Effect of an Integrated Exercise Training Program on Muscle Mass and Functional Capacity in Sarcopenic Patients With...

Liver cirrhosis is an end-stage disease with extensive fibrosis that disrupts normal architecture and impairs hepatic function. Progression to decompensation triggers severe complications like ascites, jaundice, and hepatic encephalopathy. A major extrahepatic consequence is sarcopenia (muscle wasting), which affects over 65% of these patients. Driven by ammonia accumulation and chronic inflammation, this muscle loss drastically increases frailty and mortality risk. Combined aerobic and resistance exercise (CARE) represents a highly promising, underutilized rehabilitation strategy to restore their functional capacity.

The aim of this study was to assess how a structured, home-based, integrated exercise program influences muscle mass and physical functional capacity in sarcopenic patients with decompensated cirrhosis. It was hypothesized that CARE would yield measurable gains in skeletal muscle volume, exercise endurance, and liver-related biochemical parameters relative to standard care alone.

A randomized clinical trial at Krishna College of Physiotherapy, Karad, India, evaluated 40 participants aged 30-50 years with decompensated cirrhosis and a Child-Pugh score of 7-15. Simple random sampling allocated patients equally into a control group receiving standard care (n=20) or an experimental group receiving standard care plus a 12-week CARE program (n=20). The cohort comprised 24 males and 16 females, with etiologies including alcohol-associated liver disease (52.5%), hepatitis B (7.5%), and hepatitis C (5.0%). Functional capacity and muscle mass were assessed pre- and post intervention using the Six-Minute Walk Test (6MWT) and Bioelectrical Impedance Analysis (BIA), respectively. Statistical analyses utilized paired t-tests and Wilcoxon signed-rank tests, with significance set at p < 0.05. Following the 12-week intervention, the experimental group demonstrated significant pre-to-post improvements across all metrics: 6MWT distance increased from 480.1±3.50 to 487.55±5.97 meters (p < 0.0001); serum glutamic-oxaloacetic transaminase (SGOT) dropped from 66.55±8.54 U/L to 47.3±12.9 U/L (p < 0.0001); serum glutamic-pyruvic transaminase (SGPT) decreased from 68.6±7.67 U/L to 54.15±10.03 U/L (p < 0.0001); and skeletal muscle mass increased from 24.16±2.25 to 24.77±2.96 kg (p = 0.0452). Between-group comparisons at post-intervention revealed that the experimental group achieved significantly greater improvements than the control group in 6MWT distance (p = 0.0055), SGOT (p = 0.0001), and SGPT (p = 0.0001). However, the post-intervention difference in muscle mass between the experimental and control groups did not reach statistical significance (p = 0.4134).

A structured, home-based CARE program produced significant improvements in functional capacity, biochemical markers, and muscle mass among sarcopenic individuals with decompensated cirrhosis. Exercise training is safe, feasible, and clinically beneficial in this population, offering a nonpharmacological strategy to mitigate sarcopenia and enhance quality of life. Incorporating rehabilitation into standard management of advanced liver disease may reduce morbidity, improve transplant outcomes, and extend survival. Future research should explore long-term adherence, optimal exercise intensity, and integration with nutritional interventions to maximize therapeutic benefit.