Exercise manual for liver disease patients

Abstract

Aim: To increase inspiratory muscle strength and improve the quality of life of candidates for liver transplantation.

Methods: Twenty-three candidates for liver transplantation participated in the control group and 14 made up the intervention group. The control group consisted of 18 men and 5 women, body mass index (BMI) 27.3 ± 4.5 kg/m(2) and Model for End-Stage Liver Disease (MELD) 18.2 ± 6.1. The intervention group consisted of 11 men and 3 women, BMI 28.6 ± 5.4 kg/m(2) and MELD 18 ± 4.5. The presence or absence of ascites was identified in the first patient evaluation and after three months. We evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure, spirometry, root mean square (RMS) of diaphragm and rectus abdominis, and the quality of life. The exercises were performed daily by patients at home for three months and were supervised at distance monthly. The manual consisted of diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT(®), lifting upper limbs with a bat and strengthening the abdomen.

Results: There was significant difference (P = 0.01) between the first (initial) and the third month (final) MIP in the control group and in the intervention group, but there was no difference (P = 0.45) between the groups. The RMS of the diaphragm was lower (P = 0.001) and the functional capacity was higher (P = 0.006) in the intervention group compared to the control. The general health and mental health domains received higher scores after three months in the control group (P = 0.01) and the intervention group (P = 0.004), but there was no significant difference between them. The comparison between the presence of initial ascites with the presence of ascites was performed after three months in the control group (P = 0.083) and intervention group (P = 0.31). There was no significant difference, in relation to the presence of ascites after three months between groups (P = 0.21). In the intervention group, patients with ascites at the end of the time period had decreased scores on the social aspects SF-36 domain (P = 0.023) compared to those who had no ascites.

Conclusion: The proposed exercises provide an increase in the inspiratory muscle strength and improve functional capacity, consequently bettering the quality of life of liver disease patients.

Keywords: Breathing exercises; Electromyography; Muscle strength; Pre-operative period; Respiratory muscles.

Figure 1

Manual of exercises for liver disease patients. A: Manual of exercises; B: Complications before the liver transplantation; C: How to do breath diaphragmatic; D: How to do breath diaphragmatic; E: Breath diaphragmatic standing or sitting; F: Breath diaphragmatic with weight on the belly; G: Lift warms with bat; H: Training with Threshold IMT^®; I: How to do abdominal exercises; J: Instructions for patients; K: To avoid alcoholic beverages, tobacco, frying and pastries; L: Complications after liver transplantation; M: Physical therapy after surgery; N: Incentive phrase for patients.