Effects of Aerobic Exercise on Autonomic and Endothelial Function and Splanchnic Hemodynamics in Compensated Cirrhosis: RCT Study.

BACKGROUND

Patients with cirrhosis often develop autonomic dysfunction (AD) and endothelial dysfunction (ED), which correlate with higher mortality. Aerobic exercise (AE) is a potential intervention, yet its effects on the autonomic nervous system (ANS) and hemodynamics remain underinvestigated in cirrhosis.

METHODS

We conducted a parallel-group randomized controlled trial including 50 sedentary patients with compensated cirrhosis. Participants were randomized to a 16-week moderate-intensity AE plus nutritional consultation (AE group; n = 25) or nutritional consultation alone (control group, CG; n = 25). Outcomes included heart rate variability (HRV), flow-mediated dilation (FMD) for peripheral circulation, mesenteric Doppler ultrasound for splanchnic hemodynamics, and sarcopenia-related outcomes (body composition, handgrip strength dynamometry, and the 6-min walk test [6MWT]). Data were analysed using intention-to-treat (ITT), modified ITT (mITT), and per-protocol approaches, as well as general linear mixed models (LMM).

RESULTS

Of the 50 participants (mean age, 62.6 ± 7.0 years; 60% female), 44 participants completed the study. Although most outcomes showed no statistically significant between-group differences, LMM analysis confirmed a significant reduction in the low-frequency to high-frequency (LF/HF) (β = -0.87, p = 0.04), indicating worsening ANS while AE remained stable. Based on mITT analysis, the AE group showed a significant with-in group increase in portal vein volume flow (median Δ = 350.66 mL/min, p = 0.003). Additionally, AE demonstrated significant improvement in 6MWT compared with CG (mean Δ = 32 m, IQR: 12.00-51.60 m, p < 0.01). No major adverse events occurred.

CONCLUSIONS

AE is safe and effectively improves functional capacity in compensated cirrhosis. However, positive signals in autonomic and hepatic parameters were not between-group significant, necessitating a cautious interpretation.