August 20, 2019
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Strength training ‘recovers lost muscle mass’ from cirrhosis

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Supervised progressive resistance training increased muscle strength and size in patients with compensated cirrhosis while also providing beneficial effects on general performance measures, according to a study published in Clinical Gastroenterology and Hepatology.

“In cirrhosis, muscle strength and muscle mass are reduced and associated with disease severity,” Luise Aamann, MD, PhD, from the Aarhus University Hospital in Denmark, and colleagues wrote. “Nutritional supplementation can reverse muscle depletion in cirrhosis; however, nutrition is not sufficient as a sole treatment. Recovery of lost muscle strength and mass may be crucial and improve survival.”

A team of hepatologists, radiologists, neurologists, sport scientists and dietitians conducted the study. Of the 39 participants initially enrolled and randomly assigned to the exercise group or the control group, 19 exercisers and 15 controls completed intervention and follow-up.

Those lost to follow-up included one from the exercise group who discontinued due to inflammatory bowel disease, two controls who developed acute-on-chronic liver failure and died, and two controls who withdrew their consent because of alcohol overuse.

After 12 weeks with 36 planned sessions for the exercise group, the exercisers demonstrated increases in knee extension peak torque (119 Nm to 134 Nm; P < .001), their cross sectional area (CSA)50% (57.4 cm2 to 62.6 cm2; P < .001) and CSA60% (58.5 cm2 to 64.6 cm2; P < .001), 6-minute walk test distance (509 m to 541 m; P < .01) and their whole body lean mass (62 kg to 64.1 kg; P < .01) compared with no significant changes in the control group.

Additionally, the exercisers showed a greater gain in muscle strength (11 Nm; 95% CI, 0-22) and muscle size (4.4 cm2; 95% CI, 1.4-7.5) compared with the control group. The increases in muscle strength correlated with increased muscle size (r = 0.74; P < .001).

Based on the SF-36 patient-reported outcome questionnaire, participants in the exercise group had improved mental component summaries (49.9 to 54 points; P < .01) and in the vitality (P < .01) and mental health domains (P = .03) compared with no difference among controls.

“Supervised progressive resistance training is safe and is readily applicable for the clinical maintenance of patients,” Aamann and colleagues wrote. “This trial provides evidence that resistance training can recover the losses of strength and muscle mass in patients with cirrhosis, but the prognostic significance cannot be determined from our data. However, there is an increased risk of mortality in sarcopenic cirrhosis patients. Hence, possible benefits include a decrease in complications and mortality.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.