Changes in Hepatic Venous Pressure Gradient Induced by Physical Exercise in Cirrhosis: Results of a Pilot Randomized Open Clinical Trial

Macías-Rodríguez, Ricardo U; Ilarraza-Lomelí, Hermes;
Ruiz-Margáin, Astrid; Ponce-de-León-Rosales, Sergio; Vargas-Vorácková,
Florencia; García-Flores, Octavio; Torre, Aldo; Duarte-Rojo, Andrés.
Clinical and Translational Gastroenterology, July 2016, Vol. 7 Issue:
Number 7 pe180-e180, 1p;

Abstract: OBJECTIVES:Exercise has been
scarcely studied in patients with cirrhosis, and prior evidence showed
hepatic venous pressure gradient (HVPG) to be increased in response to
exercise. The aim of this study was to investigate the effects of a
supervised physical exercise program (PEP) in patients with

METHODS:In an open-label, pilot clinical trial, patients with
cirrhosis were randomized to PEP (cycloergometry/kinesiotherapy plus
nutritional therapy, n=14) or control (nutritional therapy, n=15); for
14 weeks. Primary outcomes were: the effect of PEP in HVPG, and quality
of life (chronic liver disease questionnaire, CLDQ). As secondary
outcomes we investigated changes in physical fitness (cardiopulmonary
exercise testing), nutritional status (phase angle—bioelectrical
impedance), ammonia levels, and safety.

RESULTS:Twenty-two patients
completed the study (11 each). HVPG decreased in subjects allocated to
PEP (−2.5 mm Hg (interquartile range: −5.25 to 2); P=0.05), and
increased in controls (4 mm Hg (0–5); P=0.039), with a significant
between-groups difference (P=0.009). No major changes were noted in
CLDQ in both groups. There was significant improvement in ventilatory
efficiency (VE/VCO2) in PEP group (−1.9 (−3.12 to −0.1); P=0.033), but
not in controls (−0.4 (−5.7 to 1.4); P=0.467). Phase angle improvement
and a less-pronounced exercise-induced hyperammonemia were noted only
in PEP group. No episodes of variceal bleeding or hepatic
encephalopathy were observed.

CONCLUSIONS:A supervised PEP in patients
with cirrhosis decreases the HVPG and improves nutritional status with
no changes in quality of life. Further studies evaluating physical
training in cirrhosis are eagerly awaited in order to better define the
benefits of sustained exercise.