Impact of structured exercise-based regimen on frailty in pediatric cirrhosis: A randomized controlled trial.

OBJECTIVES: Physical exercise may improve muscle mass and functional capacity in cirrhosis. This randomized controlled trial evaluates the impact of an exercise-based regimen versus standard medical therapy (SMT) on frailty scores, clinical outcomes, body composition analysis (BCA), and myokines in children with cirrhotic liver disease (CLD). METHODS: Children (9-18 years of age) with CLD with five Fried's frailty criteria score >5 were randomly assigned to groups that received exercise training + SMT (n = 23) or SMT alone (n = 23). Exercise regimen included aerobic and resistance exercises for a total of at least 50 min/day for 3-5 days per week for 24 weeks. Frailty assessment was done at baseline, 12 and 24 weeks while myokines levels and BCA was evaluated at baseline and after 12 weeks. RESULTS: At 12 and 24 weeks, the delta change in frailty scores was significantly greater in the exercise group compared to the SMT group (p < 0.001). Frailty score <5 was achieved by 60% and 85% of the exercise group at 12 and 24 weeks, compared to 32% and 37% in the SMT group. At 12 weeks, the exercise group showed a significant delta reduction in myostatin levels compared to the SMT group (p = 0.02). Significant improvements were observed in skeletal muscle mass (SMM) and phase angle in the exercise group at 12 weeks. CONCLUSIONS: In this pilot trial, exercise regimen significantly improved frailty scores and SMM compared to the SMT. Larger trials are warranted to further evaluate the long-term benefits of exercise in pediatric cirrhotic population.