nach oben

Erschienen in:

01.08.2014 | Original Article

Randomized Pilot Study: Effects of an Exercise Programme and Leucine Supplementation in Patients with Cirrhosis

verfasst von: Eva Román, Mª Teresa Torrades, Mª Josep Nadal, Guillem Cárdenas, Juan Camilo Nieto, Sílvia Vidal, Helena Bascuñana, Cándido Juárez, Carlos Guarner, Juan Córdoba, Germán Soriano

Erschienen in: Digestive Diseases and Sciences | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Physical exercise could improve functional limitations, muscle mass, and health-related quality of life (HRQoL) in patients with cirrhosis.

Aim

The purpose of this study was to evaluate the efficacy and safety of an exercise programme and leucine supplementation to increase exercise capacity, muscle mass, and HRQoL in patients with cirrhosis.

Patients and Methods

Seventeen outpatients with cirrhosis were randomized to an exercise group (n = 8) or a control group (n = 9) in a pilot study. The programme of moderate exercise was performed for 12 weeks under supervision of a physiotherapist. All patients received oral leucine (10 g/day) during the study. At baseline and at the end of the study, we determined exercise capacity (6-min walk and 2-min step tests), anthropometric measurements, and HRQoL by Short Form-36 (SF-36) questionnaire. We also analyzed safety regarding complications of cirrhosis, liver and renal function, inflammatory response and oxidative stress.

Results

In the exercise group, exercise capacity improved, as shown by the increase in the 6-min walk test from 365 (160–420) to 445 m (250–500) (p = 0.01), and in the 2-min step test (p = 0.02). Lower thigh circumference also increased, from 41 (34–53) to 46 cm (36–56) (p = 0.02), and the domains of SF-36 general health (p = 0.03), vitality (p = 0.01) and social function (p = 0.04) improved significantly. In the control group, no statistically significant changes were observed in any of the parameters. We did not observe complications of cirrhosis in either group during the study.

Conclusions

A programme of moderate physical exercise together with leucine supplements in patients with cirrhosis is safe and improves exercise capacity, leg muscle mass and HRQoL.

Nur mit Berechtigung zugänglich

Alberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17:445–450.PubMedCrossRef

Montano-Loza AJ, Meza-Junco J, Prado CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10:166–173.PubMedCrossRef

Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transpl. 2012;18:146–151.PubMedCrossRef

Kachaamy T, Bajaj JS, Heuman DM. Muscle and mortality in cirrhosis. Clin Gastroenterol Hepatol. 2012;10:100–102.PubMedCrossRef

Terziyski K, Andonov V, Marinov B, Kostaniev S. Exercise performance and ventilatory efficiency in patients with mild and moderate liver cirrhosis. Clin Exp Pharmacol Physiol. 2008;35:135–140.PubMed

Alameri HF, Sanai FM, Al Dukhayil M, et al. Six minute walk test to assess functional capacity in chronic liver disease patients. World J Gastroenterol. 2007;13:3996–4001.PubMed

Román E, Córdoba J, Torrens M, et al. Falls and cognitive dysfunction impair health-related quality of life in patients with cirrhosis. Eur J Gastroenterol Hepatol. 2013;25:77–84.PubMedCrossRef

Carey EJ, Steidley DE, Aqel BA, et al. Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transpl. 2010;16:1373–1378.PubMedCrossRef

Córdoba J, Mínguez B. Hepatic encephalopathy. Semin Liver Dis. 2008;28:70–80.PubMedCrossRef

10.

Olde Damink SW, Jalan R, Redhead DN, et al. Interorgan ammonia and amino acid metabolism in metabolically stable patients with cirrhosis and TIPSS. Hepatology. 2002;36:1163–1171.PubMedCrossRef

11.

Hunter GR, McCarthy JP, Bamman MM. Effects of resistance training in older adults. Sports Med. 2004;34:329–348.PubMedCrossRef

12.

Tabet JY, Meurin P, Driss AB, et al. Benefits of exercise training in chronic hearth failure. Arch Cardiovasc Dis. 2009;102:721–730.PubMedCrossRef

13.

Segura-Orti E, Johansen KL. Exercise in end-stage renal disease. Semin Dial. 2010;23:422–430.PubMedCrossRef

14.

Dereli EE, Yaliman A. Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme in quality of life in patients with Parkinson’s disease. Clin Rehabil. 2010;24:352–362.PubMedCrossRef

15.

