Home-Based Physical Activity and Diet Intervention to Improve Physical Function in Advanced Liver Disease: A Randomized
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ORIGINAL ARTICLE
Home‑Based Physical Activity and Diet Intervention to Improve Physical Function in Advanced Liver Disease: A Randomized Pilot Trial Hui Wei Chen1 · Arny Ferrando2 · Michelle G. White3 · Richard A. Dennis2,4 · Jesse Xie3 · Margaret Pauly5 · Sanghee Park2 · Thaddeus Bartter6 · Michael A. Dunn1 · Astrid Ruiz‑Margain7 · W. Ray Kim8 · Andres Duarte‑Rojo1,3,5 Received: 4 October 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Frailty · Sarcopenia · Prehabilitation · Exercise 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 Hui Wei Chen and Arny Ferrando have contributed equally. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-019-06034-2) contains supplementary material, which is available to authorized users. * Andres Duarte‑Rojo [email protected] Extended author information available on the last page of the article
DXA Dual-energy X-ray absorptiometry HB-PAP Home-based physical activity program HR He
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