Exercise Training Improves Function in Liver Cirrhosis

STRUCTURED exercise training in liver cirrhosis improved functional capacity and muscle strength while demonstrating a favourable safety profile, according to a systematic review of randomised controlled trials.

The review evaluated the efficacy and safety of physical exercise for adults with pre-transplant liver cirrhosis, focusing on muscle mass, strength and functional capacity. Researchers searched six databases and identified four randomised controlled trials involving 135 analysed patients with liver cirrhosis. Risk of bias and certainty of evidence were assessed using Risk of Bias 2 and GRADE, respectively.

Supervised Training Improves Functional Outcomes

Supervised exercise was associated with improvements in functional capacity and muscle strength compared with usual care. Six-minute walk test distance increased by up to 69 m, while cardiopulmonary effort time increased by 2.0 min.

Muscle strength also improved following supervised exercise programmes. Isokinetic knee torque increased by 11 N.m, while handgrip strength increased by 2.6 kgf. Localised imaging using magnetic resonance imaging or dual-energy X-ray absorptiometry showed modest gains in muscle mass. However, total lean mass measured using bioelectrical impedance remained unchanged.

By comparison, unsupervised home-based training produced improvements that were not significant.

Findings Support Supervised Exercise

No exercise-induced variceal bleeding, acute decompensation or severe adverse events were reported in the included trials. Overall risk of bias raised some concerns, primarily because performance tests could not be blinded.

The certainty of evidence was rated as moderate for functional capacity and muscle mass and low for muscle strength. The findings therefore supported structured, supervised physical exercise as a safe and effective intervention for improving functional capacity and muscle strength in stable patients with liver cirrhosis.

The authors concluded that supervision was important for achieving the stimulus threshold required to reverse sarcopenia. Further large-scale randomised controlled trials were needed to determine whether these improvements translated into meaningful long-term pre-transplant outcomes.

Reference

Fontana PMC et al. Effects of exercise training on muscle and functional outcomes in adults with liver cirrhosis: a systematic review. SN Compr Clin Med. 2026;8:400.

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