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Impact of structured exercise-based regimen on frailty in pediatric cirrhosis: A randomized controlled trial
Deepika Yadav1, Jaya Benjamin2, Rakesh Kumar3
1Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Insights
Exercise significantly improved frailty and muscle mass in children with cirrhosis. This regimen offers a promising approach to enhance physical function and body composition in this vulnerable population.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Exercise Physiology
- Clinical Nutrition
Background:
- Cirrhotic liver disease (CLD) in children can lead to muscle wasting and functional decline.
- Current management often focuses on medical therapy, with limited exploration of exercise interventions.
Purpose of the Study:
- To evaluate the impact of an exercise-based regimen compared to standard medical therapy (SMT) on frailty, body composition, and myokines in pediatric CLD patients.
- To assess the efficacy of exercise in improving muscle mass and functional capacity.
Main Methods:
- A randomized controlled trial involving children (9-18 years) with CLD and frailty criteria score >5.
- Participants were assigned to either exercise training + SMT or SMT alone for 24 weeks.
- Frailty, body composition analysis (BCA), and myokine levels were assessed at baseline and follow-up intervals.
Main Results:
- The exercise group showed significantly greater improvement in frailty scores at 12 and 24 weeks compared to the SMT group (p<0.001).
- A higher percentage of children in the exercise group achieved reduced frailty scores.
- Significant improvements in skeletal muscle mass (SMM) and a reduction in myostatin levels were observed in the exercise group at 12 weeks.
Conclusions:
- An exercise regimen significantly improved frailty scores and SMM in children with CLD compared to SMT.
- Exercise demonstrates potential as a therapeutic strategy for pediatric cirrhotic patients.
- Larger trials are needed to confirm long-term benefits.
Objectives:
Physical exercise may improve muscle mass and functional capacity in cirrhosis. This randomized controlled trial evaluates the impact of an exercise-based regimen versus standard medical therapy (SMT) on frailty scores, clinical outcomes, body composition analysis (BCA), and myokines in children with cirrhotic liver disease (CLD).
Methods:
Children (9-18 years of age) with CLD with five Fried's frailty criteria score >5 were randomly assigned to groups that received exercise training + SMT (n = 23) or SMT alone (n = 23). Exercise regimen included aerobic and resistance exercises for a total of at least 50 min/day for 3-5 days per week for 24 weeks. Frailty assessment was done at baseline, 12 and 24 weeks while myokines levels and BCA was evaluated at baseline and after 12 weeks.
Results:
At 12 and 24 weeks, the delta change in frailty scores was significantly greater in the exercise group compared to the SMT group (p < 0.001). Frailty score <5 was achieved by 60% and 85% of the exercise group at 12 and 24 weeks, compared to 32% and 37% in the SMT group. At 12 weeks, the exercise group showed a significant delta reduction in myostatin levels compared to the SMT group (p = 0.02). Significant improvements were observed in skeletal muscle mass (SMM) and phase angle in the exercise group at 12 weeks.
Conclusions:
In this pilot trial, exercise regimen significantly improved frailty scores and SMM compared to the SMT. Larger trials are warranted to further evaluate the long-term benefits of exercise in pediatric cirrhotic population.