Role of physiotherapy and Benefits of exercise in CLD:
- Assessment of CLD related complications: sarcopenia, frailty, fatigue, functional decline, hepatic osteodystrophy.
- Design exercise program:
- 30‐to‐60–minute sessions combining both aerobic and resistance training to achieve ≥150 minutes/week is a reasonable recommendation for CLD
- To increase muscle mass combination of moderate-strengthening exercise regimen with the supplementation of a branched-chain amino acid (BCAA), leucine. Dietitian consultation for appropriate diet is needed.
- Aerobic exercise to enhance cardiopulmonary fitness
Benefits of exercise in CLD:
- The increased muscle mass from exercise can facilitate the removal of ammonia from the muscle and reduce the development of hepatic encephalopathy.
- Evidence suggests that moderate exercise can potentially improve functional capacity, improve lean muscle mass and reduce the risk of falls
Precautions:
- Risk of hypoglycemia: liver is the site of glycogen storage and gluconeogenesis
- Exercise intolerance multiple rest breaks needed(not bed rest)
- The use of weights may not be appropriate for patients with esophageal/gastric varices.
- Most patients with portal hypertension are receiving beta blockers so monitoring exercise can’t depend on heart rate. Moreover, beta blockers increases fatigue and dizziness.
