Exercise interventions may result in positive outcomes on muscular or cardiorespiratory fitness and quality of life in patients with advanced liver disease, results from a systematic review suggest.

“Fragility and sarcopenia are common complications of advanced liver disease,” the authors said. “Due to the associated morbidity/mortality, targeted efforts have been made to prevent and/or ameliorate both by enrolling these patients in targeted exercise programs.”

The trials were independently searched in the PubMed and Embase databases from inception until November 18, 2021. An independent arbitrator adjudicated on all disagreements.

The authors described the outcomes as follows: muscle fitness (peak inspiratory/expiratory pressures, muscle size, muscle strength, and bioimpedance test), cardiorespiratory fitness (cardiopulmonary exercise test and 6-minute walk distance), quality of life and others (security or signs of fragility).

Eleven randomized controlled trials involving four home interventions, with a total of 358 participants, met the eligibility criteria. Interventions lasted 8 to 14 weeks and included walking, cycling, resistance exercises, balance and coordination training, and breathing exercises. All results compared pre- and post-intervention measures.

Statistically significant improvements in at least one fitness, muscle condition and quality of life variable were observed in nine, 10 and six studies, respectively. Only one study reported indices of frailty.

Attrition rates ranged from 5% to 36%, while membership rates were wide ranging from 14% to 100%. Of note, complications of portal hypertension were not observed in the intervention groups in the nine studies reporting these outcomes.

“Although attrition and compliance vary, these interventions appear to be safe in patients with cirrhosis and are well tolerated,” the authors said.