Home-based exercise programs reduce fatigue among women with primary biliary cholangitis

A 12-week home exercise program reduced fatigue and improved quality of life in 25 women with primary biliary cholangitis, according to research presented at The Liver Meeting Digital Experience.

“Fatigue is perhaps the most commonly reported symptom, affecting 40% to 80% of our patients in varying degrees, but despite this, there is no medical therapy for this debilitating symptom,” Alice Freer, of the department of physiotherapy at University Hospital Birmingham, said during the presentation.

Freer and colleagues conducted a single arm, open label clinical trial of a home-based exercise program that comprised 25 women (median age, 54; median PBC-40 fatigue score, 42) with primary biliary cholangitis and moderate to severe fatigue. The sex makeup of the cohort was “representative of a typical [primary biliary cholangitis] PBC population,” Freer said. Researchers excluded patients who had untreated secondary causes of fatigue, such as hypovitaminosis or hypothyroidism or advanced liver disease, according to Freer. They monitored activity levels with an accelerometer. Each participant had an individualized exercise program that varied in difficulty and researchers designed to remain “high intensity, but low impact,” Freer said. Participants engaged in the individualized exercise program from weeks 1 to 5 and 7 to 11; they also received weekly telephone-based support from week 1 to 5.

The primary endpoint was a reduction in PBC-40 fatigue score by 5 or more points. Researchers also assessed fatigue with fatigue impact scale (FIS) scores; quality of life with composite PBC-40 scores; sleep with Epworth Sleep Scores (ESS); anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) scores; aerobic exercise capacity with incremental shuttle walk test (ISWT) and metabolic equivalent of task (MET); and functional capacity with short physical performance battery (SPPB) at baseline, week 6 and week 12.

Median PBC40 fatigue scores decreased at 6 weeks (–5; P < .001) and 12 weeks (–10; P < .001), with 88% (n = 23) of patients meeting the primary endpoint of 5 or more points at week 12. There were also decreases in composite PBC40 scores (–10.5 points; P < .001), FIS (–4; P < .001), ESS (–5; P < .001) and HADS scores (–2; P < .001) at week 12. IWST scores improved at week 6 (50 m; P < .001) and week 12 (100 m; P < .001). MET scores (0.65; P < .001) and SPPB scores (1 point; P < .001) improved at week 12, with 96% (n = 24) achieving maximum SPPB function at week 12.

“Although it’s really important to acknowledge that this study is a feasibility study, it does demonstrate that the concept of home-based, remotely-monitored programs are not only safe and feasible within this cohort, but more excitingly, the results suggest that graded exercise can be applied as a treatment modality to help reduce symptoms of fatigue whilst also improving quality of life, exercise and functional capacity,” Freer said.

Freer reports receiving speaking and teaching fees from Intercept Pharma.