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

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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.

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