A 12-week home-based exercise program with nutritional guidance is associated with improved functional capacity in chronic liver disease.

BACKGROUND & AIMS: Although exercise therapy improves physical function in chronic liver disease (CLD), structured programs remain underutilized in routine hepatology care. We evaluated the feasibility, safety, and potential functional impact of a structured home-based exercise program in patients with CLD. METHODS: In this prospective study, patients with CLD received guideline-based nutritional guidance, followed by a 12-week individualized home-based exercise program combining aerobic and resistance training. Primary endpoints were changes in functional capacity (six-minute walking test, Liver Frailty Index, Short Physical Performance Battery), muscle strength, and muscle mass. Secondary endpoints included laboratory parameters and exercise-related adverse events. RESULTS: Among 46 patients (median age 75 years; 70% male), including 20 (46%) with cirrhosis (median Child-Pugh score 5), 43 (93%) completed the 12-week intervention. Significant improvements were observed from baseline at week 12 in six-minute walking test (Hodges-Lehmann estimate, 33 m; 95% confidence interval [CI] 14-49), Liver Frailty Index (-0.14; 95% CI, -0.23 to -0.02), and Short Physical Performance Battery (1; 95% CI, 1-2). Body weight-normalized knee extensor strength significantly increased (0.03; 95%CI, 0.01-0.06), whereas handgrip strength and skeletal muscle mass did not change. Physical activity increased after physiotherapist instruction and were maintained throughout the intervention period. No exercise-related serious adverse events or deterioration in liver functional reserves were observed. CONCLUSIONS: A home-based exercise program, combining aerobic and resistance training, with periodic adjustment by rehabilitation professionals was feasible, safe, and associated with improvements in functional capacity in patients with CLD, without adverse effects on liver functional reserves. CLINICAL TRIAL REGISTRATION: The study protocol is registered at Japan Registry of Clinical Trials (jRCT1040230078).