Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Clin Gastroenterol Hepatol. 2020 May;18(5):1179-1187.e6. doi: 10.1016/j.cgh.2019.07.058. Epub 2019 Aug 5.
BACKGROUND & AIMS: Cirrhosis is often complicated by reduced muscle mass and strength, which limits the ability to perform daily activities and affects quality of life. Resistance training can increase muscle strength and mass in elderly and chronically ill patients. We performed a randomized controlled trial to investigate whether resistance training increases muscle strength and size in patients with compensated cirrhosis.
We performed a prospective study of 39 patients with cirrhosis (Child-Pugh class A or B) seen at an outpatient clinic in Denmark from January 2015 through March 2017. Participants protein intake and activity levels were registered daily. Participants were randomly assigned (1:1) to a group that performed 36 1-hour sessions of physical exercise (supervised progressive resistance training for 1 hour, 3 times weekly for 12 weeks) or a control group (no change in daily activity level). Maximal muscle strength was measured as the peak torque in isokinetic knee extension and muscle size was measured as the cross-sectional area of the quadriceps muscle, assessed by magnetic resonance imaging of the thigh.
The exercise group increased their muscle strength by 13% (from a mean 119 Nm to 134 Nm)-an 11 Nm greater gain in mean strength than that of the control group (P = .05). The exercise group increased their quadriceps cross-sectional area by 10% (from a mean 58.5 cm to 64.6 cm)-a 4.4 cm greater gain than that of the control group (P < .01). The exercise group had significant increases in whole-body lean mass and body cell mass, and significant increases in 6-minute walking distance and the mental component summary of the short form-36 questionnaire. Adverse events were minor and equal between groups.
In a randomized trial of patients with compensated cirrhosis, we found that 12 weeks of supervised progressive resistance training increased muscle strength and size and had beneficial effects on general performance measures, compared with patients who did not change their daily activity routine (control subjects). ClinicalTrials.gov no: NCT02343653.
肝硬化常伴有肌肉减少和肌肉无力，这限制了患者日常活动的能力，并影响了生活质量。抗阻训练可增加老年和慢性病患者的肌肉力量和质量。我们进行了一项随机对照试验，以研究抗阻训练是否可增加代偿期肝硬化患者的肌肉力量和大小。
我们对 2015 年 1 月至 2017 年 3 月期间在丹麦门诊就诊的 39 例肝硬化患者（Child-Pugh 分级 A 或 B）进行了前瞻性研究。参与者每天登记蛋白质摄入量和活动水平。参与者被随机分配（1:1）到进行 36 次 1 小时身体锻炼的组（监督性渐进式抗阻训练 1 小时，每周 3 次，共 12 周）或对照组（日常活动水平无变化）。最大肌肉力量通过等速膝关节伸展的峰值扭矩来测量，肌肉大小通过大腿磁共振成像来测量股四头肌的横截面积。
锻炼组的肌肉力量增加了 13%（从平均 119 Nm 增加到 134 Nm）-比对照组的平均力量增加了 11 Nm（P =.05）。锻炼组股四头肌横截面积增加了 10%（从平均 58.5 cm 增加到 64.6 cm）-比对照组增加了 4.4 cm（P <.01）。锻炼组的全身瘦体重和细胞内液质量显著增加，6 分钟步行距离和简明 36 项健康调查简表的精神成分评分显著提高。不良事件轻微且两组间无差异。
在一项代偿期肝硬化患者的随机试验中，我们发现与未改变日常活动常规的患者（对照组）相比，12 周的监督性渐进式抗阻训练增加了肌肉力量和大小，并对一般表现测量有有益影响。临床试验.gov 注册号：NCT02343653。
