Interventions to improve sarcopenia in cirrhosis: A systematic review

Table 2 Exercise interventions to improve sarcopenia in cirrhosis

Ref.	Study participants characteristics	Study design	Patients enrolled	Intervention	Duration of intervention	Diagnosis of sarcopenia	Results
Zenith et al[39], 2014	mean age: 57 years; males/females: 15/4; mean BMI: 28; CTP score: 6; setting: Canada	RCT ; Intervention = 9; Control = 10	19	Supervised exercise (cycle ergometer 3 d/wk). 5 min warm up on low level cycling, exercise initiated at 30 min per session and increased by 2.5 min per session until study completion	8 wk	Quadriceps muscle thickness measured by ultrasound and thigh circumference	Peak VO2 thigh thickness and circumference increased at end of intervention
Debette-Gratien et al[40], 2015	Mean Age: 51 ± 12; males/females: 6/3; mean BMI: NA; CTP score: 7; setting: France	Quasi experimental (pre-post intervention)	13	Personalized Adapted Physical Activity	12 wk	Functional capacity and muscle strength	Post intervention significant increase in the mean exercise VO2 peak and the mean quadriceps isometric strength
Roman et al[41], 2016	mean age: 63; males/females: 17/6; mean BMI: 31; CTP score: 6; setting: Spain	RCT	23	Intervention: 1-h session 3 times/wk; Control: Sham intervention	12 wk	Functional capacity by CPET, Anthropometry, DEXA and Timed up and GO study	Increase in total effort time, ventilatory anaerobic threshold time and upper thigh circumference. Decrease in MA and mid-thigh skin fold thickness. DEXA showed decrease in fat body mass and increase in lean body mass, lean appendicular mass and lean leg mass. No changes in the control group
Macias-Rodriguez et al[42], 2016	mean age: 52; males/females: 19/6; mean BMI: 27.5; CTP score: 6; setting: Mexico	RCT	25	Intervention group: PEP (personalized exercise program) (cycloergometry/kinesiotherapy plus nutrition); control: only nutrition	14 wk	BIA and CPET	Significant improvement in ventilatory efficiency (VE/VCO2) and phase angle
Kruger et al[43], 2018	mean age: 53-56; males/females: 23/17; mean BMI: 29; CTP score: 6; setting: Canada	RCT	40	Home exercise training i.e., moderate to high intensity cycling exercise, 3 d/wk vs usual care	8 wk	Measurement of peak VO2; Aerobic endurance using 6-min walk test; Ultrasound to measure thigh muscle circumference and mass	Significant increase in peak VO2, aerobic endurance, thigh circumference and insignificant improvement in thigh muscle thickness as measured by the average feather index

CPET: Cardiopulmonary exercise testing; CSA: Cross sectional area; BMI: Body mass index.