The effect of eight weeks of home based aerobic exercise training on peak exercise oxygen consumption, six-minute walk test distance, thigh muscle mass, and health related quality of life in Child Pugh class A and B cirrhosis patients

Abstract

Purpose: Cirrhosis patients have reduced peak aerobic power (peak VO2) that is associated with reduced survival. Supervised endurance training is an effective therapy to increase exercise tolerance in cirrhosis. The effect of home-based endurance exercise training (HET) on improving peak VO2 in cirrhosis patients has not been studied. The aim of this pilot study was to evaluate the safety and efficacy of 8 weeks of HET on peak VO2, aerobic endurance, thigh muscle thickness and circumference, and quality of life. Methods: Stable patients with Child Pugh class A and B cirrhosis were randomized to 8 weeks of HET (n=20) or usual care (controls, n=20). The HET group performed moderate-high intensity cycle exercise 3 days per week. An exercise therapist supervised a HET session biweekly. Paired t-test was used for within group comparisons and ANCOVA was used to perform between group comparisons due to baseline differences and small sample size. Results: The cohort (n=40) was 58% male (mean age of 57 ± 8 years), and 70% had Child Pugh class A cirrhosis. The between group VO2 difference trended to significance (1.7 (-0.33 to 3.7), p=0.09) and the between group 6-minute walk test significantly increased (33.7 (5.1 to 62.4), p=0.02). Within groups, the HET group had a significant increase in peak VO2 from baseline (17.3 ± 4.5 to 19.0 ± 6.4 mL/kg/min, p=0.03). There was a significant increase in the thigh circumference (50.6 ± 5.8 to 52.4 ± 6.6 cm, p=0.02) and thigh muscle thickness (1.25 ± 0.40 to 1.31 ± 0.38 cm/m2, p=0.05). There were no significant changes in quality of life and no there were no adverse events reported. Conclusions: Eight weeks of HET shows promise as a safe and effective intervention to improve fitness outcomes in patients with liver cirrhosis.