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Home-Based Physical Activity and Diet Intervention to Improve Physical Function in Advanced Liver Disease: A Randomized Pilot Trial

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Abstract

Introduction

A decline in physical function is highly prevalent and a poor prognostic factor in cirrhosis. We assessed the benefits of a home-based physical activity program (HB-PAP) in patients with cirrhosis with a randomized pilot trial.

Methods

All participants received a personal activity tracker to monitor daily activities and were given 12 g/day of an essential amino acid supplement. The HB-PAP intervention consisted of biweekly counseling sessions to increase physical activity for 12 weeks. Six-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) assessed changes in aerobic fitness. Different anthropometric measuring tools were used for skeletal muscle and adiposity assessment.

Results

Seventeen patients (60% male; 29% nonalcoholic steatohepatitis/cryptogenic, 29% hepatitis C, 24% alcohol, 18% other) were randomized, 9 to HB-PAP group. There were no significant differences in MELD-sodium between HB-PAP and controls at baseline or after the 12-week intervention. By the end of study, there was a significant between-group difference in daily step count favoring the active group (2627 [992–4262], p = 0.001), with less sedentary patients in the active group (33–17% vs. 25–43%, p = 0.003). The 6MWT improved in the HB-PAP group (423 ± 26 m vs. 482 ± 35 m), while the controls had a nonsignificant drop (418 ± 26 m vs. 327 ± 74 m) with a significant between-group difference. CPET did not change. Other than an improvement in psoas muscle index, there were no differences in anthropometry, or in quality of life.

Conclusions

HB-PAP maintained physical performance and improved aerobic fitness according to 6MWT but not CPET, supporting the use of personal activity trackers to monitor/guide home-based prehabilitation programs in cirrhosis.

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Abbreviations

6MWT:

Six-minute walk test

ALMI:

Appendicular lean mass index

ACSM:

American College of Sports Medicine

AT:

Adipose tissue

BMI:

Body mass index

CT:

Computed tomography

CPET:

Cardiopulmonary exercise testing

CSA50:

Cross-sectional area at 50% of femur length

DXA:

Dual-energy X-ray absorptiometry

HB-PAP:

Home-based physical activity program

HR:

Heart rate

IQR:

Interquartile range

IMAT:

Intramuscular adipose tissue

LE-LMI:

Lower extremities lean mass index

LMI:

Lean mass index

MELD:

Model for end-stage liver disease

NASH:

Nonalcoholic steatohepatitis

PMI:

Psoas muscle index

RER:

Respiratory exchange ratio

SBP:

Systolic blood pressure

SD:

Standard deviation

SIP:

Sickness impact profile

SMI:

Skeletal muscle index

TMI:

Thigh muscle index

TMV:

Thigh muscle volume

VAT:

Anaerobic threshold

VE/VCO2 :

Ventilatory efficiency

VCO2 :

Carbon dioxide production

VO2 :

Oxygen consumption

VO2peak :

Peak oxygen uptake

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Funding

This study was funded by the University of Arkansas for Medical Sciences College of Medicine Clinician Scientist Program. The SliceOmatic software was purchased by VA Rehabilitation Merit Review Award # RX0012030 (RAD). The contents do not represent the views of the VA or US Government.

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Author notes

  1. Hui Wei Chen and Arny Ferrando have contributed equally.

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 201, Pittsburgh, PA, 15213, USA

    Hui Wei Chen, Michael A. Dunn & Andres Duarte-Rojo

  2. Department of Geriatrics, Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Arny Ferrando, Richard A. Dennis & Sanghee Park

  3. Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Michelle G. White, Jesse Xie & Andres Duarte-Rojo

  4. Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA

    Richard A. Dennis

  5. Liver Transplant Program, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Margaret Pauly & Andres Duarte-Rojo

  6. Division of Pulmonary Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Thaddeus Bartter

  7. Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Astrid Ruiz-Margain

  8. Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA

    W. Ray Kim

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  1. Hui Wei Chen
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Corresponding author

Correspondence to Andres Duarte-Rojo.

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Conflict of interest

AAF is co-inventor of the essential amino acid used in this study (US Patent 9,364,463 B2; UAMS; Ferrando, AA/Wolfe, RR-inventors). AAF was blinded to all data acquisition, consolidation, and interpretation. ADR and MAD advise for Axcella Health.

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Chen, H.W., Ferrando, A., White, M.G. et al. Home-Based Physical Activity and Diet Intervention to Improve Physical Function in Advanced Liver Disease: A Randomized Pilot Trial. Dig Dis Sci 65, 3350–3359 (2020). https://doi.org/10.1007/s10620-019-06034-2

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  • DOI: https://doi.org/10.1007/s10620-019-06034-2

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