Sarcopenia and physical deconditioning are frequent complications in patients with
cirrhosis and end-stage liver disease (ESLD). They are the end result of impaired
dietary intake, chronic inflammation, altered macronutrient and micronutrient metabolism,
and low physical activity. Frailty is the end result of prolonged sarcopenia and physical
deconditioning. It severely affects a patient's functional status and presents in
approximately 1 in 5 patients on the liver transplantation waiting list. Sarcopenia,
poor physical fitness/cardiopulmonary endurance (CPE), and frailty are all associated
with increased mortality in ESLD. Clinical trials addressing the usefulness of exercise
in patients with cirrhosis have shown that it improves the metabolic syndrome, sarcopenia,
CPE, health-related quality of life, and hepatic venous pressure gradient. Although
evidence on the benefits of exercise on clinical outcomes derived from large clinical
trials is still missing, based on existing literature from multiple medical subspecialties,
we believe that an exercise program coupled to a tailored nutritional intervention
benefits both cardiopulmonary and musculoskeletal functions, ultimately translating
into improved functional status, sense of well-being, and possibly less complications
from portal hypertension. In conclusion, although supervised exercise training is
the prevailing approach to manage ESLD patients, such intervention is not sustainable
or feasible for most patients. Innovative home-based physical activity interventions
may be able to effectively reach a larger number of patients. Liver Transplantation
24 122-139 2018 AASLD.