The influence that hepatic cirrhosis provides in exercise capacity and muscle strength: a review

Krüger, Renata Lopes; Teixeira, Bruno Costa; Dias, Alexandre Simões; Reischak-Oliveira, Álvaro

doi:10.1590/0103-5150.028.003.AR02

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Review articles • Fisioter. Mov. 28 (3) • Jul-Sep 2015 • https://doi.org/10.1590/0103-5150.028.003.AR02 copy

The influence that hepatic cirrhosis provides in exercise capacity and muscle strength: a review

Influência da cirrose hepática na potência aeróbia e força muscular: uma revisão

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Hepatic cirrhosis leads to a series of physiological changes, among which stand out cardiorespiratory and muscle impairments. These changes determine a negative impact on quality of life and may cause physical inactivity.

Objective

The objective of this study was to review, in the most current scientific literature, the influence that hepatic cirrhosis provides in exercise capacity and muscle strength, and the effect of exercise when applied to this situation.

Materials and methods

For this review, research on original studies was carried out on Medical Literature Analysis and Retrieval System Online (assessed by PubMed), Scopus and Web of Science between the years 1990 to 2015. In order to be included, studies had to meet the following criteria: a) be from original articles; b) evaluate exercise capacity or muscle strength; and c) provide relevant results.

Results and Discussion

: The majority of studies concluded that the exercise capacity and muscle strength are decreased in individuals with cirrhosis when compared to control subjects.

Final considerations

Hepatic cirrhosis has negative effect on cardiorespiratory and neuromuscular capacity during physical exercise in individuals with liver disease.

Cirrhosis; Exercise; Exercise capacity; Strength

Authors	Sample characterization	Variables tested	Results
Campillo et al. (21)	Alcoholic Cirrhosis Group (ACG): 10; Control Group (CG): 6	VO_2max and muscle mass. Child-Pugh classification. Physical exercise intervention in a treadmill during 32 minutes.	CG presented greater VO_2max and muscle mass. A negative correlation was found between VO_2max and Child-Pugh, ACG had a good tolerance to physical exercise.
Campillo et al. (22)	Cirrhosis Group: 24	VO_2peak and muscle mass. Child-Pugh classification. Aerobic training.	Predicted VO_2max value was greater than accurate value. A negative correlation was found between VO_2max and Child-Pugh. Increases in VO_2max and muscle mass were found in 2 subjects. Increase in Child-Pugh classification was found in other 2 subjects.
Delissio et al. (23)	Cirrhosis Group (CIG): 4; Control Group (CG): 4	VO_2max. Physical exercise intervention on a treadmill for 90 minutes at 50% of VO_2max.	No significant differences were found between groups.
Tarter et al. (42)	Alcoholic Cirrhosis Group (ACG): 49; Nonalcoholic Cirrhosis Group (NCG): 45; Control Group (CG): 50	Concentric and eccentric muscle strength of lower and upper limbs. Psychomotor tests.	CG demonstrated greater muscle strength and psychomotor test results. No significant differences were found between ACG and NCG.
Andersen et al. (43)	Alcoholic Cirrhosis Group (ACG): 24; Control Group: 24	Knee, hip, elbow and wrist extensors and flexors muscle strength, shoulder adductors and abductors, muscle mass, triceps skinfold thickness, and mid-arm circumference. Child-Pugh classification.	ACG presented less muscle mass for all variables, except for wrist extension. No significant differences were found between Child-Pugh classifications. Anthropometric assessment represented nutritional state.
Epstein et al. (25)	Cirrhosis and Hepatopulmonary Sindrome Group (HPS): 5; Cirrhosis and Hypoxemia Group (CHG): 9; Cirrhosis Group (CG): 10	VO_{2 peak}. Child-Pugh Classification.	CG presented greater VO_2peak. No significant differences were found between Child-Pugh classifications.
Epstein et al. (24)	Cirrhosis Group (CIG): 19; Control Group (CG): 12	VO_2peak. Child-Pugh Classification.	CG presented Greater VO_2peak. No significant differences were found between Child-Pugh classifications.
Wong et al.(26)	Cirrhosis Group (CIG): 18; Ascites Cirrhosis Group (ACG): 21; Control Group (CG): 12	VO_2peak. and VO_2AT.	GC presented greater VO_2peak and VO_2AT.
Wiesinger et al. (27)	Cirrhosis Group: 26; Child-Pugh Class A: 3, B: 7 and C: 9	VO_2AT, knee extensors and hand-grip muscle strength.	Groups B and C presented the lowest VO_2AT. Group C presented less muscle strength compared to A. There was a negative correlation between hand-grip strength and Child-Pugh.
Epstein et al. (28)	Transplantation Survival Group: 53; Nonsurvivals Group: 6	VO_2peak and VO_2AT. Child-Pugh and MELD Classifications.	Survivals had greater VO_2peak and VO_2AT.
Dharancy et al. (29)	Cirrhosis Group before Transplantation: 135	VO_2peak. MELD Classification.	Patients with low VO_2peak have less chances of surviving after transplantation. There was a negative correlation between VO_2peak and MELD.
Terziyski et al. (32)	Cirrhosis Group (CIG): 19; Control Group (CG): 19	VO_2peak. Child-Pugh Classification.	CG presented greater VO_2peak. There was a negative correlation between VO_2peak and Child-Pugh.
Lemyze et al. (31)	Pre- and Post- Cirrhosis Transplantation Group: 20	VO_2peak. MELD Classification.	There was an increase on VO_2peak after transplantation. There were no significant differences between MELD classifications.
Galant et al. (33)	Alcoholic Cirrhosis Group (ACG): 27	VO_2max. MELD.	There was a negative correlation between VO_2maxand MELD.
Zenith et al. (34)	Cirrhosis Training Group (CTG): 9; Cirrhosis Control Group (CCG): 10	VO_2peak. Child-Pugh Classification. Aerobic Training.	CTG presented greater VO_2peak.
Debette-Gratien et al (35)	Cirrhosis post-transplantation group (CIG): 8	VO_2peak and knee extensors muscle strength. Child-Pugh Child-Pugh and MELD classifications. Aerobic training.	VO_2peak and muscle strength increases.

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[1] * RLK: MSc student, e-mail:renatalkruger@gmail.com BCT: PhD student, e-mail:brunoct100@hotmail.com ASD: PhD, e-mail:simoesdias@terra.com.br ARO: PhD, e-mail:alvaro.oliveira@ufrgs.br