Effects of Aerobic Exercise on Autonomic and Endothelial Function and Splanchnic Hemodynamics in Compensated...

Patients with cirrhosis often develop autonomic dysfunction (AD) and endothelial dysfunction (ED), which correlate with higher mortality. Aerobic exercise (AE) is a potential intervention, yet its effects on the autonomic nervous system (ANS) and hemodynamics remain underinvestigated in cirrhosis.

We conducted a parallel-group randomized controlled trial including 50 sedentary patients with compensated cirrhosis. Participants were randomized to a 16-week moderate-intensity AE plus nutritional consultation (AE group; n = 25) or nutritional consultation alone (control group, CG; n = 25). Outcomes included heart rate variability (HRV), flow-mediated dilation (FMD) for peripheral circulation, mesenteric Doppler ultrasound for splanchnic hemodynamics, and sarcopenia-related outcomes (body composition, handgrip strength dynamometry, and the 6-min walk test [6MWT]). Data were analysed using intention-to-treat (ITT), modified ITT (mITT), and per-protocol approaches, as well as general linear mixed models (LMM).

Of the 50 participants (mean age, 62.6 ± 7.0 years; 60% female), 44 participants completed the study. Although most outcomes showed no statistically significant between-group differences, LMM analysis confirmed a significant reduction in the low-frequency to high-frequency (LF/HF) (β = -0.87, p = 0.04), indicating worsening ANS while AE remained stable. Based on mITT analysis, the AE group showed a significant with-in group increase in portal vein volume flow (median Δ = 350.66 mL/min, p = 0.003). Additionally, AE demonstrated significant improvement in 6MWT compared with CG (mean Δ = 32 m, IQR: 12.00-51.60 m, p < 0.01). No major adverse events occurred.

AE is safe and effectively improves functional capacity in compensated cirrhosis. However, positive signals in autonomic and hepatic parameters were not between-group significant, necessitating a cautious interpretation.