Duarte-Rojo A, Torres-Vega MA, Villamil-Ramírez H, et al. Changes in peripheral blood mononuclear cells glutamine synthetase mRNA after exercise in healthy volunteers: exploring an alternative proposal for non hepatic ammonia metabolism. Rev Invest Clin. 2012;64:164–172.PubMed

16.

Ploeger HE, Takken T, de Greef MH, Timmons BW. The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. Exerc Immunol Rev. 2009;15:6–41.PubMed

17.

Guarner C, Soriano G. Bacterial translocation and its consequences in patients with cirrhosis. Eur J Gastroenterol Hepatol. 2005;17:27–31.PubMedCrossRef

18.

García-Pagán JC, Santos C, Barberá JA, et al. Physical exercise increases portal pressure in patients with cirrhosis and portal hypertension. Gastroenterology. 1996;111:1300–1306.PubMedCrossRef

19.

Bandi JC, García-Pagán JC, Escorsell A, et al. Effects of propranolol on the hepatic hemodynamic response to physical exercise in patients with cirrhosis. Hepatology. 1998;28:677–682.PubMedCrossRef

20.

Saló J, Guevara M, Fernández-Esparrach G, et al. Impairment of renal function during moderate physical exercise in cirrhotic patients with ascites: relationship with the activity of neurohormonal systems. Hepatology. 1997;25:1338–1342.PubMedCrossRef

21.

Sinniah D, Fulton TT, McCullough H. The effect of exercise on the venous blood ammonium concentration in man. J Clin Pathol. 1970;23:715–719.PubMedCentralPubMedCrossRef

22.

Mergener M, Martins MR, Antunes MV, et al. Oxidative stress and DNA damage in older adults that do exercise regularly. Clin Biochem. 2009;42:1648–1653.PubMedCrossRef

23.

Jalan R, Kapoor D. Reversal of diuretic-induced hepatic encephalopathy with infusion of albumin but not colloid. Clin Sci. 2004;106:467–474.PubMedCrossRef

24.

Lee KC, Yang YY, Wang YW, et al. Increased plasma malondialdehyde in patients with viral cirrhosis and its relationship to plasma nitric oxide, endotoxin and portal pressure. Dig Dis Sci. 2010;55:2077–2085.PubMedCrossRef

25.

Ritland S, Petlund CF, Knudsen T, Skrede S. Improvement of physical capacity after long-term training in patients with chronic active hepatitis. Scand J Gastroenterol. 1983;18:1083–1087.PubMedCrossRef

26.

Campillo B, Fouet P, Bonnet JC, Atlan G. Submaximal oxygen consumption in liver cirrhosis. Evidence of severe functional aerobic impairment. J Hepatol. 1990;10:163–167.PubMedCrossRef

27.

Pattullo V, Duarte-Rojo A, Soliman W, et al. A 24-week dietary and physical activity lifestyle intervention reduces hepatic insulin resistance in the obese with chronic hepatitis C. Liver Int. 2013;33:410–419.PubMedCrossRef

28.

Konishi I, Hiasa Y, Tokumoto Y, et al. Aerobic exercise improves insulin resistance and decreases body fat and serum levels of leptin in patients with hepatitis C virus. Hepatol Res. 2011;41:928–935.PubMedCrossRef

29.

Kawaguchi T, Izumi N, Charlton MR, Sata M. Branched-chain amino acids as pharmacological nutrients in chronic liver disease. Hepatology. 2011;54:1063–1070.PubMedCrossRef

30.

Les I, Doval E, García-Martínez R, et al. Effects of branched chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy. Am J Gastroenterol. 2011;106:1081–1088.PubMedCrossRef

31.

Walker DK, Dickinson JM, Timmerman KL, et al. Exercise, amino acids and aging in the control of human muscle protein synthesis. Med Sci Sports Exerc. 2011;43:2249–2258.PubMedCentralPubMedCrossRef

32.

ATS Committee on Proficiency Standards for Clinical Pulmonary. Function laboratories. ATS statement: guideline for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–117.

33.

Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001;34:768–773.PubMedCrossRef

34.

Romero-Gómez M, Córdoba J, Jover R, et al. Red Nacional de Investigación de Encefalopatía Hepática. Normality tables in the Spanish population for psychometric tests used in the diagnosis of minimal hepatic encephalopathy. Med Clin (Barc). 2006;127:246–249.CrossRef

35.

Kircheis G, Wettstein M, Timmermann L, Schnitzler A, Häussinger D. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology. 2002;35:357–366.PubMedCrossRef

36.

Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384–1387.PubMedCrossRef

37.

Pichurko BM. Exercising your patient: which test(s) and when? Respir Care. 2012;57:100–110.PubMedCrossRef

38.

Lukaski H. Sarcopenia: assessment of muscle mass. J Nutr. 1997;127:994S–997S.PubMed

39.

Wang J, Thornton JC, Kolesnik S, Pierson RN Jr. Anthropometry in body composition. An overview. Ann NY Acad Sci. 2000;904:317–326.PubMedCrossRef

40.

Alonso J, Prieto L, Antó JM. The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clin (Barc). 1995;104:771–776.

41.

Pina IL, Apstein CS, Balady GJ, et al. Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation. 2003;107:1210–1225.PubMedCrossRef

42.

Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–1413.PubMedCrossRef

43.

Centers for Disease Control and Prevention. Target Heart Rate and Estimated Maximum Heart Rate. Atlanta, GA, USA. 2011. http://www.cdc.gov/physicalactivity/everyone/measuring/heartrate.html. Accessed 27 February 2014.

44.

Beyer N, Aadahl M, Strange B, et al. Improved physical performance after orthotopic liver transplantation. Liver Transpl Surg. 1999;5:301–309.PubMedCrossRef

45.

Hughes VA, Roubenoff R, Wood M, Frontera WR, Evans WJ, Fiatarone Singh MA. Anthropometric assessment of 10-y changes in body composition in the elderly. Am J Clin Nutr. 2004;80:475–482.PubMed

46.

Kotoh K, Nakamuta M, Fukushima M, et al. High relative fat-free mass is important for maintaining serum albumin levels in patients with compensated liver cirrhosis. World J Gastroenterol. 2005;11:1356–1360.PubMed

47.

Packer N, Hoffman-Goetz L, Ward G. Does physical activity affect quality of life, disease symptoms and immune measures in patients with inflammatory bowel disease? A systematic review. J Sports Med Phys Fit. 2010;50:1–44.

48.

Stroth S, Hille K, Spitzer M, Reinhardt R. Aerobic endurance exercise benefits memory and affect in young adults. Neuropsychol Rehabil. 2009;19:223–243.PubMedCrossRef

49.

Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc. 2011;86:876–884.PubMedCentralPubMedCrossRef

50.

Kim HK, Suzuki T, Saito K, et al. Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. J Am Geriatr Soc. 2012;60:16–23.PubMedCrossRef

51.

Wilkinson DJ, Hossain T, Hill DS, et al. Effects of leucine and its metabolite β-hydroxy-β-methylbutyrate on human skeletal muscle protein metabolism. J Physiol. 2013;591:2911–2923.PubMedCentralPubMed

52.

Salerno F, Borroni G, Moser P, et al. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol. 1993;88:514–519.PubMed

53.

Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;10:CD005305.PubMed

54.

Heran BS, Chen JM, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;7:CD001800.PubMed

55.

Román E, Córdoba J, Torrens M, et al. Minimal hepatic encephalopathy is associated with falls. Am J Gastroenterol. 2011;106:476–482.PubMedCrossRef

56.

Soriano G, Román E, Córdoba J, et al. Cognitive dysfunction is associated with falls. A prospective study. Hepatology. 2012;55:1922–1930.PubMedCrossRef

57.

Michael YL, Whitlock EP, Lin JS, et al. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153:815–825.PubMedCrossRef

58.

Francoz C, Glotz D, Moreau R, Duran F. The evaluation of renal function and disease in patients with cirrhosis. J Hepatol. 2010;52:605–613.PubMedCrossRef

59.

Cervoni JP, Thévenot T, Weil D, et al. C-reactive protein predicts short-term mortality in patients with cirrhosis. J Hepatol. 2012;56:1299–1304.PubMedCrossRef

Titel: Randomized Pilot Study: Effects of an Exercise Programme and Leucine Supplementation in Patients with Cirrhosis
verfasst von: Eva Román
Mª Teresa Torrades
Mª Josep Nadal
Guillem Cárdenas
Juan Camilo Nieto
Sílvia Vidal
Helena Bascuñana
Cándido Juárez
Carlos Guarner
Juan Córdoba
Germán Soriano
Publikationsdatum: 01.08.2014
Verlag: Springer US
Erschienen in: Digestive Diseases and Sciences / Ausgabe 8/2014
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-014-3086-6

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Randomized Pilot Study: Effects of an Exercise Programme and Leucine Supplementation in Patients with Cirrhosis