Physical Activity Patterns in Frail and Nonfrail Patients With End-Stage Liver Disease

Frailty commonly complicates cirrhosis and is associated with poorer outcomes. While patients with cirrhosis may be sedentary, there are few comprehensive descriptions of their physical activity (PA) patterns related to frailty. Our aim was to identify PA characteristics that may be used in interventions to improve PA and reduce frailty.

In a cross-sectional cohort study, forty patients with cirrhosis (mean age 63; 30 nonfrail, 10 frail) wore an accelerometer/thermal sensing armband for 7 days. Postural status (e.g., upright movement, upright sedentary, lying down), Metabolic Equivalent of Tasks (METs) and active bouts were identified.

Patients were highly sedentary most of the time (89 ± 7% and 85 ± 10% of the day, in frail and nonfrail cirrhotics, respectively). Compared with nonfrail cirrhotics, frail patients spent significantly shorter amount of time moving in an upright position (7% ± 5 vs. 12% ± 5, P = 0.013 in frail and nonfrail cirrhotics, respectively), had significantly fewer and shorter durations of active bouts per day (number of active bouts: 9 ± 12 vs. 19 ± 14; duration: 13.2 ± 1.5 min and 15.9 ± 2.6 min in frail and nonfrail cirrhotics, respectively), and had a lower amount of steps per wear time hours (41.7 ± 37.1 vs. 116.8 ± 85.4, P = 0.003 in frail and nonfrail, respectively). Traditional measures such as METs or aerobic bouts did not differ between groups.

Active bout measures, as opposed to more traditional measures such as METs, differentiate between frail and nonfrail cirrhotics suggesting they may be used to assess changes resulting from targeted interventions to improve physical activity.