACG 2016.

Puneeta Tandon, MD, MSc(Epi), of the University of Alberta, Canada, and colleagues randomly assigned 40 patients with cirrhosis to either an 8-week regimen of home-based endurance exercise training (HET; n = 20) or usual care (control group; n = 20) to determine if 8 weeks HET was safe and had any positive effect on peak aerobic power (VO₂).

“We know that patients with cirrhosis have reduced exercise capacity (VO₂) ... we also know VO₂ is linked to sarcopenia and frailty,” Tandon said during her presentation. “There are limited studies addressing exercise as a treatment for these conditions … I think this is in part due to concern raising portal pressure.”

Tandon expressed the importance of exercise and its effect on this patient population.

“In 2014 we published the first pilot randomized control trial of site-based supervised exercise therapy in cirrhosis,” Tandon said. “Although that study showed significant improvements in the VO₂, having to come in 3 times a week to our center to exercise wasn’t practical for many patients. That led us to perform the current trial of HET.”

The patients who underwent HET performed moderate to high-intensity exercise 3 days per week, and were observed by an exercise specialist once every 2 weeks. Of the patients, 70% had Child-Pugh A cirrhosis and 30% had Child-Pugh B cirrhosis.

Between the groups, the 6-minute walk test significantly improved, with a 33-meter change (P = 0.02) and a difference in VO2 trended to significance from baseline, with a 1.7 mL/kg/min change (P = .095). “Although lower than in our supervised exercise trial, this still represents a clinically meaningful improvement.”

Within the exercise group, there was an improvement in thigh circumference (50.6 ± 5.8 vs. 52.4 ± 6.6; P = .02) and a trend to improvement in thigh muscle thickness (1.25 ± 0.4 vs. 1.31 ± 0.38 cm/m2; P = .05)

The researchers did not observe any differences in the quality of life or any adverse events during cardiopulmonary exercise testing or HET.

Tandon concluded: “Exercise has implications for the management of impaired exercise tolerance, sarcopenia and physical frailty. Larger studies are needed to confirm the benefits of HET, to extend these findings to patients with more advanced liver dysfunction and to find innovative strategies to increase adherence.” – by Melinda Stevens

Reference:

Kruger C, et al. Abstract #8. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 14-19, 2016; Las Vegas, NV.

Disclosure: The researchers report no relevant financial disclosures.