Randomized Controlled Trial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2016; 6(2): 429-436
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.429
Exercise manual for liver disease patients
Vivian Limongi, Daniele Costa Dos Santos, Aurea Maria de Oliveira da Silva, Ilka de Fátima Santana Ferreira Boin, Raquel Silveira Bello Stucchi
Vivian Limongi, Aurea Maria de Oliveira da Silva, Ilka de Fátima Santana Ferreira Boin, Raquel Silveira Bello Stucchi, Daniele Costa dos Santos, Unit of Liver Transplantation, Hospital de Clinicas, State University of Campinas (Unicamp), Campinas 13020-060, Brazil
Author contributions: Limongi V, Dos Santos DC and Oliveira da Silva AM designed the research along with acquisition and interpretation of the data; Boin IFSF and Stucchi RSB revised it critically before final approval of the version to be submitted.
Supported by Fapesp n° 2010/19326-5.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Medical Sciences Faculty, Unicamp, CEP: 922/2009.
Clinical trial registration statement: This study is registered at http://www.ensaiosclinicos.gov.br/rg/RBR-8fz3mj/ the registration identification number is RBR-8fz3mj.
Informed consent statement: All participants of the study, or their legal guardian, provided informed written consent prior to the study enrollment.
Conflict-of-interest statement: No conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vivian Limongi, MSc, Physiotherapist, Unit of Liver Transplantation, Hospital de Clinicas, State University of Campinas (Unicamp), Rua Culto à Ciência, 369 Ap 40. Botafogo, Campinas 13020-060, Brazil. vivian_limongi@hotmail.com
Telephone: +55-19-996183284 Fax: +55-19-32891577
Received: January 14, 2016
Peer-review started: January 15, 2016
First decision: February 2, 2016
Revised: February 18, 2016
Accepted: April 14, 2016
Article in press: April 18, 2016
Published online: June 24, 2016
Processing time: 160 Days and 19.8 Hours
Abstract

AIM: To increase inspiratory muscle strength and improve the quality of life of candidates for liver transplantation.

METHODS: Twenty-three candidates for liver transplantation participated in the control group and 14 made up the intervention group. The control group consisted of 18 men and 5 women, body mass index (BMI) 27.3 ± 4.5 kg/m2 and Model for End-Stage Liver Disease (MELD) 18.2 ± 6.1. The intervention group consisted of 11 men and 3 women, BMI 28.6 ± 5.4 kg/m2 and MELD 18 ± 4.5. The presence or absence of ascites was identified in the first patient evaluation and after three months. We evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure, spirometry, root mean square (RMS) of diaphragm and rectus abdominis, and the quality of life. The exercises were performed daily by patients at home for three months and were supervised at distance monthly. The manual consisted of diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT®, lifting upper limbs with a bat and strengthening the abdomen.

RESULTS: There was significant difference (P = 0.01) between the first (initial) and the third month (final) MIP in the control group and in the intervention group, but there was no difference (P = 0.45) between the groups. The RMS of the diaphragm was lower (P = 0.001) and the functional capacity was higher (P = 0.006) in the intervention group compared to the control. The general health and mental health domains received higher scores after three months in the control group (P = 0.01) and the intervention group (P = 0.004), but there was no significant difference between them. The comparison between the presence of initial ascites with the presence of ascites was performed after three months in the control group (P = 0.083) and intervention group (P = 0.31). There was no significant difference, in relation to the presence of ascites after three months between groups (P = 0.21). In the intervention group, patients with ascites at the end of the time period had decreased scores on the social aspects SF-36 domain (P = 0.023) compared to those who had no ascites.

CONCLUSION: The proposed exercises provide an increase in the inspiratory muscle strength and improve functional capacity, consequently bettering the quality of life of liver disease patients.

Keywords: Respiratory muscles; Pre-operative period; Electromyography; Muscle strength; Breathing exercises

Core tip: Studies on the effects of exercises, mainly those on breathing for liver transplant patients on the waiting list, are rare in the literature. This study proposes a manual of exercises for this group in order to increase muscle strength and improve their quality of life, as sarcopenia found in these patients contributes to a worsening of quality of life and is associated with mortality. The results are encouraging and may represent the beginning of further studies in the area and the establishment of exercise protocols for liver diseases.