Effect of a 12-week home-based exercise training program on aerobic capacity, muscle mass, liver and spleen stiffness, and quality of life in cirrhotic patients: a randomized controlled clinical trial

Pavapol Sirisunhirun, Wimolrak Bandidniyamanon, Yonworanat Jrerattakon, Kobkun Muangsomboon, Pornpoj Pramyothin, Supot Nimanong, Tawesak Tanwandee, Phunchai Charatcharoenwitthaya, Siwaporn Chainuvati, Watcharasak Chotiyaputta, Pavapol Sirisunhirun, Wimolrak Bandidniyamanon, Yonworanat Jrerattakon, Kobkun Muangsomboon, Pornpoj Pramyothin, Supot Nimanong, Tawesak Tanwandee, Phunchai Charatcharoenwitthaya, Siwaporn Chainuvati, Watcharasak Chotiyaputta

Abstract

Background: Physical inactivity and sarcopenia are two important predictors associated with increased morbidity and mortality in patients with cirrhosis. At present, the benefit of a home-based exercise training program is not well established in cirrhotic patients. The main objective of this study was to evaluate the effect of a 12-week home-based exercise training program on aerobic capacity in cirrhotic patients.

Methods: This is a randomized controlled study. Patients with compensated cirrhosis were randomized by a block of 4 with concealed allocation to the home-based exercise training (n = 20) or control (n = 20). Both groups received protein supplementation (9 g/day) for 12 weeks. The home-based exercise training program included several aerobic/isotonic moderate-intensity continuous training exercises for 40 min per session, at least four times a week, with a total duration of 12 weeks. The heart rate was continuously monitored using a Garmin® watch. In the control group, patients received exercise instruction without active encouragement and continuous monitoring. The primary outcome was a change in the 6-min walk test from baseline. Secondary outcomes were the difference in thigh muscle thickness, liver stiffness, spleen stiffness, and quality of life.

Results: A total of 40 patients were enrolled prospectively. The mean age was 56.3 ± 7.8 years, with a male predominance of 65%. The mean body mass index was 25.23 ± 3.0 kg/m2, and all were Child-Pugh A. Chronic hepatitis B or C was the primary cause of cirrhosis. The baseline values were a 6-min walk test of 475 ± 70 m, liver stiffness of 15.3 ± 9.3 kPa, spleen stiffness of 29.8 ± 21.7 kPa, and thigh muscle thickness (average compression index) of 0.64 ± 0.2 cm/m2. All baseline characteristics between the two groups were not different except the mean muscle mass which was significantly higher in the home-based exercise training group (p = 0.03, 95% CI 0.01 to 0.17). At the end of the study, no significant difference in the 6-min walk test was observed (p = 0.36, 95% CI -15.5 to 41.7). Liver stiffness measurement significantly improved in both groups, but no significant difference between groups was demonstrated (p = 0.77, 95% CI -1.3 to 1.8). Thigh muscle thickness was not different between groups. The fatigue domain of the quality of life index was significantly improved in the home-based exercise training group compared with the control group (p = 0.05, 95% CI 0.00 to 0.67). No adverse events occurred in a home-based exercise training program.

Conclusions: A 12-week moderate-intensity home-based exercise training program in compensated cirrhotic patients significantly improved the fatigue domain of the quality of life index without an increase in adverse events. However, no benefit in terms of aerobic capacity, thigh muscle mass, liver stiffness, and spleen stiffness was demonstrated.

Trial registration: Thai Clinical Trials Registry number TCTR20190926002, 26/09/2019 (Retrospectively registered).

Keywords: Aerobic capacity; Cirrhosis; Health-related quality of life; Home-based exercise; Sarcopenia.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Ultrasonography was used to measure thigh muscle thickness. The locations of measurement were the depth of the right quadriceps muscle at one-third and one-half of the total distance from the top of the patella to the iliac crest (A). The depth of the right quadricps muscle composed of the rectus femoris and vastus intermedius (B). Two readings were obtained for each point: a compression reading and a feather weight reading. Abbreviation: RF, rectus femoris; VI, vastus intermedius
Fig. 2
Fig. 2
Individual patient 6-min walk test result compared between before and after the intervention for both the home-based exercise training (HoBET) group and the control group. The dotted lines represent individual patients, and the black solid lines indicate the mean before and after the intervention

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