Efficacy of a 12-week supervised home-based exercise program and nutritional supplementation in cirrhotic patients with sarcopenia: A prospective pilot study.

BACKGROUND AND AIMS: Sarcopenia is common in cirrhosis and associated with poor outcomes. Effective interventions remain uncertain. This study evaluated the efficacy of a 12-week supervised home-based exercise combined with branched-chain amino acids (BCAA)-enriched nutritional supplementation on muscle mass in cirrhotic patients with sarcopenia.

METHODS

This open-label, within-patient comparison pilot study enrolled compensated cirrhotic patients (Child-Pugh≤8) with sarcopenia, defined by CT-based L3 skeletal muscle index (SMI). Participants followed a supervised structured exercise program consisting of progressive resistance training using body weight and resistance bands (30 min/day, ≥5 sessions/week) and aerobic training (increase daily steps to 5000-10,000/day). Patients also received dietary counseling with daily BCAA supplementation (210 kcal, protein 13.5 g). Primary outcome was the change in SMI at 12 weeks. Secondary outcomes included changes in psoas muscle index (PMI), Liver Frailty Index (LFI), aerobic fitness (6-minute walk test [6MWT], cardiopulmonary exercise test), and quality of life (QoL).

RESULTS

Twelve patients completed the study (age 63.3 ± 7.2 years, 58.3 % female). SMI significantly increased from 37.6 ± 2.2 to 44.5 ± 3.0 cm2/m2 (p < 0.001), with sarcopenia resolution in 91.7 %. PMI also improved (4.6 ± 1.7 to 6.1 ± 1.8 cm2/m2, p = 0.002). LFI decreased (4.2 ± 0.4 to 3.7 ± 0.4, p = 0.01), and 6MWT improved (372.5 ± 58.2 to 442.5 ± 78.7 m, p = 0.003). Physical component domain of QoL significantly increased (p < 0.001). No major adverse events occurred.

CONCLUSION

A home-based exercise program combined with nutritional supplementation improved muscle mass, frailty, functional capacity, and QoL in cirrhotic patients with sarcopenia. Larger trials are needed to confirm these findings.