Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jul 14;7(7):e180.
doi: 10.1038/ctg.2016.38.

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

Ricardo U Macías-Rodríguez  1 , Hermes Ilarraza-Lomelí  2 , Astrid Ruiz-Margáin  1 , Sergio Ponce-de-León-Rosales  3 , Florencia Vargas-Vorácková  1 , Octavio García-Flores  1 , Aldo Torre  1 , Andrés Duarte-Rojo  4
Affiliations

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

Ricardo U Macías-Rodríguez et al. Clin Transl Gastroenterol. .

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 cirrhosis.

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. ClinicalTrials.gov:NCT00517738.

PubMed Disclaimer

Conflict of interest statement

Guarantor of the article: Andrés Duarte-Rojo, MD, DSc.

Specific author contributions: Study concept and design: R.U.M.-R., H.I.-L., S.P.-d.-L.R., F.V.-V., A.T., and A.D.-R.; acquisition of the data: R.U.M.-R., H.I.-L., A.R.-M., O.G.-F., and A.D.-R.; analysis, interpretation of data and drafting of the manuscript: R.U.M.-R., H.I.-L., A.R.-M., and A.D.-R.; critical revision of the manuscript: S.P.-d.-L.R.; obtained the study funding: R.U.M.-R., A.T., and A.D.-R. All authors approved the final version of the manuscript.

Financial support: This study was fully supported by National Council of Science and Technology (Consejo Nacional de Ciencia y Tecnología, CONACYT) Mexico. Andres Duarte-Rojo was also supported by the "Angeles Espinosa Yglesias" Award 2009 from FUNSALUD/FUNDHEPA, México.

Potential competing interests: None.

Figures

Figure 1
Figure 1
CONSORT diagram of the study protocol.
Figure 2
Figure 2
Changes in workload in the exercise group. * change between baseline and final workload, ** change between baseline and maximum workload.
Figure 3
Figure 3
Changes in hepatic hemodynamics at baseline and final evaluations in exercise (a) and control groups (b). Individual changes on HVPG in exercise (c) and control groups (d). HVPG, hepatic venous pressure gradient; FHVP, free hepatic venous pressure; WHVP, wedged hepatic venous pressure.
See this image and copyright information in PMC

References

    1. Orozco LJ, Buchleitner AM, Gimenez-Perez G et al. Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database Syst Rev 2008: CD003054. - PubMed
    1. Wen CP, Wai JP, Tsai MK et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 2011; 378: 1244–1253. - PubMed
    1. Gregg EW, Chen H, Wagenknecht LE et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA 2012; 308: 2489–2496. - PMC - PubMed
    1. Eckel RH, Jakicic JM, Ard JD et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: 2960–2984. - PubMed
    1. Garber CE, Blissmer B, Deschenes MR et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43: 1334–1359. - PubMed

Associated data