Personalized Adapted Physical Activity Before Liver Transplantation: Acceptability and Results

Background. Altered aerobic capacity and muscular strength among patients suffering from cirrhosis are poor prognosis factors of the overall survival after liver transplantation (LT). A program of adapted physical activity (APA) is recommended in patients awaiting solid organ transplantation. However, there is no standard program in LT, and therefore none is applied. Methods. Prospective pilot study to evaluate the acceptability of a 12-week personalized APA and its impact on aerobic capacity, muscle strength, and quality of life before LT. Results. Thirteen patients (six men, seven women) were included. Five patients interrupted the program: two for personal convenience, two were transplanted before the end of the program, and one for deterioration of the general condition. Eight patients (mean age, 51 +/- 12 years; mean Child Pugh, 7 +/- 3; and mean model for end-stage liver disease score, 13 +/- 6) completed the program. The mean VO2 peak values increased from 21.5 +/- 5.9 mL/kg per min at baseline to 23.2 +/- 5.9 mL/kg per min after 12 weeks of training (P<0.008). The maximum power (P=0.02), the 6-min walk distance (P<0.02), the strength testing of knee extensor muscles (P=0.008), and the ventilatory threshold power (P=0.02) were also significantly increased. Quality of life scale showed a global trend to improvement. No adverse event was observed. Conclusion. A personalized and standardized APA is acceptable, effective and safe in patients awaiting LT. It positively influences the index of fitness and quality of life. Its promising impact on the post-transplantation period, duration of hospitalization, and 6-month survival needs to be prospectively evaluated in a large randomized study.