Home Exercise Training Improves Exercise Capacity in Cirrhosis Patients: Role of Exercise Adherence

Calvin Kruger, Margaret L McNeely, Robert J Bailey, Milad Yavari, Juan G Abraldes, Michelle Carbonneau, Kim Newnham, Vanessa DenHeyer, Mang Ma, Richard Thompson, Ian Paterson, Mark J Haykowsky, Puneeta Tandon, Calvin Kruger, Margaret L McNeely, Robert J Bailey, Milad Yavari, Juan G Abraldes, Michelle Carbonneau, Kim Newnham, Vanessa DenHeyer, Mang Ma, Richard Thompson, Ian Paterson, Mark J Haykowsky, Puneeta Tandon

Abstract

Cirrhosis patients have reduced peak aerobic power (peak VO2) that is associated with reduced survival. Supervised exercise training increases exercise tolerance. The effect of home-based exercise training (HET) in cirrhosis is unknown. The objective was to evaluate the safety and efficacy of 8 weeks of HET on peak VO2, 6-minute walk distance (6MWD), muscle mass, and quality of life in cirrhosis. Random assignment to 8 weeks of HET (moderate to high intensity cycling exercise, 3 days/week) or usual care. Exercise adherence defined as completing ≥80% training sessions. Paired t-tests and analysis of covariance used for comparisons. Forty patients enrolled: 58% male, mean age 57 y, 70% Child Pugh-A. Between group increases in peak VO2 (1.7, 95% CI: -0.33 to 3.7 ml/kg/min, p = 0.09) and 6MWD (33.7, 95% CI: 5.1 to 62.4 m, p = 0.02) were greater after HET versus usual care. Improvements even more marked in adherent subjects for peak VO2 (2.8, 95% CI: 0.5-5.2 mL/kg/min, p = 0.02) and 6MWD (46.4, 95% CI: 12.4-80.5 m, p = 0.009). No adverse events occurred during testing or HET. Eight weeks of HET is a safe and effective intervention to improve exercise capacity in cirrhosis, with maximal benefits occurring in those who complete ≥80% of the program.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Patient trial flow. The flow of patients through the trial as per CONSORT guidelines.
Figure 2
Figure 2
Individual patient changes in Peak VO2 (mL/kg/minute). When compared to the UC group, peak VO2 in the HET group improved by 1.7 mL/kg/minute (95% CI: −0.33 to 3.7), p = 0.098). Abbreviations: VO2, oxygen uptake.
Figure 3
Figure 3
Individual patient changes in 6MWD (meters). When compared to the UC group, 6MWD in the HET group improved by 33 meters (95% CI: 5.1 to 62.4), p = 0.02). Abbreviations: 6MWD, six minute walk distance.

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