Home Exercise Therapy Is Well Tolerated and Improves Exercise Capacity in Patients with Child Pugh a and B Cirrhosis: 2016 ACG Governors Award for Excellence in Clinical Research

Introduction: Cirrhosis patients have reduced peak aerobic power (peak VO2) that is associated with reduced survival. Supervised endurance training is an effective therapy to increase exercise tolerance in cirrhosis. Many patients have challenges coming in regularly for supervised training. The effect of home-based endurance exercise training (HET) on improving on peak VO2 in cirrhosis patients has not been studied. The aim of this pilot study was to evaluate the safety and efficacy of 8 weeks of HET on peak VO2, aerobic endurance (6-minute walk distance), thigh muscle thickness (2D ultrasound) and circumference, and quality of life. Methods: Clinically stable patients with cirrhosis were randomly assigned to 8 weeks of HET (n=20) or usual care (controls, n=20). The HET group performed moderate to high intensity (heart rate equal to 60-80% peak VO2) cycle exercise for 3 days per week. An exercise specialist supervised an HET session once every two weeks and had regular telephone contact between these sessions. Paired t-test was used for within group comparisons and analysis of covariance was used to perform between group comparisons. Results: The cohort (n=40) was 58% male, had a mean age of 57±8 years, and 70% and 30% had Child Pugh class A and B cirrhosis, respectively. The between group VO2 difference trended to significance (P=0.09) and the between group 6-minute walk test increased (Table 1). When within group differences were considered, the HET group had a significant increase in peak VO2 from baseline (17.3±4.5 to 19.0±6.4 mL/kg/min, P=0.03). The 6-minute walk test distance trended to significance (from 476.0±89.8 to 490.7±104.1 meters, P=0.08). There was also a significant increase in the thigh circumference (50.6±5.8 to 52.4±6.6, P=0.02) and thigh muscle thickness (1.25 ±0.40 to 1.31 ±0.38 cm/m2, P=0.05). There was no significant difference in quality of life and no adverse events occurred during cardiopulmonary exercise testing or HET.Table 1: Pilot results from an 8 week, home-based exercise program compared to usual care (control) for patients with cirrhosisConclusion: The 8 weeks of HET is a safe and effective intervention that results in a clinically meaningful improvement in peak VO2, aerobic endurance distance, and increases thigh muscle mass in clinically stable patients with cirrhosis. Clinicaltrials.gov number, NCT02267421. Funded by an ACG Clinical Research Award.