Exercise in cirrhosis: Translating evidence and experience to practice
Author(s): ,
Margaret McNeely
Affiliations:
Physical Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
,
Deborah Ann Josbeno
Affiliations:
University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Physical Therapy, Pittsburgh, PA, USA
,
Mark Joseph Franklin Haykowsky
Affiliations:
Integrated Cardiovascular Exercise Physiology and Rehabilitation (iCARE) Laboratory, College of Nursing and Health Innovation, The University of Texas Arlington, Arlington, TX, USA
,
Nancy Howes
Affiliations:
London Health Sciences Centre, London, ON, Canada
,
Jennifer Holman
Affiliations:
Transplant Centre, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada
,
Michael Andrew Dunn
Affiliations:
Center for Liver Diseases, Thomas E Starzl Transplantation Institute and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
,
Bandar Al-Judaibi
Affiliations:
Medicine, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
,
Andres Duarte-Rojo
Affiliations:
Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
,
Kenneth Riess
Affiliations:
Physical Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
,
Kathleen Patricia Ismond
Affiliations:
Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
Puneeta Tandon
Affiliations:
Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
Corresponding author. Address: Zeidler Centre, 8540-112th Street, Edmonton, AB T6G 2X8, Canada.
EASL LiverTree™. Tandon P. Nov 1, 2018; 256714
Dr. Puneeta Tandon
Dr. Puneeta Tandon

Access to this content is an EASL members and LiverTree™ Privileged Users benefit.

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Summary

Physical inactivity, sarcopenia, and frailty are highly prevalent, independent predictors of morbidity and mortality in patients with cirrhosis. Across a range of chronic diseases, exercise training is a key recommendation supported by guidelines and, for some conditions, even by governmental funding of exercise programmes. Consistent with the broader chronic disease literature, the evidence for a benefit of exercise in cirrhosis is promising. Several small trials have reported significant improvements in muscle health (mass, strength, functional capacity), quality of life, fatigue, and reductions in the hepatic venous pressure gradient, without adverse events. With strong emerging evidence surrounding the substantial risks of sarcopenia/frailty and our first-hand experiences with liver pre-transplant exercise programmes, we contend that routine patient care in cirrhosis should include an exercise prescription. Some clinicians may lack the resources and necessary background to translate the existing evidence into a practicable intervention. Our team, comprised of physiotherapists, exercise physiologists, hepatologists, transplant specialists, and knowledge translation experts from six North American centres, has distilled the essential background information, tools, and practices into a set of information ready for immediate implementation into clinics ranging from a family practice setting to specialty cirrhosis clinics. Augmenting the rationale and evidence are supplementary materials including video and downloadable materials for both patients and the physician. Supporting the exercising patient is a section regarding information about nutrition, providing practical tips suitable for all patients with cirrhosis.

Keyword(s)
Physical activity, End-stage liver disease, Pre-transplant candidate, 6-min walk test, Pre-habilitation, Frailty, Sarcopenia, Nutrition
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