Exercise Capacity and Functional Status in Liver Transplant Candidates: Identifying perceived determinants and consequences

Abstract

Purpose: Exercise capacity is an independent predictor of the disease prognosis in many clinical conditions. This study aims to predict the functional exercise capacity determinants and investigate the association between the functional status variables in liver transplant candidates. Methods: This prospective cross-sectional study consisted of thirty patients who were scheduled for liver transplantation. Respiratory and peripheral muscle strengths were measured using a mouth pressure device and a hand-held dynamometer, respectively. Dyspnea, physical activity, fatigue, exercise capacity, physical performance, and quality of life of participants were evaluated using the Modified Borg Scale, the International Physical Activity Questionnaire, the Turkish version of the Checklist Individual Strength Questionnaire, the Six-minute Walk Test, the 30-sec Sit-to-Stand Test, and the Liver Disease Symptom Index 2.0, respectively. A multivariate linear regression analysis was conducted to identify independent predictors of exercise capacity. Results: The six-minute walk distance was inversely and strongly correlated with dyspnea (r=−0.668, p<0.001) and age (r=−0.678, p<0.001) and had a strong positive correlation with Sit-to-Stand Test score (r=0.745, p<0.001). A moderate positive correlation was observed between six-minute walk distance and maximal inspiratory pressure (r=0.532, p=0.002), maximal expiratory pressure (r=0.522, p=0.003) and upper extremity muscle strength (r=0.479, p=0.007). Physical performance was a significant predictor of exercise capacity, accounting for 65.9% of the variance. Conclusion: Physical performance status may have a fundamental role in improving post-transplant outcomes in liver transplant candidates.

Keywords

• Exercise Performance
• Functional Level
• Liver Failure

References

1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatology 2019;70(1):151-171.
2. Galant L, Ferrari R, Forgiarini Jr L, Monteiro M, Marroni C, Dias A. Relationship between MELD severity score and the distance walked and respiratory muscle strength in candidates for liver transplantation. Transplant Proc 2010;42(5):1729-1730.
3. Kaltsakas G, Antoniou E, Palamidas AF, et al. Dyspnea and respiratory muscle strength in end-stage liver disease. World J Hepatol 2013;5(2):56.
4. Lai JC, Dodge JL, Sen S, Covinsky K, Feng S. Functional decline in patients with cirrhosis awaiting liver transplantation: Results from the functional assessment in liver transplantation (FrAILT) study. Hepatology 2016;63(2):574-580.
5. Jurado R, Morales I, Taboada D, et al. Coping strategies and quality of life among liver transplantation candidates. Psicothema 2011;23(1):74-79.
6. Garcia A, Veneroso C, Soares D, Lima A, Correia M. Effect of a physical exercise program on the functional capacity of liver transplant patients. Transplant Proc 2014;46(6):1807-1808.
7. Saglam M, Arikan H, Savci S, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills 2010;111(1):278-284.
8. Taşkın B, Vardar-Yagli N, Calik-Kutukcu E, et al. An Evaluation Functional Capacity in Relation to Dyspnea and Fatigue, Muscle Strength, and Dynamic Balance in Patients with Liver Transplantation. Eur Respir J 2019;54(Suppl):63, PA1211.

9. Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am J Respir Crit Care Med 1969;99(5):696-702.
10. Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care 2015;18(5):465-470.
11. Ergin G, Yildirim Y. A validity and reliability study of the Turkish Checklist Individual Strength (CIS) questionnaire in musculoskeletal physical therapy patients. Physiother Theory Pract 2012;28(8):624-632.
12. VanWagner LB, Uttal S, Lapin B, et al. Use of Six-Minute Walk Test to Measure Functional Capacity After Liver Transplantation. Phys Ther 2016;96(9):1456-1467.
13. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998;158(5):1384-1387.
14. Zanini A, Aiello M, Cherubino F, et al. The one repetition maximum test and the sit-to-stand test in the assessment of a specific pulmonary rehabilitation program on peripheral muscle strength in COPD patients. Int J Chron Obstruct Pulmon Dis 2015;10:2423-2430.
15. Eraydın A, Akarsu M, Hakim GD, Keskinoğlu P, Ellidokuz H. The validity and reliability of “The liver disease symptom index 2.0” for Turkish society. Turk J Gastroenterol 2014;25(05):531-538.
16. Swinscow TDV, Campbell MJ. Correlation and regression. In: Statistics at Square One. 10th ed. London: BMJ Book; 2002. p.111–125.
17. Lai JC, Volk ML, Strasburg D, Alexander N. Performance-based measures associate with frailty in patients with end-stage liver disease. Transplantation 2016;100(12):2656-2660.
18. Carey EJ, Steidley DE, Aqel BA, et al. Six‐minute walk distance predicts mortality in liver transplant candidates. Liver Transpl 2010;16(12):1373-1378.
19. Yadav A, Chang YH, Carpenter S, et al. Relationship between sarcopenia, six‐minute walk distance and health‐related quality of life in liver transplant candidates. Clin Transpl 2015;29(2):134-141.
20. Faustini Pereira JL, Galant LH, Rossi D, et al. Functional capacity, respiratory muscle strength, and oxygen consumption predict mortality in patients with cirrhosis. Can J Gastroenterol Hepatol 2016;2016, Article ID 6940374.
21. Galant LH, Junior LAF, Dias AS, Marroni CA. Functional status, respiratory muscle strength, and quality of life in patients with cirrhosis. Rev Bras Fisioter 2012;16(1):30-34.
22. Haugen CE, McAdams-DeMarco M, Holscher CM, et al. Multicenter study of age, frailty, and waitlist mortality among liver transplant candidates. Ann Surg 2020;271(6):1132-1136.
23. da Silva ÁM, Cliquet Jr A, Boin I. Profile of respiratory evaluation through surface electromyography, manovacuometry, and espirometry in candidates on the liver transplant waiting list. Transplant Proc 2012;44(8):2403-2405.
24. Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transpl 2012;18(2):146-151.
25. García PS, Cabbabe A, Kambadur R, Nicholas G, Csete M. Elevated myostatin levels in patients with liver disease: a potential contributor to skeletal muscle wasting. Anesth Analg 2010;111(3):707-709.
26. Dasarathy S. Etiology and management of muscle wasting in chronic liver disease. Curr Opin Gastroenterol 2016;32(3):159-165.
27. Ney M, Gramlich L, Mathiesen V, et al. Patient-perceived barriers to lifestyle interventions in cirrhosis. Saudi J Gastroenterol 2017;23(2):97-104.
28. Dunn MA, Josbeno DA, Schmotzer AR, et al. The gap between clinically assessed physical performance and objective physical activity in liver transplant candidates. Liver Transpl 2016;22(10):1324-1332.
29. Ergene T, Karadibak D, Polat KY. Fatigue and Physiotherapy in Liver Transplant Recipients. Clin Exp Health Sci 2019;9(3):278-282.
30. Dunn MA, Rogal SS, Duarte‐Rojo A, Lai JC. Physical Function, Physical Activity, and Quality of Life after Liver Transplantation. Liver Transpl 2020;26(5):702-708.